---
title: "High blood pressure"
url: "https://acuiq.com/wiki/evidence/hypertension"
updated: 2026-10-09
last_verified: 2026-10-09
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-09"
reading_minutes: 9
sources: 12
---

# High blood pressure

_What the Cochrane review, three later reviews, five trials against sham or other points, and American and British guidance report on acupuncture for essential hypertension._

Trials of acupuncture for high blood pressure (hypertension) measure pressure in one of two ways: with a cuff in the clinic, or with an ambulatory monitor worn for 24 hours, which averages readings across a day and night away from the clinic. Most enrol people with essential, or primary, hypertension: raised blood pressure with no underlying cause that tests can find. Two distinctions decide what a trial can show. Some trials measure pressure within hours of the last session and others weeks or months after treatment stops, and the treatment of hypertension depends on control that lasts. Some compare acupuncture with sham acupuncture, a procedure made to resemble it, and others with no added treatment, a waiting list or drugs. [Sham acupuncture](/wiki/research/sham-acupuncture) describes the kinds of sham in use. No trial on this page tested acupuncture as a long-term substitute for antihypertensive medication.

## The Cochrane review

The [Cochrane review](https://doi.org/10.1002/14651858.CD008821.pub2) by Yang and colleagues was published in November 2018. It searched English-language databases to February 2017 and Chinese ones to January 2015, and included 22 randomised trials with 1,744 adults with primary hypertension, 18 of them from China. The trials compared acupuncture, alone or added to other care, with no treatment, sham acupuncture or an antihypertensive drug, and most were at high risk of bias because participants or staff were not blinded.

| Comparison and outcome | Trials (people) | Result | Certainty (GRADE) |
| --- | --- | --- | --- |
| Sham: systolic pressure 1 to 24 hours after the last session | 4 (386) | 3.4 mmHg lower with acupuncture | Very low |
| Sham: diastolic pressure 1 to 24 hours after the last session | 4 (386) | 1.9 mmHg lower with acupuncture | Very low |
| ACE inhibitors and calcium antagonists: short-term pressure | 8 and 7 | Larger falls with acupuncture, judged most likely to reflect bias | Not graded |
| Adverse events | 4 (426) | Mostly needling pain and spot bleeding; one hypertensive emergency in an acupuncture group | Low |

GRADE is the scale reviews use to say how far a result can be trusted; very low means the true effect is likely to be substantially different. Only one included trial measured pressure months after treatment had stopped, and it found no lasting fall. The authors concluded that there is no evidence for the sustained effect needed to manage chronically raised blood pressure, that the short-term effect is uncertain, and that future trials must use sham controls and test for an effect lasting at least seven days. Safety could not be assessed because only eight trials reported adverse events. No later version of the review had been published by October 2026.

## Later reviews

A [2026 review](https://doi.org/10.3389/fmed.2026.1888399) by Zhong and colleagues searched to March 2026 and included 15 randomised studies with 1,846 participants, against sham, waiting list, no treatment, usual care or drugs, keeping needle acupuncture and electroacupuncture apart from stimulation through the skin without needles. At the end of treatment, office systolic pressure was 6.6 mmHg lower with acupuncture, on low-certainty evidence, while office diastolic pressure showed no clear difference, on very low-certainty evidence. Evidence from 24-hour monitoring was sparse and rated very low. Sham-controlled studies gave wider confidence intervals than the pooled set, and reductions were larger among people taking stable antihypertensive medication than among those taking none. No serious adverse event was confirmed as caused by treatment, but the authors rated the safety evidence very low because trials defined and recorded adverse events inconsistently, and wrote that the trials were not designed to test sustained control or cardiovascular events.

A [2026 meta-analysis](https://doi.org/10.1080/08037051.2026.2654103) by Li and colleagues, limited to trials published from 2015 to 2024, pooled 7 trials with 812 people against a mix of controls and found systolic pressure 6.7 mmHg and diastolic 6.6 mmHg lower, with high inconsistency between trials (I² 73% and 91%, where higher values mean the trials disagree more). The authors did not grade the evidence and called it limited by the small number of studies and the variation between interventions. A [second 2026 review](https://doi.org/10.1080/08037051.2025.2605798) by Gao and colleagues in the same group pooled 13 trials with 1,080 people in which acupuncture was added to antihypertensive drugs and compared with the drugs alone; 24-hour average systolic and diastolic pressures were both about 3.6 mmHg lower with the combination. None of these trials used a sham control.

