Moxibustion for prehypertension and stage I hypertension: a pilot randomized controlled trial

Intervention of hypertension by acupuncture-related therapies: A network meta-analysis

BACKGROUND

The prevalence of essential hypertension contributed significantly to morbidity and mortality rates. Acupuncture-related therapies were commonly employed in hypertension treatment. Nevertheless, a lack of conclusive evidence left uncertainties regarding the optimal strategies for managing hypertensive populations.

OBJECTIVES

Conduct a comprehensive systematic review to evaluate the existing clinical evidence about the effectiveness of acupuncture and moxibustion-related therapies in managing hypertension, by employing network meta-analysis techniques.

METHODS

A comprehensive electronic search was conducted across n of databases. This search covered studies available up to October 2022. Randomized controlled trials assessing acupuncture and moxibustion-related therapies in managing hypertension based on traditional Chinese medicine were screened. Primary outcome measures included the antihypertensive effectiveness rate, variations in blood pressure and the incorporation of Traditional Chinese Medicine (TCM) syndrome manifestations. The review follows the guidelines outlined in the PRISMA statement.

RESULTS

We identified a total of 24 trials with 1867 patients, which evaluated the efficacy of various acupuncture-related therapies for hypertension management. Network meta-analysis showed that moxibustion and auricular point sticking combined with medication therapy had the best effect in terms of antihypertensive effective rate (medication + moxibustion + auricular pressure vs. medication = 1.29 [1.09, 1.54]; sucra = 85.9, p < .05) and hypertension symptom improvement (medication + moxibustion + auricular pressure vs. medication = -1.55 [-2.98, -0.13]; sucra = 96.1, p < .05). Acupuncture combined with moxibustion combined with medication therapy had the best effect in reducing systolic pressure (medication + moxibustion + acupuncture vs. medication = -8.50 [-10.19, -6.80]; sucra = 100, p < .05) and diastolic blood pressure (medication + moxibustion + acupuncture versus medication = -4.72 [-6.71, -2.72]; sucra = 99.71, p < 0.05).

CONCLUSIONS

Network meta-analysis suggested that the combined use of moxibustion and auricular point application in conjunction with drug therapy showed the highest likelihood of being the most effective treatment in terms of antihypertensive efficiency rates and improvement in hypertension symptoms. Furthermore, the combination of acupuncture and moxibustion alongside drug treatment emerged as the most promising approach for reducing systolic blood pressure and diastolic blood pressure. Limited by the methodological quality and quantity of the included studies, the results need to be interpreted with caution. It is necessary to conduct more high-quality randomized controlled trials of acupuncture-related therapies for the adjuvant treatment of hypertension in the future.

IMPLICATIONS FOR PRACTICE

Clinicians can use acupuncture-related therapies to inform their treatment decisions and potentially incorporate acupuncture-related therapies into their hypertension management protocols.

The efficacy and safety of acupuncture and moxibustion for the management of nausea and vomiting in pregnant women: A systematic review and meta-analysis

Background

Nausea and vomiting, which cause considerable multifaceted effects, are commonly experience in early pregnancy. Various therapeutic strategies are employed, including both conventional agents and complementary medicine. However, the effectiveness of complementary medicine remains controversial. The objective of this meta-analysis is to evaluate efficacy and safety of acupuncture and moxibustion in pregnant women.

Methods

We conducted a comprehensive search using electronic databases such as PubMed, Embase, ISI Web, Medline, Cochrane, clinicaltrial.gov, and several Chinese databases. A total of 21 randomized controlled trials were included in this study for quantitative analysis. Forest plots were utilized to evaluate the efficacy and safety of acupuncture and moxibustion. Egger's test was employed to assess publication bias.

Results

The pooled analysis revealed that the acupuncture/moxibustion group was more effective than control group in alleviating nausea and vomiting in early pregnant women (RR: 0.28; 95%CI: 0.21, 0.37). Similar results were observed when comparing the acupuncture group to traditional herbs (RR: 0.08; 95 % CI: 0.01, 0.60), conventional therapy (RR: 0.15; 95 % CI: 0.04, 0.57), and the blank control group (RR: 0.33; 95 % CI: 0.22, 0.51). Moxibustion also exhibited the ability to alleviate nausea and vomiting compared with the blank control group (RR: 0.21; 95 % CI: 0.08, 0.52). As for safety, there were no significant differences in severe adverse events between the acupuncture group and the control group (RR: 0.77; 95%CI: 0.52, 1.14), the blank control group (RR: 0.61; 95%CI: 0.34, 1.10), the sham acupuncture group (RR: 1.05; 95%CI: 0.63, 1.73), or the conventional therapy group (RR: 0.32; 95%CI: 0.06, 1.55).

