Acupuncture for primary hypertension: a systematic review and meta-analysis of randomised controlled trials

Background Primary hypertension is a significant global health burden. While acupuncture is traditionally employed for blood pressure management, robust evidence from high-quality trials is still needed.Objective This systematic review and meta-analysis evaluated the efficacy and safety of acupuncture for primary hypertension, based on randomized controlled trials (RCTs) published between 2015 and 2024.Methods We searched seven major databases for RCTs comparing acupuncture to control interventions. The primary outcomes were changes in systolic (SBP) and diastolic (DBP) blood pressure. Meta-analyses utilized random-effects models, and the Cochrane Risk of Bias tool assessed study quality.Results Seven RCTs (n = 812) were included. Acupuncture was associated with lower SBP (MD = −6.73 mmHg, 95% CI: −8.84 to −4.62) and DBP (MD = −6.59 mmHg, 95% CI: −9.42 to −3.76). Heterogeneity was substantial for SBP (I2 = 73.3%) and considerable for DBP (I2 = 90.9%). Notably, the SBP analysis included seven studies whereas the DBP analysis included six studies, and the similar absolute pooled reductions should be interpreted cautiously given the small and not fully overlapping study sets. Exploratory subgroup analyses suggested blood pressure reductions across several acupuncture modalities, though each subgroup contained very few studies. Adverse-event reporting was limited and inconsistent across studies. Formal tests for publication bias were underpowered given the small number of included studies.Conclusions Acupuncture may have blood pressure-lowering effects in patients with primary hypertension, but the evidence is limited by substantial heterogeneity, a small number of studies, and considerable variation in intervention type and exposure. Larger, well-designed, multi-center RCTs with standardized protocols and longer follow-up are needed to confirm these findings and establish optimal treatment parameters.