Blood Pressure and Chiropractic This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to: Frankp@chiro.org
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Chiropractic Research Results for High Blood Pressure
Atlas Vertebra Realignment and Achievement of Arterial Pressure Goal
in Hypertensive Patients: A Pilot Study
Journal of Human Hypertension 2007 (May); 21 (5): 347352 ~ FULL TEXT
Anatomical abnormalities of the cervical spine at the level of the Atlas vertebra are associated with relative ischaemia of the brainstem circulation and increased blood pressure (BP). Manual correction of this mal-alignment has been associated with reduced arterial pressure. Using a double blind, placebo-controlled design at a single center, 50 drug naive (n=26) or washed out (n=24) patients with Stage 1 hypertension were randomized to receive a National Upper Cervical Chiropractic (NUCCA) procedure or a sham procedure. Patients received no antihypertensive meds during the 8-week study duration. The primary end point was changed in systolic and diastolic BP comparing baseline and week 8, with a 90% power to detect an 8/5 mm Hg difference at week 8 over the placebo group. The study cohort had a mean age 52.7+/-9.6 years, consisted of 70% males. At week 8, there were differences in systolic BP (-17+/-9 mm Hg, NUCCA versus -3+/-11 mm Hg, placebo; P<0.0001) and diastolic BP (-10+/-11 mm Hg, NUCCA versus -2+/-7 mm Hg; P=0.002). No adverse effects were recorded. We conclude that restoration of Atlas alignment is associated with marked and sustained reductions in BP similar to the use of two-drug combination therapy.
You may also enjoy this WebMD review titled Chiropractic Cuts Blood Pressure and another ABC News article, titled: Could a Neck Adjustment Lower Your Blood Pressure? Here's an additional commentary from: a video from ABC News.
Please NOTE that the announcer's statement that very few chiropractors are trained in this technique is NOT accurate. Dr. Dickholtz practices one of the many "upper cervical" (UC) techniques (called NUCCA), but in fact there is no proof that any one of the UC techniques is superior to any other. It is probable that more than 50% of the DCs in America are trained in at least one upper cervical specific technique, and could get similar results.
The Good News? The Research Department at Palmer College of Chiropractic is currently managing the first clinical trial that will compare 3 different upper cervical techniques. This is fortunate because Palmer is one of the few chiropractic colleges to teach a wide variety of UC techniques within it's curricula.
Sympathetic and Parasympathetic Responses to Specific Diversified Adjustments
to Chiropractic Vertebral Subluxations of the Cervical and Thoracic Spine
J Chiropr Med. 2008 (Sep); 7 (3): 8693
Diastolic pressure (indicating a sympathetic response) dropped significantly postadjustment among those receiving cervical adjustments, accompanied by a moderate clinical effect (0.50). Pulse pressure increased significantly among those receiving cervical adjustments, accompanied by a large effect size (0.82). It is preliminarily suggested that cervical adjustments may result in parasympathetic responses, whereas thoracic adjustments result in sympathetic responses. Furthermore, it appears that these responses may demonstrate the relationship of autonomic responses in association to the particular segment(s) adjusted.
Adjustments and Brief Massage Treatment at Sites of Subluxation in Subjects with
Essential Hypertension: Pilot Study
J Manipulative Physiol Ther 2002 (May); 25 (4): 221239
This pilot study elucidated several procedural issues that should be addressed before undertaking a full-scale clinical trial on the effects of chiropractic adjustments in patients with essential hypertension. A multidisciplinary approach to recruitment may need to be used in any future efforts because of the limited subject pool of patients who have hypertensive disease but are not taking medications for its control. Measures need to be used to assure comparable groups regarding prognostic variables such as weight. Studies such as these demonstrate the feasibility of conducting a full-scale 3-group randomized clinical trial in the private practice setting.
Adjustment vs Resting Control Groups: A Possible Effect of the Cervico-sympathetic
and/or Pressor Reflex
J Manipulative Physiol Ther 2001 (Feb); 24 (2): 101109
The results indicate that palpation and vectored atlas adjustment causes a significant decrease in systolic blood pressure in patients with putative upper cervical subluxation/joint dysfunction in comparison with resting controls. Similar results were also demonstrated when subjects acted as their own controls. The lack of randomization, blinding, and a manipulated control group are factors that weaken these findings. The sudden drop in systolic pressure is proposed to be due to stimulation of the cervicosympathetic reflex or moderation of muscle tone and elimination of the effects of the pressor reflex.
J Manipulative Physiol Ther 1993 (Oct); 16 (8): 544549
Specific contact short lever arm spinal adjustments may cause a hypotensive effect in a medicated hypertensive patient that may lead to complications (e.g., hypotension). Since a medicated hypertensive patient's blood pressure may fall below normal while he or she is undergoing chiropractic care, it is advised that the blood pressure be closely monitored and medications adjusted, if necessary, by the patient's medical physician.
Chiropractic: The J Chiro Res & Clin Invest 1992; 8 (2): 3032
This report represents observations on eight patients presenting with hypertension. A multiple baseline across subjects deisgn is used in this study. Changes or relief of symptoms is affected by adjusting the occipito-atlanto-axial subluxation complex. The author suggests a relationship between the displaced skull and the cervical spine with hypertension.
and on Blood Pressure, Heart Rate and Plasma Catecholamine Levels
J Manipulative Physiol Ther 1991 (Oct); 14 (8): 450456
Posttreatment goniometric measurements revealed that in sham-adjusted controls, mean lateral-flexion asymmetries had not changed significantly during the 4-hr time period examined. However, in subjects who received lower cervical adjustments, dramatic ameliorations of asymmetry magnitude were observed which persisted throughout the entire 4-hr posttreatment time period. On the other hand, in the face of this rather robust biomechanical effect, heart rate and blood pressure measurements obtained at -60 and -15 min prior to treatments, and at 5, 30, 60, 120 and 240 min following treatments, revealed no significant differences between adjusted and sham-adjusted subjects at any of the time periods examined.