## Trials against sham and other points

Five trials have measured blood pressure across a course of several weeks, and three of them after treatment stopped.

| Trial | People | Control | Course | Difference at the end of the course | After treatment stopped |
| --- | --- | --- | --- | --- | --- |
| SHARP, Macklin 2006 | 192, off medication | Invasive sham | Up to 12 sessions over 6 to 8 weeks | None significant at 10 weeks | Not given in the trial’s abstract |
| Flachskampf 2007 | 160, most on unchanged medication | Sham | 22 sessions over 6 weeks | 24-hour pressure 6.4/3.7 mmHg lower than sham | Back to pretreatment levels at 3 and 6 months |
| Li 2015 | 65, off medication | Electroacupuncture at other points | 8 weekly sessions | About 6/4 mmHg lower than control points | Systolic 5 mmHg below baseline after 1 month, in 21 followed |
| Zheng 2019 | 428, mild hypertension | Sham and waiting list | 18 sessions over 6 weeks | 24-hour systolic 2.7 mmHg lower than sham, not significant | 3.3 mmHg lower than sham at week 9 |
| AHEaD 2026 | 30, off medication | Non-penetrating sham | 24 sessions over 12 weeks | Systolic 9.1 mmHg lower than sham | 8.4 mmHg lower at 30 days |

The [Stop Hypertension with the Acupuncture Research Program (SHARP)](https://doi.org/10.1161/01.HYP.0000241090.28070.4c), published in Hypertension in 2006 by Macklin and colleagues, randomised people with untreated pressures of 140/90 to 179/109 mmHg to individualised traditional Chinese acupuncture, acupuncture at preselected points, or sham needling. Participants had been weaned off antihypertensive drugs before enrolment; their pressure was checked every 14 days, and drugs were prescribed if it exceeded 180/110 mmHg. Systolic pressure fell by 3.6 mmHg with active acupuncture and 3.8 mmHg with sham, and no subgroup by age, sex, race, baseline pressure or Chinese medicine diagnosis responded differently.

The [German trial](https://doi.org/10.1161/CIRCULATIONAHA.106.661140) by Flachskampf and colleagues, published in Circulation in 2007, kept 78% of its participants on their existing medication unchanged, and 140 completed the course. Points were chosen for each person by Chinese medicine diagnosis. It is the trial in which the Cochrane review recorded the hypertensive emergency.

A [2015 trial](https://doi.org/10.1089/acu.2015.1106) by Li and colleagues in the United States compared electroacupuncture at [`PC05`](/points/PC05) (Jianshi), [`PC06`](/points/PC06) (Neiguan), [`ST36`](/points/ST36) (Zusanli) and [`ST37`](/points/ST37) (Shangjuxu) with electroacupuncture at LI 6-7 and GB 37-39, which the authors' earlier experiments had found to have little effect on pressure. Its control was a second set of points rather than a sham, and the follow-up group was the patients willing to continue. [Electroacupuncture](/wiki/techniques/electroacupuncture) describes how the current is applied.

The [2019 trial](https://doi.org/10.1111/jch.13490) by Zheng and colleagues at 11 hospitals in China gave electroacupuncture at 2 Hz along one of two sets of channels, which did not differ and were pooled; the sham group was needled at four points the group had used as inert in earlier studies. At the primary outcome, week 6, the acupuncture group differed significantly from neither the sham nor the waiting list, and the sham and waiting-list groups did not differ from each other. The authors described the effect as small. The [AHEaD trial](https://pubmed.ncbi.nlm.nih.gov/42615787/), a single-centre trial published in Arquivos Brasileiros de Cardiologia in 2026, enrolled adults with prehypertension or stage 1 hypertension at low cardiovascular risk, 14 to acupuncture and 16 to sham.

## What guidelines say

The American Heart Association’s 2013 [scientific statement](https://doi.org/10.1161/HYP.0b013e318293645f) on alternative approaches to lowering blood pressure, by Brook and colleagues, reviewed two meta-analyses and the German, Korean and SHARP trials. It gave acupuncture a Class III, no benefit, Level of Evidence B rating and stated that acupuncture is not recommended in clinical practice to reduce blood pressure; it rated device-guided slow breathing higher, at Class IIa. The [2025 AHA/ACC high blood pressure guideline](https://doi.org/10.1161/CIR.0000000000001356), published on 14 August 2025 by Jones and colleagues for 13 organisations, does not mention acupuncture; among stress-reduction approaches it lists meditation and device-guided breathing. NICE’s guideline [NG136](https://www.nice.org.uk/guidance/ng136/chapter/Recommendations), published in August 2019 and last updated in February 2026, recommends lifestyle advice on diet, exercise, alcohol, caffeine, salt and smoking, and does not mention acupuncture. [Clinical guidelines](/wiki/evidence/clinical-guidelines) compares other bodies’ positions.

