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Current Hypertension Guidelines (JNC 8 vs. 2017 AHA/ACC)
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Acupuncture: is one of the most accepted CAM therapies, most well: known branch of hypertension guidelines canada pdf Traditional Chinese Medicine, which flows intensive research a few decades in the US, Europe, even in China. Is backed by proving research results of Evidence Based Medicine for properly as well. Results: Acupuncture and TCM, are one of the most researched area of non—conventional, szívverés magas vérnyomás kezelésére therapies.
We have already demonstrated convincingly established by the management of the majority of acupuncture point physiological responses. The mediator neurohormonal transmitters are already known about now. The performance of in: service training is a university competence. Evidence Based Medicine has an efficient and effective use based on the quality of training in: service training, which is conducted in some Universities for more decades. Further development of this training, quality education can only be realistic to achieve the goals which effectively give rise to a dedicated TCM Confucius Institute Pecs University.
What is the essence of mechanical peripheral stimulus, the nervous and neurohumoral mechanism mediating acupuncture e. Is there an acceptable and relevant professional literature proving the efficiency of clinical acupuncture? The application of this principle can be carried out by mechanical stimulus: needle puncture, massage, temperature stimulus, vacuum based suction, as well as by ultrasound, laser, etc.
In China it has been known for centuries about different herbs on which meridian they are effective hypertension guidelines canada pdf whether they belong to the type of yin or yang. So the knowledge of channels and points was also taken into consideration in Chinese phytotherapy. We can say, that we are talking about a diagnostic and therapeutic whole body complex system 3 based on a unitary theoretic foundation which is consistent in itself.
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A newer recognition is the study and application of the Yamamato4 scalp system. Is it more efficient to treat an acupuncture point already known than to place the needle into a sham acupuncture point?
- Carter, PharmD; William C.
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By examining the efficiency of acupunctural pain-killing [ 1 ] 6 came to the conclusion that pains induced in acute, laboratory conditions both in humans and animals could only be efficiently alleviated by stimulating acupuncture points, while in the case of treating non-acupuncture points there was no really measurable pain-killing effect observed.
At the same time, in the cases of chronic pain this difference is not so obvious. A great number of cases are needed to achieve the statistical significance a minimum of experimental persons per examination ; furthermore this issue has not been closed up to now.
Do acupuncture points have a specific anatomic structure? According to the finding of a number of microscopic and electromicroscopic examinations there is no separate structure apart from our skin sense organ representative of special acupuncture points, but a bigger number of sensory nerve endings can be recognized at the indicated points, e.
Physiological and biophysical description of acupuncture points In Europe it was the French Niboyet who first described that the areas of the skin surface with low electrical resistance can be identified with acupuncture points.
Simultaneous factors influencing skin resistance must also be taken into consideration since a hypertension guidelines canada pdf can be hindered by several influential factors temperature, surface humidity, calibration of the measuring device. During hypertension guidelines canada pdf measurement we apply a very weak measuring current.
The surface of the skin shows mV potential difference in its areas, where it is the surface to be considered more negative compared to the deeper layers [ 5 - 7 ]. When measuring skin potential values acupuncture points are also measurable and bigger differences can be measured in these areas.
This partially gives an explanation on the chemical and hypertension guidelines canada pdf processes induced by the needle applied.
During acupuncture it is not only the damage potential that induces current, but also the needle itself functions as a thermo element, since when applying the needle there is a temperature difference of more than 10°C. According to our latest knowledge it is a virtual network system which refers to the succesive sequences of the recognized bioactive acupuncture points, so it is not a separately and touchable anatomic structure.
The very first clear answer to the nervous mediation of low— frequency Electroacupuncture EA applied via inserted needles was given by Chiang [ 11 ], whose research is still going on. This explains why an electric stimulation with hypertension guidelines canada pdf hypertension guidelines canada pdf and higher current stability is important.
This is in accord with the following nervous mechanism in case of applying a low frequency and high intensity electro-acupuncture EA. The fibres responsible for the impulse transmission are myelinated type 2 and 3 afferents with a small diameter.
They are responsible for the numbness and the feeling of fullness induced by the spreading needle sensation but the pain is mediated by the bare type 4 fibres. In case of an activation of skin nerves the A-delta fibres play a role. This pre-sinaptically inhibits either through encephalin or dynorphin mediation but not through ß-endorfin one, which means it blocks the transmission of the pain stimuli.
Consequently, the encephalins and the hypertension guidelines canada pdf may block the pain already at the level of the spinal cord.
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Next the needle stimuli advance through the ascending hypertension guidelines canada pdf to the thalamus in the spinal cord. In hypertension guidelines canada pdf peri-aquaeductal grey matter PAG of the midbrain hypertension guidelines canada pdf activates the raphe nucleus in the caudal part of the medulla oblongata through encephalin mediation.
It sends back descending impulses in the dorsolateral part of the spinal cord DLT through monoamine serotonin and norepinephrine mediation to the cells of the spinal cord. Both monoamine mechanisms might take part in pain-killing. The originally activated ascending tract in spinal cord also activates the nucleus arcuatus in the hypothalamus-hypophysis complex, while other parts of the hypothalamus receive ß-endorphin from the hypothalamus itself.
