| Objectives:Firstly, by means of data mining method, to explore the principle of selecting acupoints along meridian in the treatment of essential hypertension with acupuncture; Secondly, using net-work Meta-analysis to synthesis the direct and indirect evidence of eletro-acupuncture verse manual acupuncture for essential hypertension. So as to investigate the effectiveness difference between eletro-acupuncture verse manual acupuncture; Thirdly, to evaluate the effectiveness differenc e between acupoints on involved meridian based on syndrome difference and non acupoints for patients with essential hypertension.Methods:1. Data mining the principal of acupoints selection for essential hypertensionBy means of computer and manual retrieval, we collected randomized controlled trials about acupuncture for essential hypertension. Then a literature database on acupuncture prescription for essential hypertension was established, utilizing Weka data mining software to analysis the principal of acupoints selection for essential hypertension.2. The net-work Meta analysis of acupuncture for essential hypertensionBy means of computer and manual retrieval, we collected randomized controlled trials about eletro-acupuncture and manual acupuncture for essential hypertension. Then evaluated the quality of included studies with risk bias assessment tool and extracted the data, utilizing Weka data mining software to analysis the principal of acupoints selection for essential hypertension.3. The effectiveness of acupuncture for essential hypertension at acupoints on involved meridian based on syndrome differentiation:A multi-center randomized, controlled trialTotal 288 included participants were randomized into three groups:Acupoints on involved meridian group(AIM), Non acupoint group(NA), Waiting list group(WL). Patients in AIM and NA groups were given verum acupuncture and sham acupuncture treatment for 30 minutes,3 sessions per week,18 sessions in total during 6 weeks. The primary endpoints were the 24 hour mean systolic blood pressure and 24 hour mean diastolic blood pressure. Combining with secondary endpoints to investigate the effectiveness of acupuncture on the involved meridians for patients with essential hypertension.Results:1. Acupoints selection for essential hypertension after data mining(1) The acupoints prescription for essential hypertension put emphasis on acupoints located on meridian of jueyin and yangming, especially the liver meridian of foot-jueyin, then the large intestine meridian of hand-yangming and the stomach meridian of foot-yangming.(2) The total frequency of acupoint utilization was 491, Specific points at specific meridians were the most predominately used in the acupoints prescription, particularly those five-shu points and primary points. in which the three used most acupoints were taichong(59 times), quchi(48 times), zusanli(35 times).(3) The most commonly used acupoints combinitions were taichong combined with quchi, zusanli combined with taichong, taichong combined with taixi.2. Network Meta analysis of acupuncture for essential hypertension(1) An initial search yielded 2763 potential literature citations. After screening titles, abstracts, keywords of all studies, excluded not RCTs(n=765), not clinical research (n=1436), duplicate reporting (n=68); Potential relevant articles were selected and retrieved for a full text assessment. Further screening for eligibility was performed by two independent reviewers by using inclusion and exclusion criteria, excluded not RCTs(n=405), not clinical research (n=35), duplicate reporting (n=3); Finally,51 RCTs were included.(2) The quality of included studies were evaluated with with risk bias assessment tool:among 51 studies,28 studies described the randomization method; 5 studies described the allocation concealment,10 described the blinding method; 10 studies reported with data missing, among them 1 study reported 27% drop-off rate. And all the missing data did not included in intention to treat analysis; Only 1 study had published the protocol previously; 4 studies declared no other bias.(3) The results of heterogeneity test showed Q=245.19,12=78.79%(P<0.0001),the studies were significantly heterogeneous. Random effects model were used, the result of network Meta analysis showed, systolic blood pressure:the SMD of electro-acupuncture versus manual acupuncture was 0.21, [95%CI:-0.59; 1.01]; diastolic blood pressure:the SMD of electro-acupuncture versus manual acupuncture is 0.22, [95%CI:-0.58; 1.02]; effective rate:the SMD of electro-acupuncture versus manual acupuncture is 1.02, [95%CI:0.82; 1.26], there was no significantly difference between electro-acupuncture and manual acupuncture.3. The the effectiveness of acupuncture for essential hypertension at acupoints on involved meridian based on syndrome differentiation:A multi-center randomized, controlled trial(1) 24h mean systolic blood pressure:The 24h mean systolic blood pressure was reduced after AIM acupuncture treatment(P<0.05). There was significant differences between AIM, NA and WL at week 6(P<0.05); at week 9, There was significant differences between AIM and WL (P<0.05).(2) 24h mean diastolic blood pressure:The 24h mean diastolic blood pressure was reduced after AIM acupuncture treatment(P<0.05). There was significant differences between AIM, NA and WL at week 6(P<0.05).(3) Daytime mean systolic blood pressure:The daytime mean systolic blood pressure was reduced after AIM acupuncture treatment(P<0.05). There was significant differences between AIM, NA and WL at week 6(P<0.05).(4) Daytime mean diastolic blood pressure:The daytime mean diastolic blood pressure was reduced after AIM acupuncture treatment(P<0.05). There was significant differences between AIM, NA and WL at week 6(P<0.05). at week 12, There was significant differences between AIM and WL (P<0.05).(5) Night mean systolic blood pressure:The night mean systolic blood pressure was reduced after AIM acupuncture treatment(P<0.05). There was significant differences between AIM and WL at week 12(P<0.05).(6) Night mean diastolic blood pressure:The daytime mean diastolic bloood pressure was reduced after AIM acupuncture treatment(P<0.05). There was no significant differences between AIM, NA and WL at week 6,9,12.(P>0.05)(7) Daytime systolic blood pressure load:The daytime systolic blood pressure load was reduced after AIM acupuncture treatment(P<0,05). There was significant differences between AIM and NA at week 6(P<0.05). There was significant differences between AIM and WL at week 12.(P<0.05).(8) Daytime diastolic blood pressure load:The daytime systolic bloood pressure load was reduced after AIM acupuncture treatment(P<0.05). There was no significant differences between AIM, NA and WL at week 6,9,12.(P>0.05).(9) Night systolic/diastolic blood pressure load:The night systolic/diastolic blood pressure load were reduced after AIM acupuncture treatment(P<0.05). There were no significant differences between AIM, NA and WL at week 6,9,12.(P>0.05).(10) Pulse pressure:The pulse pressure was reduced after AIM acupuncture treatment(P<0.05). There was no significant differences between AIM, NA and WL at week 6,9,12.(P>0.05).(11) Circadian rhythm:There was significant differences between AIM and WL at week 6(P<0.05). There was no significant differences between AIM, NA and WL at week 6,9,12.(P>0.05).Conclusions:1. Based on the available evidence, the results of network meta analysis showed that both manual acupuncture and electro-acupuncture were able to lower the blood pressure. And exerted similar efficacy in the treatment of essential hypertension.2. Based on the results of data mining, we found that there was a remarkable regularity in acupoints selection along meridians in the acupuncture treatment of essential hypertension Which was mainly utilizing specific points located on meridians of jueyin and yangming.3. Based on the results of randomized control trial, it was demonstrated that AIM was efficacious in improving 24h mean systolic/diastolic blood pressure, day time and night systolic/diastolic blood pressure, day time systolic/diastolic blood pressure load, night systolic/diastolic blood pressure load and pulse pressure.4. It was founded that AIM was more efficacious than WL in improving 24h mean systolic/diastolic blood pressure, day time and night systolic/diastolic blood pressure, day time systolic/diastolic blood pressure load and circadian rhythm.5. It was demonstrated that AIM was more efficacious than NA in improving 24h mean systolic/diastolic blood pressure, day time and night systolic/diastolic blood pressure, day time systolic/diastolic blood pressure load. |
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