Efficacy of Acupuncture in the Treatment of Essential Hypertension: An Overview of Systematic Reviews and Meta-Analyses

Table 6

Results of evidence quality.

Author, year	Outcomes	Intervention vs. comparison	Studies (participants)	Limitations	Inconsistency	Indirectness	Imprecision	Publication bias	Relative effect (95% CI)	Heterogeneity	Quality
Liu et al., 2012 [26]	The effective rate of lowering blood pressure	Acupuncture vs. western medicine	7 (612)	-1①	0	0	-1③	0	(0.60, 1.45)	9%	L
		Acupuncture+western medicine vs. western medicine	3 (175)	-1①	0	0	-1③	-1⑤	(1.45, 6.01)		VL
	The effective rate of improving symptoms	Acupuncture vs. western medicine	3 (180)	-1①	0	0	-1③	-1⑤	(1.22, 5.39)		VL
		Acupuncture+ western medicine vs. western medicine	1 (60)	-1①	0	0	-2③	-1⑤	, (1.87, 46.68)		VL
Yu et al., 2013 [27]	The effective rate of lowering blood pressure	Acupuncture vs. western medicine	14 (1164)	-1①	-1②	0	0	0	, (0.946, 1.135)		L
	The efficacy of improving SBP		10 (768)	-1①	-1②	0	0	0	(-0.378, 0.129)		L
	The efficacy of improving DBP		10 (768)	-1①	0	0	0	0	(-0.195, 0.092)		M
Zhang et al., 2013 [28]	The effect of reducing the magnitude of SBP	Acupuncture vs. western medicine	8 (772)	-1①	-1②	0	-1③	0	(0.11, 2.59)		VL
		Acupuncture+western medicine vs. western medicine	2 (140)	-1①	0	0	-1③	-1⑤	(5.51, 11.09)		VL
		Acupuncture vs. sham acupuncture	1 (160)	-1①	-1②	0	-1③	-1⑤	(4.67, 9.33)	Not applicable	VL
	The effect of reducing the magnitude of DBP	Acupuncture vs. western medicine	8 (772)	-1①	-1②	0	-1③	0	(-1.43, 2.46)		VL
		Acupuncture+western medicine vs. western medicine	2 (140)	-1①	0	0	-1③	-1⑤	(2.88, 6.45)		VL
		Acupuncture vs. sham acupuncture	1 (160)	-1①	-1②	0	-1③	-1⑤	(1.29, 4.71)	Not applicable	VL
Qian, 2013 [29]	The efficacy of improving 24 h SBP	Acupuncture vs. sham acupuncture	1	-1①	-1②	0	-1③	-1⑤	(-8.72, -1.28)	No information	VL
		Acupuncture+traditional therapy(western medicine/lifestyle modification) vs. traditional therapy	2	-1①	-1②	0	-1③	-1⑤	(-10.37, -4.65)	No information	VL
	The efficacy of improving 24 h DBP	Acupuncture vs. sham acupuncture	1	-1①	-1②	0	-1③	-1⑤	No statistical significance	No information	VL
		Acupuncture+traditional therapy(western medicine/lifestyle modification) vs. traditional therapy	2	-1①	-1②	0	-1③	-1⑤	(-4.32, -0.22)	No information	VL
	The efficacy of improving 12 h SBP	Acupuncture vs. sham acupuncture	1	-1①	-1②	0	-1③	-1⑤	(-8.56, -1.44)	No information	VL
		Acupuncture+traditional therapy(western medicine/lifestyle modification) vs. traditional therapy	6	-1①	-1②	0	-1③	0	(-9.45, -5.86)	No information	VL
	The efficacy of improving 12 h DBP	Acupuncture vs. sham acupuncture	1	-1①	-1②	0	-1③	-1⑤	No statistical significance	No information	VL
		Acupuncture+traditional therapy(western medicine/lifestyle modification) vs. traditional therapy	6	-1①	-1②	0	-1③	0	(-4.16, -1.57)	No information	VL
Guo et al., 2013 [30]	The effective rate of lowering blood pressure	Acupuncture+western medicine vs. western medicine	10 (679)	-1①	0	0	-1③	0	(3.24, 8.44)		L
	The efficacy of improving SBP		4 (275)	-1①	0	0	-1③	0	(-10.89, -5.81)		L
	The efficacy of improving DBP		4 (275)	-1①	-1②	0	-1③	0	(-7.97, -4.69)		VL
Zhang et al., 2014 [31]	The effective rate of lowering blood pressure	Acupuncture vs. western medicine	7 (612)	-1①	-1②	0	-1③	0	(0.45, 2.00)	%	VL
		Acupuncture+western medicine vs. western medicine	4 (262)	-1①	0	0	-1③	0	(2.60, 10.11)		L
	The efficacy of improving SBP	Acupuncture vs. western medicine	3 (180)	-1①	0	0	-1③	-1⑤	6 (-7.98, 1.46)	%	VL
		Acupuncture+western medicine vs. western medicine	2 (152)	-1①	0	0	-1③	-1⑤	(-13.66, -5.34)		VL