It effects through the blood current only to a small extent, it rather gets to the cell on a direct retrograde way without getting through the blood-brain barrier Figures 1 and 2. Anyhow, the destruction of hypophysis in experimental animals inhibits the creation of an acupunctural effect. The hypophysis also releases ACTH in an equimolar amount with ß-endorphin since their precursor is common.
Figure 1: Regulation of acupuncture in EU. Adrenocorticotropic Hormone ACTH stimulates the adrenal gland to release cortisol, which explains the anti-inflammatory effect of acupuncture in conditions such as asthma, arthritis, etc. At the same time this little amount of cortisol does not have harmful side effects neither does it cause a positive feed-back. The recent excellent radiological hypertension guidelines canada pdf techniques PET, fMRI prove that acupuncture can activate further parts of central nervous system parts such as nucleus accumbens, amygdala, habenula, thalamic nuclei, etc.
In a study of volunteer participants with artificially induced toothache were treated by manual stimulation of Large Intestine 4 LI4 on hand acupuncture point 14 to relieve pain.
One group received intravenous saline; the other group received intravenous naloxone. None of the participants knew which group they were in.
This is a typical example of double blind clinical research.
In the first group the pain was eliminated in 30 min and the effect persisted longer than one hour. The pain did hypertension guidelines canada pdf subside in naloxone group in spite of dry needling. At the same time the participants of placebo group received placebo injection with the instruction that it was a strong pain-killer medicine. These participants did not experience any alleviation of their pain at all.
Shortly after the publication, that the dosage of naloxone needed to block AA depended on applied frequency of electro-acupuncture. It is less in case of 2 Hz than hypertension guidelines canada pdf case of 15 Hz and comparatively lot more naloxone was necessary to inhibit pain relief induced by Hz EA. Based on cross-tolerance studies it has become certain that there are different endogenous opiate mediations depending on the frequency of needle stimulation, and all this takes place via different receptors.
Based on this knowledge the explanation of the antihypertensive effect of acupuncture compared with angiotensinconverting- enzyme inhibitor ACE inhibitors is thought provoking. The antihypertensive effect of opioids was already known. Using the opioids as medicine is proved to be difficult because their elimination in the body is too fast.
On the other hand if we inhibit the final synthesis of angiotensin II-ACE inhibitors are examples of this-it loses its antiopioid effect; hence we can lower blood pressure, however it eventually happens due to opioid peptides of the body.
Lowering blood pressure in the so called magas vérnyomás 1 fokozat 2 fok stage of hypertension could be achieved more directly through opioids facilitated by acupuncture.
Augmentation theory: Acupuncture raises the level of triglycerides, certain hormons, prostaglandins, leukocytes, gamma globulins, opsonins, and antibodies immunstimulatory effect. Endorphin theory: Acupuncture stimulates the production of endorphins especially the enkephalins, and dynorphins analgesia.
Hypertension and nephrology
Neurotransmitter theory: Acupuncture can influence on the production and secretion of several neurotransmitters serotonine, noradrenaline depression and emotional diseases, the decreased level of serotonin may lead to weight loss.
Gate control theory: On the level of interneurons of the spine acupuncture stimulated somatosensoric A:delta fibres block the thinner viscerosensor C fibers transmitting hypertension guidelines canada pdf incomming pain information, by which they prevent its spreading into higher level center and prevent the perceiving of pain anaestesy, analgesy, Diffuse Noxious Magas vérnyomás hatása az agyra Control: postulated by le Bars, Local segmental effect: axon reflex, vasoactive neuropeptides: mostly calcitonin gene related peptid CGRPsubstance P SP : Lundeberg, Kashiba, Schaffer, Calsson,endorphin: antiinflammatory effect Stein, Yassouridis, Differencess between extitatons of A: delta fibres and A: beta fibres, conduction velocity, inhibition of heterosegmental nociceptive stimulus Sandkuhler, they are the part of supraspinal descendal inhibiting mechanism.
Pomeranz,stress analgesia: through stress: induced reduction of pain sensitivity Fancelov,short time activation of endorphin system but in such an extent explanation of the long term effect is not enough. Endorphin system: endorphinerg system activating Han, Xie,PekingHypertension guidelines canada pdf, Pomeranz,Han Terenius, hypertension guidelines canada pdf most accepted explanation until this time, decrease of endorphin system regulation, chronic pain syndroms disreglative changes especially lumboischalgc pain, haedache, fibromylagia.
Endocrine effects: Hypothalamus activation Hsieh et al. Clinical effect of acupuncture can be assessed only based on human individuals, thoroughly prepared by observation. Later we follow basic rules of evidence—based medicine and then verified and confirmed clinical impact studies. Regular overview summarizing on the evidence based medicine Overall requirement for effectiveness confirmation is a sufficient amount of performed and well: prepared, random and controlled experiments.
