Acupuncture in the Treatment of Resistant Hypertension: A Narrative Review of Efficacy and Safety
Keywords:
Hypertension, Acupuncture, Resistant, Efficacy, Safety
Abstract
Resistant hypertension (RH) is a critical concern due to persistent uncontrolled blood pressure despite multiple medications, and its association with severe cardiovascular and renal complications. This narrative review aims to critically analyze existing research on acupuncture as an adjunctive treatment for RH, synthesizing evidence on its mechanisms and effects on clinical outcomes like blood pressure control and quality of life. A literature search was conducted from April to May 2025 across Google Scholar, PubMed, and ScienceDirect, using variations of keywords combination: resistant hypertension, acupuncture, electro-acupuncture, management, antihypertension, blood pressure. We found there is limited evidence for acupuncture application for RH management, even application for hypertension has been widely studied. Acupuncture is safety for hypertension management and has limited adverse event. In conclusion, acupuncture is a promising, generally safe complementary treatment for resistant hypertension, offering benefits beyond blood pressure reduction and improving quality of life, particularly for patients facing medication challenges. However, further rigorous, standardized research is needed to fully establish its role alongside conventional therapies.
References
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Liu, X., Wang, X., Ma, H., Zhang, W., 2022. Mechanisms underlying acupuncture therapy in chronic kidney disease: A narrative overview of preclinical studies and clinical trials. Front. Nephrol. 2. https://doi.org/10.3389/fneph.2022.1006506
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Zhang, H., Xia, Z., Liu, Y., Yu, S., Shi, H., Meng, Y., Wu, X., 2024. Intervention of hypertension by acupuncture-related therapies: A network meta-analysis. Int. J. Older People Nurs. 19, e12613. https://doi.org/10.1111/opn.12613
Zheng, C., Zhou, T., 2022. Effect of Acupuncture on Pain, Fatigue, Sleep, Physical Function, Stiffness, Well-Being, and Safety in Fibromyalgia: A Systematic Review and Meta-Analysis. J. Pain Res.
Zhou, M., Bu, H., Wang, D., Wang, M., Guan, Y., Sun, X., Tian, Z., Wang, H., 2022. An Overview of Systematic Reviews: Acupuncture in the Treatment of Essential Hypertension. Int. J. Gen. Med. 15, 8093–8109. https://doi.org/10.2147/IJGM.S387490
Zhou, X., Zhou, J., Zhang, F., Shu, Q., Wu, Y., Chang, H., Zhang, B., Cai, R., Yu, Q., 2024. Key targets of signal transduction neural mechanisms in acupuncture treatment of cardiovascular diseases: Hypothalamus and autonomic nervous system. Heliyon 10. https://doi.org/10.1016/j.heliyon.2024.e38197
Zoccali, C., Mallamaci, F., De Nicola, L., Minutolo, R., 2024. New trials in resistant hypertension: mixed blessing stories. Clin. Kidney J. 17, sfad251. https://doi.org/10.1093/ckj/sfad251
Biffi, A., Quarti-Trevano, F., Vanoli, J., Dell’Oro, R., Corrao, G., Mancia, G., Grassi, G., 2024. Effects of acute carotid baroreceptor stimulation on sympathetic nerve traffic in resistant and uncontrolled hypertension: a systematic review and meta-analysis. Hypertens. Res. 47, 1962–1969. https://doi.org/10.1038/s41440-024-01704-9