	The efficacy of improving DBP	Acupuncture vs. western medicine	3 (180)	-1①	0	0	-1③	-1⑤	(-5.02, 0.68)		VL
		Acupuncture+western medicine vs. western medicine	2 (152)	-1①	0	0	-1③	-1⑤	(-2.52, 2.19)		VL
Zhang L, 2017 [32]	The efficacy of improving SBP	Acupuncture vs. western medicine	23 (1705)	-1①	-1②	0	0	-1④	(-1.03, -0.29)		VL
		Acupuncture+western medicine vs. western medicine	11 (1029)	-1①	0	0	0	-1④	(-1.31, -0.96)		L
	The efficacy of improving DBP	Acupuncture vs. western medicine	23 (1705)	-1①	-1②	0	0	-1④	(-1.02, -0.21)		VL
		Acupuncture+western medicine vs. western medicine	11 (1029)	-1①	-1②	0	0	-1④	(-1.63, -0.58)		VL
	The effective rate of lowering blood pressure	Acupuncture vs. western medicine	28 (2271)	-1①	-1②	0	0	-1④	(1.03, 1.17)		VL
		Acupuncture+western medicine vs. western medicine	14 (1125)	-1①	0	0	0	-1④	(1.13, 1.25)		L
	The effective rate of improving symptoms	Acupuncture vs. western medicine	7 (465)	-1①	0	0	0	-1④	(1.11,1.31)		L
		Acupuncture+western medicine vs. western medicine	3 (276)	-1①	0	0	0	-1④	(1.09,1.31)		L
	The effective rate of comprehensive treatment	Acupuncture vs. western medicine	5 (394)	-1①	-1②	0	0	-1④	(1.14, 1.66)		VL
		Acupuncture+western medicine vs. western medicine	2 (184)	-1①	0	0	0	-1④⑤	(1.07, 1.33)		L
Zhu and Ding, 2018 [33]	The effective rate of comprehensive treatment	Acupuncture vs. western medicine/acupuncture+western medicine vs. western medicine/acupuncture+behavior therapy vs. western medicine	22 (1758)	-1①	0	0	-1③	0	(1.92, 4.24)		L
	The efficacy of improving SBP		13 (908)	-1①	-1②	0	0	0	(-6.45,-2.55)		L
	The efficacy of improving DBP		13 (908)	-1①	-1②	0	0	0	(-4.61, -1.66)		L
Han et al., 2019 [34]	The effective rate of comprehensive treatment	Acupuncture+Tianma Gouteng decoction vs. western medicine/Tianma Gouteng decoction	6 (694)	-1①	0	0	-1③	-1④	(2.97, 9.80)		VL
	The efficacy of improving SBP		3 (358)	-1①	-1②	0	-1③	-1④	(-18.48, -12.50)		VL
	The efficacy of improving DBP		3 (358)	-1①	0	0	-1③	-1④	(-11.84, -7.57)		VL
Lee et al., 2009 [35]	The effect of reducing the magnitude of SBP	Acupuncture vs. sham acupuncture	3 (358)	-1①	-1②	0	-1③	0	(-12, 1)		VL
		Acupuncture+medication vs. sham acupuncture+western medicine	2 (170)	-1①	0	0	-1③	-1⑤	(-10, -5)		VL
	The effect of reducing the magnitude of DBP	Acupuncture vs. sham acupuncture	3 (358)	-1①	-1②	0	-1③	0	(-6, 0)		VL
		Acupuncture+medication vs. sham acupuncture+western medicine	2 (170)	-1①	0	0	-1③	-1⑤	(-6, -2)		VL
Li DZ, 2014 [36]	The efficacy of improving SBP	Electroacupuncture/auricular acupuncture vs. sham acupuncture	2 (216)	-1①	0	0	-1③	0	(-2.50,5.16)		L
		Electroacupuncture/auricular acupuncture or + antihypertensive drugs vs. sham acupuncture	2 (170)	-1①	0	0	-1③	-1⑤	(-10.13, -7.03)		VL
	The efficacy of improving DBP	Electroacupuncture/auricular acupuncture vs. sham acupuncture	2 (216)	-1①	-1②	0	-1③	0	(-3.98, 3.62)		VL
		Electroacupuncture/auricular acupuncture or + antihypertensive drugs vs. sham acupuncture	2 (170)	-1①	0	0	0	-1⑤	(-5.08, -4.00)		L
Zhao et al., 2015 [37]	The efficacy of improving SBP	Acupuncture vs. western medicine	7 (510)	-1①	-1②	0	-1③	0	(-3.02, 1.89)		VL
		Acupuncture+western medicine vs. western medicine	3 (170)	-1①	-1②	0	-1③	-1⑤	(-20.11, 2.02)		VL
		Acupuncture+lifestyle modification vs. lifestyle modification	1 (60)	-1①	-1②	0	-1③	-1⑤	(-27.52, 6.46)	Not applicable	VL
	The efficacy of improving DBP	Acupuncture vs. western medicine	7 (510)	-1①	0	0	-1③	0	(-2.26, 0.24)		L
		Acupuncture+western medicine vs. western medicine	3 (170)	-1①	-1②	0	-1③	-1⑤	(-8.45, 2.72)		VL