Conclusion

Acupuncture and moxibustion might be effective for the management of nausea and vomiting in early pregnant women. Moreover, acupuncture might be a relatively safe treatment for pregnancy.

Efficacy and safety of community-based moxibustion for primary hypertension: A randomized controlled trial with patient preference arms

Moxibustion has been shown to have a potential antihypertensive effect, but its applicability for the primary care of hypertension is unclear. The authors conducted a multicenter randomized controlled trial (RCT) with patient preference arms to investigate the effect, safety, cost-effectiveness, and compliance of moxibustion in community patients with hypertension. Patients with primary hypertension were enrolled from seven communities randomly or nonrandomly assigned to receive self-administered moxibustion + the original hypertensive regimen or the original hypertensive regimen alone for 6 months. The authors mainly evaluated the effects of moxibustion on hypertensive outcomes and adverse events. As a result, a total of 160 and 240 patients were recruited into the randomized and nonrandomized arms, respectively, with 87.5% completing the follow-up. At month 6, there was a significantly greater reduction in systolic blood pressure (SBP) (difference: -10.57 mmHg), a higher proportion of responders (82.2% vs. 53.7%; odds ratio 4.00), and better improvements in hypertensive symptoms and quality of life (QoL) in the moxibustion group than in the control group in the randomized population, but there was no significant between-group difference in diastolic blood pressure (DBP). The nonrandomized findings showed the same effect direction for all outcomes, except for DBP. All moxibustion-related adverse events were mild. In conclusion, moxibustion can reduce SBP and improve hypertensive symptoms and QoL in community patients with hypertension, with good safety and low cost, although its effect on DBP remains uncertain. The findings suggest that moxibustion may be an appropriate technique for community primary care of hypertension.

Comparison of the Effects of Self-Administered Moxibustion versus Acupressure on Blood Pressure, Stress, Sleep Quality, and Quality of Life in Hypertensive Patients: A Randomized Parallel Trial

This study aimed to evaluate the effects of an 8-week self-administered moxibustion program on blood pressure, stress, sleep quality, and quality of life in hypertensive patients. We compared its effects with those of self-acupressure to assess the feasibility of using moxibustion as a self-management method for hypertension. Forty-six subjects were recruited and randomly assigned to a moxibustion group and an acupressure group. The moxibustion group applied moxa sticks to seven acupoints by themselves five times a week for 8 weeks, while the acupressure group placed acupressure patches on the same acupoints by themselves. Systolic and diastolic blood pressures were measured. Stress was assessed with plasma epinephrine, plasma norepinephrine, and the Perceived Stress Scale (PSS). Sleep quality and quality of life were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF), respectively. Systolic and diastolic blood pressures decreased in the moxibustion and acupressure groups to a similar extent after the 8-week intervention. Plasma epinephrine and norepinephrine levels and PSQI variables were not changed in both groups. PSS decreased only in the moxibustion group. Quality of life related to physical health and environmental health, as assessed by the WHOQOL-BREF, significantly improved to a similar degree in both groups. Both self-administered moxibustion and acupressure therapies were effective in reducing blood pressure in hypertensive patients.

Short-term efficacy of non-pharmacological interventions for global population with elevated blood pressure: A network meta-analysis

Background

This study aims to compare the potential short-term effects of non-pharmacological interventions (NPIs) on prehypertensive people, and provide evidence for intervention models with potential in future community-based management.

Methods

In this Bayesian network meta-analysis, Pubmed, Embase, and Web of science were screened up to 16 October 2021. Prehypertensive patients (systolic blood pressure, SBP 120-139 mmHg/diastolic blood pressure, DBP 80-89 mmHg) with a follow-up period longer than 4 weeks were targeted. Sixteen NPIs were identified during the scope review and categorized into five groups. Reduction in SBP and DBP was selected as outcome variables and the effect sizes were compared using consistency models among interventions and intervention groups. Grade approach was used to assess the certainty of evidence.

Results

Thirty-nine studies with 8,279 participants were included. For SBP, strengthen exercises were the most advantageous intervention group when compared with usual care (mean difference = -6.02 mmHg, 95% CI -8.16 to -3.87), and combination exercise, isometric exercise, and aerobic exercise were the three most effective specific interventions. For DBP, relaxation was the most advantageous intervention group when compared with usual care (mean difference = -4.99 mmHg, 95% CI -7.03 to -2.96), and acupuncture, meditation, and combination exercise were the three most effective specific interventions. No inconsistency was found between indirect and direct evidence. However, heterogeneity was detected in some studies.