Brant, L.C.C., Passaglia, L.G., Pinto-Filho, M.M., de Castilho, F.M., Ribeiro, A.L.P., Nascimento, B.R., 2022. The Burden of Resistant Hypertension Across the World. Curr. Hypertens. Rep. 24, 55–66. https://doi.org/10.1007/s11906-022-01173-w
Carey, R.M., Calhoun, D.A., Bakris, G.L., et.al, 2018. Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement from the American Heart Association. Hypertension 72. https://doi.org/10.1161/HYP.0000000000000084
Emara, T., Helmy, Z., Abdelatief, A., Essam El-Sayed Felaya, E.-S., 2025. Effect of electroacupuncture on blood pressure and quality of life in patients with primary hypertension: a randomised controlled trial. Adv. Rehabil. 39, 1–14. https://doi.org/10.5114/areh.2025.149192
Fan, M., Dai, G., Li, R., Wu, X., 2023. Efficacy of Acupuncture in the Treatment of Essential Hypertension: An Overview of Systematic Reviews and Meta-Analyses. Cardiovasc. Ther. 2023, 2722727. https://doi.org/10.1155/2023/2722727
Foley, C., Litscher, G., 2022. A Biophysical Model for Cardiovascular Effects of Acupuncture—Underlying Mechanisms Based on First Principles. Med. Acupunct. 34, 353–370. https://doi.org/10.1089/acu.2022.0050
Giollo-Junior, L.T., Cosenso-Martin, L.N., Da Silva Lopes, V., Paz Landim, M., Barufi Fernandes, L.A., Aparecido De Oliveira, K., Spaziani, A.O., Santos, A.P., Silva, M.A., Yugar-Toledo, J.C., Vilela-Martin, J.F., 2023. The Effect of Transcutaneous Electrical Nerve Stimulation in Peripheral and Central Hemodynamic Parameters on Resistant Hypertension: A Case Report. Vasc. Health Risk Manag. Volume 19, 317–323. https://doi.org/10.2147/VHRM.S408082
Hamvas, Sz., Hegyi, P., Kiss, Sz., Lohner, Sz., McQueen, D., Havasi, M., 2023. Acupuncture increases parasympathetic tone, modulating HRV − Systematic review and meta-analysis. Complement. Ther. Med. 72, 102905. https://doi.org/10.1016/j.ctim.2022.102905
Huang, C.-C., Kotha, P., Tu, C.-H., Huang, M.-C., Chen, Y.-H., Lin, J.-G., 2024. Acupuncture: A Review of the Safety and Adverse Events and the Strategy of Potential Risk Prevention. Am. J. Chin. Med. https://doi.org/10.1142/S0192415X24500617
Huang, K.-Y., Chang, C.-H., Yu, K.-C., Hsu, C.-H., 2022. Assessment of quality of life and activities of daily living among elderly patients with hypertension and impaired physical mobility in home health care by antihypertensive drugs plus acupuncture: A CONSORT-compliant, randomized controlled trial. Medicine (Baltimore) 101, e29077. https://doi.org/10.1097/MD.0000000000029077
Jacobsson, F., Himmelmann, A., Bergbrant, A., Svensson, A., Mannheimer, C., 2000. The effect of transcutaneous electric nerve stimulation in patients with therapy-resistant hypertension. J. Hum. Hypertens. 14, 795–798. https://doi.org/10.1038/sj.jhh.1001112
Kim, T.-H., Lee, M.S., Birch, S., Alræk, T., Norheim, A.J., Kang, J.W., 2023. Publication status and reporting quality of case reports on acupuncture-related adverse events: A systematic reviews of case studies. Heliyon 9. https://doi.org/10.1016/j.heliyon.2023.e20577
Li, N., Guo, Y., Gong, Y., Zhang, Y., Fan, W., Yao, K., Chen, Zhihan, Dou, B., Lin, X., Chen, B., Chen, Zelin, Xu, Z., Lyu, Z., 2021. The Anti-Inflammatory Actions and Mechanisms of Acupuncture from Acupoint to Target Organs via Neuro-Immune Regulation. J. Inflamm. Res.
