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      A protocol for systematic review and meta-analysis of the effect of acupoint therapy for essential hypertension

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          Abstract

          Background:

          Essential hypertension remains an enormous public health concern, imposing a major burden of morbidity and mortality worldwide. Relevant studies showed that acupuncture therapy might be effective in treating essential hypertension. However, there is no consistent conclusion so far. The aim of this study was to assess the efficacy and safety of acupuncture therapy for patients with essential hypertension.

          Methods:

          We searched the PubMed, Embase, the Cochrane Library, Web of Science, the Chinese National Knowledge Infrastructure (CNKI), and the Wan-fang databases from inception through November 29, 2019. Randomized controlled trials investigating acupuncture therapy for hypertension were included. We will use Endnote software X8 for studies selection, Review Manager software 5.3 for the data analysis.

          Results:

          We will synthesize current studies to evaluate the safeties and effectiveness of acupuncture for essential hypertension.

          Conclusions:

          Our study will provide the evidence of acupuncture therapy for essential hypertension.

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          Most cited references12

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          Global burden of hypertension: analysis of worldwide data.

          Patricia Kearney, Megan Whelton, Kristi Reynolds … (2005)
          Reliable information about the prevalence of hypertension in different world regions is essential to the development of national and international health policies for prevention and control of this condition. We aimed to pool data from different regions of the world to estimate the overall prevalence and absolute burden of hypertension in 2000, and to estimate the global burden in 2025. We searched the published literature from Jan 1, 1980, to Dec 31, 2002, using MEDLINE, supplemented by a manual search of bibliographies of retrieved articles. We included studies that reported sex-specific and age-specific prevalence of hypertension in representative population samples. All data were obtained independently by two investigators with a standardised protocol and data-collection form. Overall, 26.4% (95% CI 26.0-26.8%) of the adult population in 2000 had hypertension (26.6% of men [26.0-27.2%] and 26.1% of women [25.5-26.6%]), and 29.2% (28.8-29.7%) were projected to have this condition by 2025 (29.0% of men [28.6-29.4%] and 29.5% of women [29.1-29.9%]). The estimated total number of adults with hypertension in 2000 was 972 million (957-987 million); 333 million (329-336 million) in economically developed countries and 639 million (625-654 million) in economically developing countries. The number of adults with hypertension in 2025 was predicted to increase by about 60% to a total of 1.56 billion (1.54-1.58 billion). Hypertension is an important public-health challenge worldwide. Prevention, detection, treatment, and control of this condition should receive high priority.
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            1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension. Guidelines Subcommittee.

            Subcommittee Guidelines, N Ellison, L Hansson … (1999)
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              Is Acupuncture Effective for Hypertension? A Systematic Review and Meta-Analysis

              Xiao-Feng Zhao, Han-Tong Hu, Jia-Shen Li … (2015)
              Objective To determine the efficacy of acupuncture for hypertension. Method Seven electronic databases were searched on April 13, 2014 to include eligible randomized controlled trials (RCTs). Data were extracted and risk of bias was assessed. Subgroup analyses and meta- analysis were performed. Results 23 RCTs involving 1788 patients were included. Most trials had an unclear risk of bias regarding allocation concealment, blinding, incomplete outcome data and selective reporting. Compared with sham acupuncture plus medication, a meta-analysis of 2 trials revealed that acupuncture as an adjunct to medication was more effective on systolic (SBP) and diastolic (DBP) blood pressure change magnitude (n=170, SBP: mean difference (MD)= -7.47,95% confidence intervals (CI):-10.43 to -4.51,I2 =0%; DBP: -4.22,-6.26 to -2.18, 0%).A subgroup analysis of 4 trials also showed acupuncture combined with medication was superior to medication on efficacy rate (n=230, odds ratio (OR)=4.19, 95%CI: 1.65 to 10.67, I2 =0%). By contrast, compared with medication, acupuncture alone showed no significant effect on SBP /DBP after intervention and efficacy rate in the subgroup analysis. (7 trials with 510 patients, SBP: MD=-0.56, 95%CI:-3.02 to 1.89,I2 =60%; DBP: -1.01,-2.26 to 0.24, 23%; efficacy rate: 10 trials with 963 patients, OR=1.14, 95% CI: 0.70 to 1.85, I2 =54%).Adverse events were inadequately reported in most RCTs. Conclusion Our review provided evidence of acupuncture as an adjunctive therapy to medication for treating hypertension, while the evidence for acupuncture alone lowing BP is insufficient. The safety of acupuncture is uncertain due to the inadequate reporting of it. However, the current evidence might not be sufficiently robust against methodological flaws and significant heterogeneity of the included RCTs. Larger high-quality trials are required.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Medicine (Baltimore)
                Journal ID (iso-abbrev): Medicine (Baltimore)
                Journal ID (publisher-id): MEDI
                Title: Medicine
                Publisher: Lippincott Williams & Wilkins (Hagerstown, MD )
                ISSN (Print): 0025-7974
                ISSN (Electronic): 1536-5964
                Publication date Collection: 02 October 2020
                Publication date (Electronic): 02 October 2020
                Volume: 99
                Issue: 40
                Electronic Location Identifier: e22399
                Affiliations
                [a ]The First Clinical College
                [b ]Department of Teaching, School of Acupuncture and Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China.
                Author notes
                [∗ ]Correspondence: Qing-guo Liu, Department of Teaching, School of Acupuncture and Moxibustion and Tuina, Beijing University of Chinese Medicine, No. 11 North Third Ring East Road, Beijing 100026, China (e-mail: zyy678@ 123456yeah.net ).
                Article
                Publisher ID: MD-D-20-00029 Accession ID: 22399
                DOI: 10.1097/MD.0000000000022399
                PMC ID: 7535565
                PubMed ID: 33019414
                SO-VID: 2d0e5917-2d0f-4f72-8aa9-d67fb87dfce4
                Copyright © Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc.
                License:

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

                History
                Date received : 27 August 2020
                Date accepted : 28 August 2020
                Funding
                Funded by: National Natural Science Foundation of China
                Award ID: No. 81774413
                Award Recipient : Not Applicable
                Categories
                Subject: 3800
                Subject: Research Article
                Subject: Study Protocol Systematic Review
                Custom metadata
                OPEN-ACCESS TRUE

                Keywords: acupoint therapy,acupuncture,essential hypertension,protocol,systematic review and meta-analysis
                Data availability:
                Keywords: acupoint therapy, acupuncture, essential hypertension, protocol, systematic review and meta-analysis

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