Today, there is a specific statistical method, where individual examinations are an examined entity. Balanced usage of all the until now gained knowledge about medicine based hypertension guidelines canada pdf facts evidence based knowledge is conscientious and open to patient and based on current proven facts decides on the best possible treatment for patients [ 1112 ]. It is expected from the medical doctor that he hypertension guidelines canada pdf possibly the best clinical experiences in given specialization and is educated by the best research results.
In system included publications, whatever hypertension guidelines canada pdf results were, have to match certain specification requirements. New outcomes of working hypothesis formulation hypertension guidelines canada pdf important for future research.
In order to eliminate possible bias we use so: called sensitivity analysis. There we compare and examine better and worse results of individual experiments and those are then compared only with results and outcomes of the better experiments.
JAMA: a hypertonia 2014-es evidencián alapuló terápiás irányelve
We are also calling it biased when the outcomes—whether intentionally or not—are evaluating the one and the hypertension guidelines canada pdf experiment numerous times for example: when the experiment was published more times but under different names.
CAMbrella—the Pan: European Union research project 19 included one worksheet, which was discussing this topic in the recent past, when they analyzed approximately The proven clinical efficacy of the acupuncture The acupuncture treatment means a diagnosis of the patient as an individual and a planned treatment according to the given clinical pattern [ 13 ].
This also means that according to the unique, extremely detailed Chinese pulse and tongue hypertension guidelines canada pdf there are no two patients totally alike. In this regard, it is a great task to contract the results of certain experiments but the randomization itself is also dif ficult. While certain problems are always treated on the same point for instance nausea and vomiting are treated on Pericardium: 6 acupoint 20in case of a chronic pain syndrome different treatment protocols must be followed depending on the accompanying symptoms.
In order to apply the right acupuncture treatment the criteria are not hypertension guidelines canada pdf the selection of the right puncture points but also the consideration of further factors: Linde et al.
The adequacy of acupuncture can also be estimated by the minimum number of acceptable treatments. According to the criteria of Molsberger and Bowing [ 15 ] it means at least 10 sessions of treatments in which each single treatment session hypertension guidelines canada pdf a minimum of 15 min long and the record of the used acupuncture points. Patel et al. Although this approach in itself does not give an answer whether the applied acupuncture has been effective enough against the actual disease, it can be observed that experimental group members preferred treatments tailored individually to selection of points according to the standard formula.
But how to integrate individual treatments into controlled experimental methods? The certain hypertension guidelines canada pdf group members will be treated on the points according to the formula. Following the latter approach it is known that there is no connection between the number of treated points and the successfulness of a treatment, however scientists found a hypertension guidelines canada pdf significant relation regarding the number of treatments and the successfulness of the cure.
Getting less than 6 treatments was never efficient enough, but those patients who hypertension guidelines canada pdf 10 treatments recovered more successfully. According to the efficacy examination of acupuncture treatments for lumbal pain acupuncture is a suitable method but only recommended as a complementary treatment. It was found after the statistical evaluation of 7 studies on fibromyalgia that acupuncture is much more effective than [ 8 ] sham acupuncture, but there was not a long: term follow up carried out in the examined studies.
Ernst et al.
Hypertension and nephrology
In a systematic review of 22 experiments Melchart et al. They came hypertension guidelines canada pdf the conclusion that, although there is not sufficient data to prove that acupuncture is better than treating with medicine [ 16 ] patients with recurrent headache can be encouraged to try acupuncture Its application is even more recommended to treat tension headaches Han, Cheung, In a systematic review of 33 studies suggested that in case of nausea and vomiting the stimulation of Pericardium: 6 acupoint through massage, needle, etc.
It is interesting that in the 4 experiments when patients were stimulated on this point while being anesthetized, nausea was not reducible. Perhaps on this nemi erőszak magas vérnyomás ellen there is a considerable hypertension guidelines canada pdf effect manifested as well, that supposes the conscious mental state [ 15 ].
Based on 4 controlled clinical experiments we can hypertension guidelines canada pdf that if we include acupuncture in the common stroke rehabilitation treatments, the chance of a successful rehabilitation significantly increases, in addition the cost of post treatments can also be reasonably decreased Birch,Hegyi By hypertension guidelines canada pdf examination of patients in controlled clinical experiments we can conclude that: there is sufficient data provided to state that acupuncture and in particular the formularized form of ear acupuncture treatments are suitable to cease alcohol addiction 22furthermore addicts can be more motivated to go on with other therapies.
On the other hand, according to Birch the role of acupuncture is promising but contradictory regarding patients with cocaine and opiate addiction.
Further research is required in this field. It is worldwide applied as a complementary treatment for reducing withdrawal symptoms. The study recommends acupressure as well, which can be carried out hypertension guidelines canada pdf a self-treatment too.
In case of frequent urination, incontinence, recurring lower urinary tract infection and kidney stone acupuncture can be recommended due to having significantly less side effects than common pharmacotherapies. The relevant literature is about the positively influential intervention to ease delivery and cervical dilatation in case of breech birth and transverse lie hypertension guidelines canada pdf in case of multipara pregnancy. Birch evaluates 3 studies in his work already mentioned.