J Manipulative Physiol Ther. 1990 (Jul); 13 (6): 297304
Additionally, based on simultaneous serial monitoring of heart rate, blood pressure, and plasma catecholamine concentrations, it does not appear that the therapeutic procedure used in these studies is particularily stressful or traumatic, at least in otherwise asymptomatic subjects.
Undergoing Chiropractic Care
J Manipulative Physiol Ther 1988 (Aug); 11 (4): 261266
The purpose of this study was to evaluate the reliability of clinical blood pressure readings and to begin a series of experiments to determine if chiropractic adjustments cause any significant changes in blood pressure. Seventy-five students undergoing routine chiropractic health care at Palmer College of Chiropractic Clinic volunteered to participate in the blood pressure measurement protocol in one 10-min visit. Blood pressure was recorded by right arm cuff sphygmomanometer by an experienced chiropractor immediately before and again immediately after either the specific cervical adjustment or the control procedure, which was simply motion palpation. The doctors measuring blood pressures did not know to which group the subject had been assigned. Both systolic and diastolic blood pressures were statistically significantly lowered in the Experimental but not the Control group (p less than 0.01). The difference in the mean blood pressures was small and was brought about by 14 of the Experimental subjects who experienced a clinically relevant 10-20 mm hg drop. Reliability of blood pressure measurements by two doctors was established under similar conditions in an additional 25 subjects.
A Randomized, Controlled Trial
J Manipulative Physiol Ther 1988 (Dec); 11 (6): 484488
Results indicated that systolic and diastolic blood pressure decreased significantly in the active treatment condition, whereas no significant changes occurred in the placebo and control conditions. State anxiety significantly decreased in the active and control conditions. Results provide support for the hypothesis that blood pressure is reduced following chiropractic treatment. Further study is needed to examine the long-term effects of chiropractic treatment on blood pressure.
State of the Art Lecture
Hypertension 1988 (Feb); 11 (2 Pt 2): 813
Recent studies have demonstrated that the neurons of the lower brainstem that are responsible for maintaining normal levels of arterial pressure reside in a specific area of the rostral ventrolateral medulla. In rat, the critical zone corresponds to a small region containing a subpopulation of the adrenergic C1 group, defined immunocytochemically by the presence of the epinephrine-synthesizing enzyme phenylethanolamine N-methyltransferase. Neurons of this region (the C1 area), possibly including the adrenergic neurons, directly innervate preganglionic neurons in the spinal cord, and are tonically active and sympathoexcitatory.
and the Efficacy of Conservative Therapeusis
J Manipulative Physiol Ther 1986 (Mar); 9 (1): 2732
When considering the ailments that plague mankind, certainly one of the enigmatic conditions is hypertensive disease. This perplexing disorder is recognized insidiously in the clinical setting. It is believed to occur because of the complex interactions of a variety of factors which act on the components of the blood vasculature. Although afflicted individuals may appear relatively asymptomatic, the additive influences of such factors eventually culminate in deleterious sequelae. Overall, hypertension appears to be related to stress, diet and lifestyle. The autonomic nervous system, particularly its sympathetic component, appears to mediate such accumulated factors, affecting the overall clinical scenario of hypertension. Although generally aligned with the aging process, this condition also may affect younger individuals. Hypertension, therefore, may be regarded as a prime condition warranting specialized care that includes proper education during the formative years, modification of dietary habits in conjunction with daily exercise regimens, and regular spinal maintenance, all of which are covered by modern chiropractic clinical practice.
Review abstracts about chiropractic and a variety of organic and visceral disorders at the wonderful International Chiropractic Pediatric Association (ICPA) website
Other Management Approaches for Hypertension
Alternative Medicine Review 2001 (Oct); 6 (6): 590600 ~ FULL TEXT
Hypertension is a common problem facing many Americans today, with two million new cases being diagnosed each year. Although billions of dollars are spent annually in the United States for the treatment and detection of cardiovascular disease, current conventional treatments have done little to reduce the number of patients with hypertension. Alternative medicine offers an effective way to decrease the rising number of people with high blood pressure. Research has found a variety of alternative therapies to be successful in reducing high blood pressure including diet, exercise, stress management, supplements, and herbs.
Annals of Internal Medicine 2002: 136 (7): 493503
Even a small decrease in average BP can dramatically lower your risk for cardiovascular disease and death. Whether or not you currently have high blood pressure, maintain a consistent regimen of aerobic exercise to ward off disease, premature death, and obesity.
A Pilot Study in Australian General Practice
Blood Press 2000; 9 (5): 267274
There were no changes attributable to the lifestyle intervention in the subjects continuing drug therapy in BP or lifestyle variables over the study period. However, the group stopping therapy had a 6% reduction in body mass index after 9 months. These data suggest that a proportion of motivated patients willing to trial a lifestyle approach can cease drug therapy and be adequately maintained by the prescription of lifestyle advice via their GP for at least a 9-month period. Cessation of drug therapy may be an important motivating factor to achieve weight loss in this group.
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