ACUPUNCTURE AND HYPERTENSION--EFFICACY AND MECHANISMS

针灸与高血压——功效与机制

• 批准号: 2799813
• 负责人: NORMAN M KAPLAN
• 金额: $ 24.24万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-09-30 至 2001-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2799813
• 关键词: acupuncture /acupressure; alternative medicine; analgesia; blood pressure; clinical research; clinical trials; electrostimulus; endorphins; essential hypertension; heart rate; human subject; human therapy evaluation; hypertension; microelectrodes; naloxone; neurogenic hypertension; neuropharmacology; somatic afferent nerve; sympathetic nervous system; ultrasound blood flow measurement

Although traditional Chinese medicine advocates the use of acupuncture not only to induce analgesia but also to treat essential hypertension, acupuncture s postulated antihypertensive efficacy in humans has not been subjected to rigorous Western scientific testing. Before advocating acupuncture as an effective complimentary/alternative medicine strategy for essential hypertension, it is necessary to demonstrate that the beneficial effects of acupuncture are scientifically robust, long-lasting, and explicable in terms of modern scientific mechanisms. In spontaneously hypertensive rats, acupuncture-like electrical stimulation of thinly myelinated (Group III) somatic afferents activates central endorphin (naloxone-sensitive) pathways that elicit long-lasting decreases in sympathetic nerve activity (SNA) and blood pressure. The ability to record SNA with microelectrodes in conscious humans provides a new opportunity to test this novel mechanistic hypothesis in patients undergoing electroacupuncture, a modification of the ancient technique which provides a quantifiable and reproducible stimulus to human skeletal muscle afferents. Using a randomized, double- blind placebo-controlled design, we will test two major hypotheses: (1) Electroacupuncture produces a long-lasting reduction in SNA, thereby providing a safe and effective complimentary treatment of human hypertension. (2) A major mechanism mediating the blood pressure-lowering effect of acupuncture is the activation of somatic afferents which trigger a naloxone-sensitive reflex suppression of central sympathetic outflow. The distinctive features of this proposal are the use of quantitative, state-of-the-art techniques (e.g., microelectrode recordings of SNA, 24 hour ambulatory blood pressure monitoring) and a rigorous, tightly controlled experimental design to test novel mechanistic hypotheses regarding the effects of acupuncture on blood pressure in humans. Given the enormous interest in acupuncture by our lay public but the paucity of Western scientific data about its efficacy in cardiovascular disorders, our studies in normotensive and hypertensive humans should provide a conceptual framework for deciding whether to accept or reject the large body of Chinese (and Russian) literature advocating acupuncture as a safe and effective treatment of essential hypertension and other cardiovascular disorders (such as heart failure, and myocardial ischemia) in which there is an important sympathetic neural component.

尽管传统中医提倡使用针灸不仅可以镇痛，还可以治疗原发性高血压，但针灸对人体的降压功效尚未经过严格的西方科学测试。 在提倡针灸作为治疗原发性高血压的有效补充/替代医学策略之前，有必要证明针灸的有益效果在科学上是稳健的、持久的，并且可以用现代科学机制来解释。 在自发性高血压大鼠中，对薄髓鞘（第 III 组）体细胞传入神经进行类似针灸的电刺激可激活中枢内啡肽（纳洛酮敏感）通路，从而引起交感神经活动 (SNA) 和血压的长期下降。 使用微电极在有意识的人类中记录 SNA 的能力为在接受电针治疗的患者中测试这种新颖的机制假说提供了新的机会，这是对古代技术的修改，为人类骨骼肌传入提供了可量化和可重复的刺激。 使用随机、双盲安慰剂对照设计，我们将测试两个主要假设：（1）电针可持久降低 SNA，从而为人类高血压提供安全有效的补充治疗。 (2)介导针灸降血压作用的主要机制是激活躯体传入神经，从而触发中枢交感神经流出的纳洛酮敏感反射抑制。 该提案的显着特点是使用定量、最先进的技术（例如 SNA 的微电极记录、24 小时动态血压监测）和严格、严格控制的实验设计来测试有关针灸对人体血压的影响。鉴于我们的普通公众对针灸的巨大兴趣，但关于针灸治疗心血管疾病功效的西方科学数据却很少，我们对血压正常和高血压人群的研究应该提供一个概念框架，以决定是接受还是拒绝广大中国人（以及俄罗斯）文献主张针灸可以安全有效地治疗原发性高血压和其他心血管疾病（例如心力衰竭和心肌缺血），其中存在重要的交感神经成分。