## What the reviews could not settle

The Cochrane review set a test, a fall in pressure lasting at least seven days in a sham-controlled trial, and the trials since have not settled it. The sham-controlled trials in the table disagree with one another, both on whether there was a difference at the end of the course and on whether it lasted. The trials that followed people after treatment stopped did so for at most 6 months, and none measured stroke, heart attack or death, the outcomes for which blood pressure is treated. The trials against drugs carry a high risk of bias, and neither review that graded safety could rate it above low. Most trials in the Cochrane review were run in China; [Where the trials come from](/wiki/research/where-the-trials-come-from) discusses what the country of a trial tells a reader.

AcuiQ’s [hypertension](/symptoms/hypertension) and [essential hypertension](/symptoms/hypertension-essential) pages list the protocols individual studies prescribed, each with its citation.

### Sources

1. Yang J, Chen J, Yang M, Yu S, Ying L, Liu GJ, Ren YL, Wright JM, Liang FR, Acupuncture for hypertension, Cochrane Database of Systematic Reviews 2018 — https://doi.org/10.1002/14651858.CD008821.pub2
2. Zhong X, Yu C, Guo H, Acupuncture-based interventions for blood pressure control and cardiovascular risk-related outcomes in adults with hypertension: a systematic review and meta-analysis of randomized controlled trials, Frontiers in Medicine 2026 — https://doi.org/10.3389/fmed.2026.1888399
3. Li ZH, Gao HW, Shen FF, Lu Y, Chen W, Acupuncture for primary hypertension: a systematic review and meta-analysis of randomised controlled trials, Blood Pressure 2026 — https://doi.org/10.1080/08037051.2026.2654103
4. Gao H, Li Z, Zhan W, Shen F, Lu Y, Chen W, The effect of acupuncture on 24-hour ambulatory blood pressure and circadian rhythm in patients with essential hypertension: a systematic review and meta-analysis of randomised controlled trials, Blood Pressure 2026 — https://doi.org/10.1080/08037051.2025.2605798
5. Macklin EA, Wayne PM, Kalish LA, et al., Stop Hypertension with the Acupuncture Research Program (SHARP): results of a randomized, controlled clinical trial, Hypertension 2006 — https://doi.org/10.1161/01.HYP.0000241090.28070.4c
6. Flachskampf FA, Gallasch J, Gefeller O, et al., Randomized trial of acupuncture to lower blood pressure, Circulation 2007 — https://doi.org/10.1161/CIRCULATIONAHA.106.661140
7. Li P, Tjen-A-Looi SC, Cheng L, et al., Long-lasting reduction of blood pressure by electroacupuncture in patients with hypertension: randomized controlled trial, Medical Acupuncture 2015 — https://doi.org/10.1089/acu.2015.1106
8. Zheng H, Li J, Li Y, et al., Acupuncture for patients with mild hypertension: a randomized controlled trial, Journal of Clinical Hypertension 2019 — https://doi.org/10.1111/jch.13490
9. Bitencourt AR, Sousa ALL, Veiga Jardim PCB, et al., Effects of acupuncture on arterial hypertension and endothelial dysfunction: the AHEaD trial, Arquivos Brasileiros de Cardiologia 2026 — https://pubmed.ncbi.nlm.nih.gov/42615787/
10. Brook RD, Appel LJ, Rubenfire M, et al., Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the American Heart Association, Hypertension 2013 — https://doi.org/10.1161/HYP.0b013e318293645f
11. Jones DW, Ferdinand KC, Taler SJ, et al., 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM guideline for the prevention, detection, evaluation and management of high blood pressure in adults, Circulation 2025 — https://doi.org/10.1161/CIR.0000000000001356
12. National Institute for Health and Care Excellence, Hypertension in adults: diagnosis and management (NG136), published 28 August 2019, last updated 26 February 2026 — https://www.nice.org.uk/guidance/ng136/chapter/Recommendations