According to the American Heart Association 1 out 3 or 77.9 million adults have high blood pressure. Further data from the National Health and Nutrition Examination Survey (NHANES) 2007 – 2010 shows that almost 50% of these individuals do not have their high blood pressure under control. A person is considered to have high blood pressure if their reading is 140/90 (systolic/diastolic) or above. Men have a higher percentage rate than women up to the age of 45, between 45 and 64 the rates are similar, and above the age of 64 women tend to have a higher percentage rate. There are also some racial/ethnic variances in prevalence with non-Hispanic blacks having the highest percentage (42.6% for men and 47% for women), non-Hispanic whites (33.4% and 30.7%), and Mexican Americans (30.1% and 28.8%). In another report 1 out of 3 American adults are pre-hypertensive, or having higher than normal blood pressure ranges that are not quite in the high range.
What Causes High blood Pressure?
There can be many reasons why your blood pressure has become elevated, some of which can include the following:
- Kidney disease, thyroid disease
- Prescription medications (birth control pills, hormone therapy, pain relievers,and corticosteroids for asthma)
- Drug abuse (cocaine, amphetamine)
Risk factors include:
- Lack of physical activity
- Poor nutrition
Getting to the Root: How We Assess Hypertension Cases
Aside from the most obvious assessment, a blood pressure reading, we like our patients to have blood work done, as well as, an adrenal stress index test (ASI test), which looks at cortisol and DHEA levels. These two hormones are produced in the adrenal glands in response to stress, that is, the fight or flight response; and are sensitive to imbalances in the endocrine system, the thyroid in particular. These tests allow us to consider all the possible factors that can play a role in the development of hypertension, many of which are commonly occurring and can be prevented; but are often overlooked. When making our assessment we consider the following areas as potential contributors to hypertension:
- Cortisol elevation & resistance
- Food allergies
- Mineral deficiencies
- Metabolic syndrome
- Metabolic acidosis
- Inflammatory & immune deficiencies
- Circulatory limitations (ie. micro-blood stasis)
How Acupuncture Regulates Blood Pressure
Acupuncture regulates blood pressure by exploiting a complex system known as the neuroendocrine system, which is composed of the endocrine system (primarily the hypothalamus, pituitary, and thyroid / adrenals), and the intricate working relationship it has with the nervous system. The endocrine system regulates hormones and metabolism. The autonomic nervous system (ANS) is divided into two arms, a sympathetic branch (fight or flight), which plays a role in helping regulate the vascular tone and blood volume of the heart; and a parasympathetic branch (rest and digest), that regulates body processes like blood pressure and breathing. The central nervous system (CNS) is a two – way communication network consisting of the brain and spinal cord, which processes all the information from the body and external stimuli. Information is collected by the nervous system, relayed through the spinal cord to the brain, and then the brain sends signals to the body through the same mechanism.
In terms of research, there is an ongoing accumulation of data on the regulatory effect of acupuncture on the endocrine system, and how it can restore balance to hormone levels. This includes studies on thyroid hormones, corticosteroids, and reproductive hormones. Modern research has also confirmed the effects of acupuncture on the autonomic nervous system (ANS) in a wide array of studies on (ANS) disorders such as: anxiety, insomnia, polycystic ovary syndrome (PCOS), cardiovascular disease, and epilepsy. Over the last decade, there has been an increase in neuroimaging studies on the effects of acupuncture on brain centers due to advancements in imaging technologies. In one study, electroacupuncture was used to activate specific parts of the brain eliciting a hypotensive effect via the (CNS).
Recent investigations have indicated that one of the major contributors to high blood pressure is an overactive sympathetic nervous system (SNS). When the (SNS) becomes over-stimulated or dominant, it can cause vasoconstriction of the arteries in the heart; thereby inducing a hypertensive state. The latest studies show that one of the mechanisms by which acupuncture lowers blood pressure is by down-regulating the (SNS). One such study found that electroacupuncture activates neurons in the brain, which inhibits (SNS) activity by stimulating the opioid system (endorphins, enkephalins) and nociceptin. Endogenous opioids modulate the baroreflex control system, which is a feedback loop between the heart, brain, spinal cord (CNS), (SNS) and the (PNS.) When the (PNS) is stimulated in this feedback loop, it inhibits sympathetic nerve activity, and therefore lowers the blood pressure.
There have also been studies showing that acupuncture outperforms Captopril, a commonly prescribed angiotensin – converting enzyme inhibitor (ACE – inhibitor) for high blood pressure. One of these studies that compared electroacupuncture to Captopril concluded that electroacupuncture was significantly more effective than the Western medication at controlling blood pressure. A German study comparing true acupuncture to antihypertensive medications concluded that blood pressure reductions with acupuncture are comparable to monotherapies with ACE – inhibitors.
Nerves and Acupoints
When treating hypertension, we select a specific combination of acupoints, which vary depending on the particular clinical presentation of hypertension and any underlying causes. We have many options to choose from on either the front or back side of the body, distal points on the extremities, as well as, points on the ears. When we choose back points, some of which are referred to as back shu points or points that are organ specific, in this case Heart specific, we often choose Jueyinshu – BL 14 or Xinshu – BL15. These two points are specific for the pericardium and the heart respectively. Is this by coincidence? Not so much, because they’re located in the upper thoracic region at the level of T4 and T5 spinal vertebrae; which innervate the heart via sympathetic nerves. Their traditional Chinese Medicine (TCM) actions are as follows:
Jueyinshu – BL 14
- Regulates the heart
- Unbinds the chest
- Regulates & descends Qi
Xinshu – BL15
- Tonifies and nourishes the Heart
- Regulates Heart Qi
- Calms the spirit (spirit being the (SNS))
- Unbinds the chest and resolves blood stasis
- Clears Heart fire
Treatment with Eastern medicine
Eastern medicine is a dynamic system of medicine, which includes numerous forms and variations of treatments that the practitioner can choose from. For this reason, treatment protocols for blood pressure will vary from one practitioner to another depending on the disease presentation, and the style and perspective of the practitioner. Generally speaking, herbal therapy takes precedence in most treatment plans and acupuncture is used as an adjunct. This is because herbs work at a deeper level and continue the treatment while the patient is at home, while acupuncture works at a more superficial level. Together they formulate a cohesive treatment strategy that is very effective at treating the root cause of disease.
For any treatment to be truly effective, no matter what the cause of high blood pressure is, it requires great effort by the patient to make lifestyle modifications that will promote a heart healthy future. This includes:
- Changes in diet & nutrition
- Physical exercise (approved by your acupuncturist / physician)
- Light exercise (Tai Chi, Qigong, yoga, meditation)
- Quality sleep