Conclusion

NPIs can bring short-term BP reduction benefits for prehypertensive patients, especially exercise and relaxation. NPIs could potentially be included in community-based disease management for prehypertensive population once long-term real-world effectiveness and cost-effectiveness are proven.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=151518, identifier: CRD42020151518.

The Effect of Thunder-Fire Moxibustion on Lumbar Disc Herniation: Study Protocol for a Randomized Controlled Trial

Background

Lumbar disc herniation (LDH) is a common disease seen in orthopedics; it is caused by nucleus pulposus herniation. Its clinical manifestations are low back pain, radiating pain of the lower limbs, and cauda equina symptoms that seriously affect patients' quality of life. At present, oral analgesics are commonly used in the treatment of LDH; but they can produce gastrointestinal reactions and other side effects. Thunder-fire moxibustion is a method that is widely used in China to treat pain syndromes. This study aimed to design a randomized controlled trial to explore the effectiveness and safety of thunder-fire moxibustion in the treatment of lumbar disc herniation.

Methods

Ninety patients will be enrolled and randomly divided into one of two groups: the thunder-fire moxibustion group and the acetaminophen group. The thunder-fire moxibustion group will be treated with moxa sticks at BL25, GV3, BL23, and GV4; and after 15 min of local whirling moxibustion, the contralateral acupoints will be treated with moxibustion for 15 min. The study period will include two 10-day courses of treatment, for a total study duration of 20 days. The acetaminophen group participants will take one acetaminophen sustained-release tablet twice a day for the duration of the study period. In contrast, the thunder-fire moxibustion group participants will be treated with thunder-fire moxibustion every other day for 30 min. The primary outcome will be the Japanese Orthopedic Association (JOA) score. Visual analog scale (VAS) and Oswestry Disability Index (ODI) will be used as the secondary outcome measures. Adverse events (AEs) will also be recorded. Assessments will be conducted at baseline, the end of the first and second courses of treatment.

Discussion

This study will determine whether thunder-fire moxibustion is more effective and safer than acetaminophen in the treatment of patients with LDH.

Trial Registration

Chinese Clinical Trial Registry (http://www.chictr.org.cn), ChiCTR2000036079.

A randomized controlled protocol on the effect of moxibustion on the cardiac function and quality of life in patients with chronic heart failure

BACKGROUND

Chronic heart failure (CHF) is the final result of various cardiovascular diseases, with high morbidity and high mortality, which seriously threaten people's health and quality of life. It has become a public health problem in the world. There is currently no specific treatment. Moxibustion, as a complementary and replacement therapy, has advantages in the treatment of chronic heart failure, but it lacks standard clinical studies to verify it. Therefore, the purpose of this randomized controlled trial is to evaluate the effect of moxibustion on the heart function and quality of life of patients with CHF.

METHODS

This is a prospective randomized controlled trial to study the effect of moxibustion on the heart function and quality of life of patients with CHF. This is approved by the clinical research ethics committee of our hospital. Patients were randomly divided into observation group (moxibustion combined with Western medicine treatment group) or control group (conventional Western medicine treatment group). There is a follow-up for 3 months after 6 weeks of treatment. Observation indicators include total effective rate of cardiac function improvement, Minnesota Living with Heart Failure Questionnaire , left ventricular ejection fraction , N-terminal pro-brain natriuretic peptide , 6-minute walk test , adverse reactions, etc. Data were analyzed using the statistical software package SPSS version 18.0 (Chicago, IL).

DISCUSSION

This study will evaluate the clinical efficacy of moxibustion in the treatment of CHF. The results of this study will provide a reliable reference for the clinical choice of moxibustion as an adjuvant treatment for chronic heart failure.

TRIAL REGISTRATION

OSF Registration number: DOI 10.17605/OSF.IO/29XE7.

