Blood Pressure and Chiropractic

This section was compiled by Frank M. Painter, D.C.
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Chiropractic Research Results for High Blood Pressure

Chiropractic Care for Hypertension: Review of the Literature
and Study of Biological and Genetic Bases

Acta Bomedica 2020 (Nov 9); 91 (13-S): e2020017 ~ FULL TEXT

While the aim of the present article was to provide a multi-perspective overview of hypertension and blood pressure regulation, the review was limited by the lack of a formal grading system for the blood pressure and autonomic literature. However, the less rigorous nature does provide an expanded perspective that raises more questions about the need for additional research. Some studies used normotensive patients, others used hypertensive patients at varying levels of hypertension, and others had a too small sample size to draw definite conclusions. Further, many studies utilized students as a convenience sample, which may be a challenge due to the stress induced by academics. Previous research also did not take into account genetic predisposition. Individual genetic background can have effects on regulation of the sympathetic and parasympathetic tone, which could impact the responses to chiropractic therapy. [63] One example is the GNAS gene, encoding the Gs-protein α-subunit, associated with the activity of ANS and its polymorphism T393C, associated with hypertension. [74] Additionally, studies examining the effects of chiropractic care on ANS activity demonstrated inconsistencies related to HRV, electrodermal responses, and predicted blood pressure responses. [42, 43, 50] This illustrates the complexity of therapeutic intervention development and study of hypertension.

Pulse Pressure Findings Following Upper Cervical Care:
A Practice-based Observational Study

J Can Chiropr Assoc. 2019 (Apr); 63 (1): 51-58 ~ FULL TEXT

In this study we observed, through the application of an upper cervical chiropractic technique, lowered pulse pressure in patients determined to previously have had elevated pulse pressure. It is plausible that these observations are related to improved autonomic function. Further research with improved designs is a reasonable next step in this line of investigation.

Effects of Cervical High-Velocity Low-Amplitude Techniques
on Range of Motion, Strength Performance, and
Cardiovascular Outcomes: A Review

J Altern Complement Med 2017 (Sep); 23 (9): 667–675 ~ FULL TEXT

This review shows that cervical HVLA manipulation results in improvements of mobility, as well as in the cardiovascular system. A large effect size was found in CROM improvement, especially for patients with neck pain. Rotation was the most clearly improved movement. In addition, mouth opening without pain was improved after upper cervical HVLA manipulation, mainly in patients with neck pain.

Effect of Spinal Manipulation of Upper Cervical Vertebrae
on Blood Pressure: Results of a Pilot Sham-Controlled Trial

J Manipulative Physiol Ther. 2016 (Jun); 39 (5): 369–380 ~ FULL TEXT

Six weeks of toggle recoil spinal manipulation did not lower systolic or diastolic blood pressure when compared with a sham procedure. No serious adverse events from either treatment were reported. Our results do not support a larger clinical trial. Further research to understand the potential mechanisms of action involving upper cervical manipulation on blood pressure is warranted before additional clinical investigations are conducted.

Effects of Upper and Lower Cervical Spinal Manipulative Therapy
on Blood Pressure and Heart Rate Variability in Volunteers
and Patients With Neck Pain: A Randomized Controlled,
Cross-Over, Preliminary Study

J Chiropractic Medicine 2015 (Mar); 14 (1): 1–9 ~ FULL TEXT

A randomized controlled, cross-over, preliminary study was conducted on 10 asymptomatic normotensive volunteers and 10 normotensive patients complaining of acute neck pain. HRV, blood pressure (BP) and heart rate (HR), and NPS were recorded after upper cervical and lower cervical segments SMT in volunteer and patient groups.

Blood Pressure Changes in African American Patients Receiving
Chiropractic Care in a Teaching Clinic: A Preliminary Study

J Chiropractic Medicine 2013 (Jun); 12 (2): 55–59 ~ FULL TEXT

This study showed that research of this nature may be feasible in chiropractic teaching clinics. The preliminary findings of this study showed that, for a subgroup of African American patients receiving chiropractic care, blood pressure decreased for (a) hypertension stage 1 patients and (b) the sample when those with excessive body mass index were excluded.

