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.

尽管中医提倡使用针灸不仅诱导镇痛，还可以治疗基本的高血压，但针灸在人类中的假定降压功效尚未受到严格的西方科学测试。 在提倡针灸作为基本高血压的有效免费/替代医学策略之前，有必要证明针灸的有益作用在科学上是强大的，持久的，并且可以从现代的科学机制方面进行明确。 在自发的高血压大鼠中，针灸样的骨髓（III组）体细胞传入的电刺激激活了中枢性内啡肽（纳洛酮敏感）途径，从而导致交感神经活性（SNA）和血压的持久降低。 在有意识的人类中记录SNA的能力为在进行电针刺的患者中测试这一新型机械假设提供了新的机会，这是对古代技术的修改，为人类骨骼肌传入提供了可量化且可重复的刺激。 使用随机的双盲安慰剂对照设计，我们将检验两个主要假设：（1）电针仪可在SNA中持续降低，从而提供对人类高血压的安全有效治疗。 （2）介导针灸的降低血压作用的主要机制是触发纳洛酮敏感反射抑制中心交感神经流出的体细胞传入。 该提案的独特特征是使用定量，最先进的技术（例如，SNA的微电极记录，24小时的卧床血压监测）和严格的，紧密控制的实验设计来测试有关针对人类血压影响人类血压影响的新型机制假设。鉴于我们的公众对针灸具有极大的兴趣，但西方科学数据对其在心血管疾病中的疗效很难，我们在正常性和高血压的人类方面的研究应提供一个概念性的框架，以决定是否接受或拒绝大量中国（和俄罗斯）的大量中国（和俄语），以促进质量和其他涉及精神症状和其他蛋白质的治疗，并有效地治疗cardipuctiral and cardipsirant（cardip），并有效地介绍了蛋白质的毛皮均匀度量，并且缺血）其中存在重要的交感神经成分。