Li, P., Tjen-A-Looi, S.C., Guo, Z.-L., Longhurst, J.C., 2010. An arcuate-ventrolateral periaqueductal gray reciprocal circuit participates in electroacupuncture cardiovascular inhibition. Auton. Neurosci. 158, 13–23. https://doi.org/10.1016/j.autneu.2010.05.006
Li, Y.-W., Li, W., Wang, S.-T., Gong, Y.-N., Dou, B.-M., Lyu, Z.-X., Ulloa, L., Wang, S.-J., Xu, Z.-F., Guo, Y., 2022. The autonomic nervous system: A potential link to the efficacy of acupuncture. Front. Neurosci. 16. https://doi.org/10.3389/fnins.2022.1038945
Liu, X., Wang, X., Ma, H., Zhang, W., 2022. Mechanisms underlying acupuncture therapy in chronic kidney disease: A narrative overview of preclinical studies and clinical trials. Front. Nephrol. 2. https://doi.org/10.3389/fneph.2022.1006506
Shanks, J., Ramchandra, R., 2021. Angiotensin II and the Cardiac Parasympathetic Nervous System in Hypertension. Int. J. Mol. Sci. 22, 12305. https://doi.org/10.3390/ijms222212305
Silverdal, J., Mourtzinis, G., Stener-Victorin, E., Mannheimer, C., Manhem, K., 2012. Antihypertensive effect of low-frequency transcutaneous electrical nerve stimulation (TENS) in comparison with drug treatment. Blood Press. 21, 306–310. https://doi.org/10.3109/08037051.2012.680737
Tolu-Akinnawo, O., Ray, D.N., Awosanya, T., Nzerue, C., Okafor, H., 2024. Hypertension and Device-Based Therapies for Resistant Hypertension: An Up-to-Date Review. Cureus. https://doi.org/10.7759/cureus.66304
Wang, S., Fang, R., Huang, L., Zhou, L., Liu, H., Cai, M., Sha’aban, A., Yu, C., Akkaif, M.A., 2024. Acupuncture in Traditional Chinese Medicine: A Complementary Approach for Cardiovascular Health. J. Multidiscip. Healthc. 17, 3459–3473. https://doi.org/10.2147/JMDH.S476319
Wang, S.-H., Xu, J.-T., Hu, X.-J., Cui, J., 2021. Acupuncture combined with western medicine for the treatment of hypertension: A protocol for an updated systematic review and meta-analysis. Medicine (Baltimore) 100, e26412. https://doi.org/10.1097/MD.0000000000026412
Xu, M., Yang, C., Nian, T., Tian, C., Zhou, L., Wu, Y., Li, Y., Deng, X., Li, X., Yang, K., 2023. Adverse effects associated with acupuncture therapies: An evidence mapping from 535 systematic reviews. Chin. Med. 18, 38. https://doi.org/10.1186/s13020-023-00743-7
Yunshan, L., Chengli, X., Peiming, Z., Haocheng, Q., Xudong, L., Liming, L., 2025. Integrative research on the mechanisms of acupuncture mechanics and interdisciplinary innovation. Biomed. Eng. OnLine 24, 30. https://doi.org/10.1186/s12938-025-01357-w
Zhang, H., Xia, Z., Liu, Y., Yu, S., Shi, H., Meng, Y., Wu, X., 2024. Intervention of hypertension by acupuncture-related therapies: A network meta-analysis. Int. J. Older People Nurs. 19, e12613. https://doi.org/10.1111/opn.12613
Zheng, C., Zhou, T., 2022. Effect of Acupuncture on Pain, Fatigue, Sleep, Physical Function, Stiffness, Well-Being, and Safety in Fibromyalgia: A Systematic Review and Meta-Analysis. J. Pain Res.
Zhou, M., Bu, H., Wang, D., Wang, M., Guan, Y., Sun, X., Tian, Z., Wang, H., 2022. An Overview of Systematic Reviews: Acupuncture in the Treatment of Essential Hypertension. Int. J. Gen. Med. 15, 8093–8109. https://doi.org/10.2147/IJGM.S387490
Zhou, X., Zhou, J., Zhang, F., Shu, Q., Wu, Y., Chang, H., Zhang, B., Cai, R., Yu, Q., 2024. Key targets of signal transduction neural mechanisms in acupuncture treatment of cardiovascular diseases: Hypothalamus and autonomic nervous system. Heliyon 10. https://doi.org/10.1016/j.heliyon.2024.e38197
Zoccali, C., Mallamaci, F., De Nicola, L., Minutolo, R., 2024. New trials in resistant hypertension: mixed blessing stories. Clin. Kidney J. 17, sfad251. https://doi.org/10.1093/ckj/sfad251
Published
2025-09-26
How to Cite
Pratama, Y., Amelia, V., Mubarak, M., & Adnan, M. (2025). Acupuncture in the Treatment of Resistant Hypertension: A Narrative Review of Efficacy and Safety. ancasakti ournal f ublic ealth cience nd esearch, 5(3), 392-401. https://doi.org/10.47650/pjphsr.v5i3.2004
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Copyright (c) 2025 Yanasta Yudo Pratama, Vica Hilda Amelia, Muhammad Hamza Mubarak, Muhammad Luthfi Adnan
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