Moxibustion Improves Chronic Heart Failure by Inhibiting Autophagy and Inflammation via Upregulation of mTOR Expression

How moxibustion improves chronic heart failure is extremely complex and still unclear. This study aimed to explore whether moxibustion inhibits autophagy and reduces inflammation by regulating mTOR expression to induce myocardial protective effects and alleviate symptoms associated with chronic heart failure. Echocardiography was used to detect cardiac function and cardiac structure of rats, including heart rate (HR), left atrium diameter (LA), left ventricular diameter (LV), left ventricular posterior wall (LVPW), interventricular septum (IVS), ejection fraction (EF), and fractional shortening (FS). BNP and NT-pro BNP levels were measured by enzyme-linked immunosorbent assay (ELISA). Autophagy-associated protein (ATG) genes and mTOR were detected by PCR. The expression of mTOR and phosphorylated-mTOR was detected through western blotting of proteins from myocardial tissue samples. The left ventricular inflammatory response was detected by immunohistochemistry and included ICAM-1, VCAM-1, MMP-2, and MMP-9 expression. The relationship between autophagy and inflammation was analyzed by correlation analysis. The results from echocardiography and ELISA showed that moxibustion could significantly improve heart function and structure. Western blot and PCR results showed that moxibustion treatment elevated mTOR expression. Further, moxibustion could inhibit autophagy and regulate the expression of key autophagy-related genes, including Vps34, ATG3, ATG5, ATG7, ATG12, and ATG13. By contrast, rapamycin could partially reduce the effects of moxibustion. Immunohistochemistry results indicated that moxibustion could reduce myocardial inflammation. Moreover, there was a positive correlation between autophagy and inflammation. Moxibustion can protect cardiac function in rats with heart failure, possibly inhibiting excessive autophagy of cardiomyocytes and reducing inflammatory reactions through the elevation of mTOR expression.

Heat-sensitive moxibustion self-administration in patients in the community with primary hypertension: A protocol for a multi-center, pragmatic, non-randomized trial

BACKGROUND

Although the efficacy of antihypertensive drugs has been well established for primary hypertension, their effectiveness is always limited by side effects and poor compliance. Heat-sensitive moxibustion is an innovative acupoint stimulation therapy that is promising as a community health care intervention for hypertension.

AIMS

This study aims to evaluate the pragmatic effectiveness and safety of heat-sensitive moxibustion self-administration by patients in the community with primary hypertension.

METHODS

This study will adopt a multi-center, pragmatic, nonrandomized design. Six hundred patients with primary hypertension will be recruited from 4 communities. Each patient will choose to either receive heat-sensitive moxibustion self-administration + original antihypertensive drugs or maintain their original antihypertensive drugs without heat-sensitive moxibustion for 1 year.

EXPECTED OUTCOMES

The primary outcome will be changes in systolic and diastolic blood pressures and the percentage changes in the doses of antihypertensive drugs. The secondary outcomes will be changes in quality of life assessed by a validated patient-reported outcome scale and the levels of fasting blood glucose, glycated hemoglobin, total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, urinary albumin, and serum creatinine. The proportion of patients with poor compliance with the heat-sensitive moxibustion regimen will also be evaluated as a secondary outcome. The safety of heat-sensitive moxibustion will be considered by analyzing the incidence of all and serious adverse events and their correlation with heat-sensitive moxibustion.

DISCUSSION

The findings of this study will provide pragmatic evidence for heat-sensitive moxibustion self-administration in patients in the community with primary hypertension and may also establish an ethical basis for further randomized controlled trials.

TRIAL REGISTRATION

The protocol of this trial was registered in ClinicalTrials.gov at May 11, 2020 (No. NCT04381520).

The Association of Autonomic Nervous System Function With Ischemic Stroke, and Treatment Strategies

Acute ischemic stroke, especially minor stroke, and transient ischemic attack have high risks of recurrence and exacerbation into severe ischemic strokes. It remains challenging to perform risk stratification and screen high-risk groups for initiation of early treatment in these patients. Moreover, with the growing population of patients with chronic small vessel disease, the mechanisms and clinical implications require further investigation. Traditional tools such as the ABCD2 score (age, blood pressure, clinical features, duration of symptoms, diabetes) have only moderate predictive value in patients with transient ischemic attack or minor stroke. By contrast, measurement of changes in heart rate variability (HRV) is an important and novel tool for risk stratification and outcome prediction in patients with cardiovascular diseases, as it reflects the overall level of autonomic nervous system dysfunction. Thus, abnormal HRV may be useful for prognosis and improve stratification of stroke patients with diverse risks. HRV may also partially explain autonomic nervous dysfunction and other manifestations during the process of chronic cerebral small vessel disease. In summary, measurement of HRV may contribute to early initiation of interventions in acute or chronic stroke patients using novel treatments involving rebalancing of autonomic nervous system function.