		Acupuncture+lifestyle modification vs. lifestyle modification	1 (60)	-1①	-1②	0	-1③	-1⑤	(-15.06, 0.02)	Not applicable	VL
	The effect of reducing the magnitude of SBP	Acupuncture vs. sham acupuncture	2 (216)	-1①	0	0	0	0	(-0.27, 0.88)		M
		Acupuncture+western medicine vs. sham acupuncture+western medicine	2 (170)	-1①	0	0	-1③	-1⑤	(-10.43, -4.51)		VL
	The effect of reducing the magnitude of DBP	Acupuncture vs. sham acupuncture	2 (216)	-1①	0	0	-1③	0	(-2.37, -0.44)		L
		Acupuncture+western medicine vs. sham acupuncture+western medicine	2 (170)	-1①	0	0	-1③	-1⑤	(-6.26, -2.18)		VL
Chen et al., 2018 [38]	The effective rate of lowering blood pressure	Acupuncture vs. antihypertensive drugs	9 (517)	-1①	-1②	0	0	-1④	(0.98, 1.28)		VL
		Acupuncture+lifestyle modifications vs. lifestyle modifications	2 (187)	-1①	0	0	0	-1④⑤	(1.05, 1.36)		L
		Acupuncture+antihypertensive drugs vs. antihypertensive drugs	7 (517)	-1①	0	0	0	-1④	(1.08, 1.27)		L
		Electro-acupuncture vs. antihypertensive drugs	2 (99)	-1①	0	0	0	-1④⑤	(0.76, 1.16)		L
	The efficacy of improving SBP	Acupuncture vs. antihypertensive drugs	8 (541)	-1①	0	0	-1③	-1④	MD =1.4 (-1.32,4.12)		VL
		Acupuncture vs. no treatment	1 (30)	-1①	-1②	0	-1③	-1④⑤	(-2.99, 13.39)	Not applicable	VL
		Acupuncture vs. sham acupuncture	3 (106)	-1①	0	0	-1③	-1④⑤	(-4.63, 7.8)		VL
		Acupuncture+lifestyle modifications vs. lifestyle modifications	3 (246)	-1①	-1②	0	-1③	-1④	(6.72, 14.04)		VL
		Acupuncture+antihypertensive drugs vs. antihypertensive drugs	5 (365)	-1①	-1②	0	-1③	-1④	(2.95, 16.65)		VL
		Acupuncture+antihypertesive drugs vs. sham acupuncture+antihypertensive drugs	2 (170)	-1①	0	0	-1③	-1④⑤	(5.1, 12.54)		VL
		Electroacupuncture vs. antihypertensive drug	3 (200)	-1①	-1②	0	-1③	-1④	(-3.25, 6.52)		VL
		Electroacupuncture+antihypertensive drugs vs. antihypertensive drugs	1 (59)	-1①	-1②	0	-1③	-1④⑤	(3.96, 14.28)	Not applicable	VL
	The efficacy of improving DBP	Acupuncture vs. antihypertensive drugs	8 (541)	-1①	-1②	0	-1③	-1④	(-0.59, 4.67)		VL
		Acupuncture vs. no treatment	1 (30)	-1①	-1②	0	-1③	-1④⑤	(1.27,10.93)	Not applicable	VL
		Acupuncture vs. sham acupuncture	3 (106)	-1①	0	0	-1③	-1④⑤	(-2.59, 2.57)		VL
		Acupuncture+lifestyle modifications vs. lifestyle modifications	3 (246)	-1①	-1②	0	-1③	-1④	(1.94, 9.54)		VL
		Acupuncture+antihypertensive drugs vs. antihypertensive drugs	5 (365)	-1①	-1②	0	-1③	-1④	(4.67, 10.96)		VL
		Acupuncture+antihypertensive drugs vs. sham acupuncture+antihypertensive drugs	2 (170)	-1①	0	0	-1③	-1④⑤	(1.7, 7.19)		VL
		Electroacupuncture vs. antihypertensive drug	3 (200)	-1①	0	0	-1③	-1④	(-4.85, 0.62)		VL
		Electroacupuncture+antihypertensive drugs vs. antihypertensive drugs	1 (59)	-1①	-1②	0	-1③	-1④⑤	(-0.25, 9.17)	Not applicable	VL
Zhang et al., 2022 [39]	The efficacy of improving SBP	Acupuncture/electroacupuncture/needle warming therapy vs. antihypertensive drugs	4 (1176)	-1①	0	0	0	-1④	(1.34, 5.90)		L
	The efficacy of improving DBP		4 (1176)	1①	0	0	0	-1④	(1.03, 5.20)		L

Note: VL: very low; L: low; M: moderate; H: high. ① The included studies have a large bias in methodology such as randomization, allocation concealment, and blinding. ② The confidence interval overlaps less or the value of the combined results was larger. ③ The sample size from the included studies does not meet the optimal sample size or the confidence interval was not narrow enough. ④ The funnel chart is asymmetry. ⑤ Fewer studies were included, and their results were all positive, which may result in a large publication bias. The 95% confidence interval does not cross the invalid line.