Immediate Effects of Atlas Manipulation on Cardiovascular Physiology
Clinical Chiropractic 2012 (Dec); 15 (3-4): 147–157

The results of this research suggest cardiovascular physiology is not affected by CMT of the atlas in normotensive individuals. These findings in relation to existing research suggest future cervical spine CMT studies should be performed focusing on hypertensive patients.

Atlas Vertebra Realignment and Arterial Blood Pressure
Regulation in 42 Subjects

J Upper Cervical Chiropractic Research 2012 (Apr 24): 40–45

These findings suggest realignment of the atlas does not simply lower ABP but may also be part of a systemic homeostatic mechanism not yet completely understood. The same adjustment that decreased hypertensive ABP measurements also increased hypotensive ABP measurements to more normal levels. Exploration into the potential cause of these observed effects is also discussed.

Sympathetic and Parasympathetic Responses to Specific Diversified
Adjustments to Chiropractic Vertebral Subluxations of
the Cervical and Thoracic Spine

J Chiropractic Medicine 2008 (Sep); 7 (3): 86–93 ~ FULL TEXT

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.

Atlas Vertebra Realignment and Achievement of Arterial Pressure
Goal in Hypertensive Patients: A Pilot Study

J Human Hypertension 2007 (May); 21 (5): 347–352 ~ 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 very accurate. Dr. Dickholtz practices one of the many “upper cervical” (UC) techniques (called NUCCA), but in fact there is no evidence that any one of the UC techniques is measurably superior to any other. More than 50% of all the DCs in America were trained in at least one upper cervical “specific” technique, and would likely achieve similar results.

Practice-based Randomized Controlled-comparison Clinical Trial
of Chiropractic Adjustments and Brief Massage Treatment at
Sites of Subluxation in Subjects with Essential Hypertension:
Pilot Study

J Manipulative Physiol Ther 2002 (May); 25 (4): 221–239 ~ FULL TEXT

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.

Significant Changes in Systolic Blood Pressure Post Vectored
Upper Cervical Adjustment vs Resting Control Groups:
A Possible Effect of the Cervico-sympathetic
and/or Pressor Reflex

J Manipulative Physiol Ther 2001 (Feb); 24 (2): 101–109 ~ FULL TEXT

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.

Chiropractic Management of a Hypertensive Patient
J Manipulative Physiol Ther 1993 (Oct); 16 (8): 544–549

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.

Hypertension and the Atlas Subluxation Complex
Chiropractic: The J Chiro Res & Clin Invest 1992; 8 (2): 30–32

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.

Effects of Cervical Adjustments on Lateral Flexion Passive
End–range Asymmetry and on Blood Pressure, Heart Rate
and Plasma Catecholamine Levels

J Manipulative Physiol Ther 1991 (Oct); 14 (8): 450–456

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.

Time Course Considerations for the Effect of Lower Cervical
Adjustments with Respect to the Amelioration of Cervical
Lateral Flexion Passive End–range Asymmetries, and on
Blood Pressure, Heart Rate, and
Plasma Catecholamine Levels

J Manipulative Physiol Ther. 1990 (Jul); 13 (6): 297–304

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.

Preliminary Study of Blood Pressure Changes in
Normotensive Subjects Undergoing Chiropractic Care

J Manipulative Physiol Ther 1988 (Aug); 11 (4): 261–266

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.

Effects of Chiropractic Treatment on Blood Pressure
and Anxiety: A Randomized, Controlled Trial

J Manipulative Physiol Ther 1988 (Dec); 11 (6): 484–488

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.

The C1 Area of the Brainstem in Tonic and Reflex Control
of Blood Pressure: State of the Art Lecture

Hypertension 1988 (Feb); 11 (2 Pt 2): 8–13

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.

The Management of Hypertensive Disease: A Review of Spinal
Manipulation and the Efficacy of Conservative Therapeusis

J Manipulative Physiol Ther 1986 (Mar); 9 (1): 27–32

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.


Other Management Approaches for Hypertension

Natural Approach to Hypertension
Alternative Medicine Review 2001 (Oct); 6 (6): 590–600 ~ 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.

Effect of Aerobic Exercise on Blood Pressure
Annals of Internal Medicine 2002: 136 (7): 493–503

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.

Substituting Lifestyle Management for Pharmacological Control
of Blood Pressure: A Pilot Study in Australian General Practice

Blood Press 2000; 9 (5): 267–274

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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