ChiropracticRelated Articles and Hypertension
Goertz CH, Grimm RH, Svendsen K, Grandits G Treatment of Hypertensionwith Alternative Therapies (THAT) Study: a randomized clinical trial.J Hypertens. 2002 Oct;20(10):2063-8.
Berman Center for Clinical and Outcomes Research, Hennepin County MedicalCenter, Minneapolis, Minnesota, USA. goertz@mail.nih.gov
OBJECTIVES: To examine the effect of spinal manipulation on blood pressure.DESIGN: This randomized clinical trial compared the effects of chiropracticspinal manipulation and diet with diet alone for lowering blood pressurein participants with high-normal blood pressure or stage I hypertension.Blood pressure observers were blinded to treatment group. SETTING: The studywas conducted at the Berman Center for Clinical and Outcomes Research inMinnesota. Chiropractic treatments were administered by chiropractic physicianswithin private practice settings.PARTICIPANTS One hundred and forty men andwomen, aged 25-60 years, with high-normal blood pressure or stage I hypertension,were enrolled. One hundred and twenty-eight participants completed the study.INTERVENTIONS: (i) A dietary intervention program administered by a dietitianor (ii) a dietary intervention program administered by a doctor of chiropracticin conjunction with chiropractic spinal manipulation. The frequency of treatmentfor both groups was three times per week for 4 weeks, for a total of 12 visits.MAIN OUTCOME MEASURES: The primary outcomes for this study were change frombaseline in diastolic and systolic blood pressure. RESULTS: Study groupswere comparable at baseline. Changes in potentially confounding covariatesdid not differ between groups. Average decreases in systolic/diastolic bloodpressure were -4.9/5.6 mmHg for diet group and -3.5/4.0 mmHg for the chiropracticgroup. Between group changes were not statistically significant. CONCLUSIONS:For patients with high normal blood pressure or stage I hypertension, chiropracticspinal manipulation in conjunction with a dietary modification program offeredno advantage in lowering either diastolic or systolic blood pressure comparedto diet alone.
Plaugher G, Long CR, Alcantara J, Silveus AD, Wood H, Lotun K, Menke JM,Meeker WC, Rowe SH. Practice-based randomized controlled-comparison clinicaltrial of chiropractic adjustments and brief massage treatment at sites ofsubluxation in subjects with essential hypertension: pilot study. JManipulative Physiol Ther. 2002 May;25(4):221-39.
Director of Research, Life Chiropractic College West, 25001 Industrial Boulevard,Hayward, CA 94545, USA.
OBJECTIVE: To determine the feasibility of conducting a randomized clinicaltrial in the private practice setting examining short- and long-term effectsof chiropractic adjustments for subjects with essential hypertension comparedwith a brief soft tissue massage, as well as a nontreatment control group.DESIGN: Randomized controlled-comparison trial with 3 parallel groups. SETTING:Private practice outpatient chiropractic clinic. PATIENTS: Twenty-three subjects,aged 24 to 50 years with systolic or diastolic essential hypertension. INTERVENTIONS:Two months of full-spine chiropractic care (ie, Gonstead) consisting primarilyof specific-contact, short-lever-arm adjustments delivered at motion segmentsexhibiting signs of subluxation. The massage group had a brief effleurageprocedure delivered at localized regions of the spine believed to be exhibitingsigns of subluxation. The nontreatment control group rested alone for a periodof approximately 5 minutes in an adjustment room. MAIN OUTCOME MEASURES:Cost per enrolled subject, as well as systolic and diastolic blood pressure(BP) measured with a random-0 sphygmomanometer and patient reported healthstatus (SF-36). Pilot study outcome measures also included an assessmentof cooperation of subjects to randomization procedures and drop-out rates,recruitment effectiveness, analysis of temporal stability of BPs at the beginningof care, and the effects of inclusion/exclusion criteria on the subject pool.RESULTS: Thirty subjects enrolled, yielding a cost of $161 per enrolled subject.One subject was later determined to be ineligible, and 6 others dropped out.In both the chiropractic and massage therapy groups, all subjects were classifiedas either overweight or obese; in the control group there were only 2 classifiedas such. SF-36 profiles for the groups were similar to that of a normal population.The mean change in diastolic BP was -4 (95% confidence interval [CI]: -8.6,0.5) in the chiropractic care group, 0.5 (95% CI: -3.5, 4.5) in the briefmassage treatment group, and -4.9 (95% CI: -9.7, -0.1) in the no treatmentcontrol group. At the end of the study period, this change was -6.3 (95%CI: 13.1, 0.4), -1.0 (95% CI: -7.5, 15.6), -7.2 (95% CI: -13.3, -1.1) inthe 3 study groups. The mean improvements in the chiropractic care and notreatment control groups remained consistent over the follow-up period. CONCLUSIONS:This pilot study elucidated several procedural issues that should be addressedbefore undertaking a full-scale clinical trial on the effects of chiropracticadjustments in patients with essential hypertension. A multidisciplinaryapproach to recruitment may need to be used in any future efforts becauseof the limited subject pool of patients who have hypertensive disease butare not taking medications for its control. Measures need to be used to assurecomparable groups regarding prognostic variables such as weight. Studiessuch as these demonstrate the feasibility of conducting a full-scale 3-grouprandomized clinical trial in the private practice setting.
Webster, Sk ;Dickholtz, M ;Woodfield, C ;Bakris, Gl ;Acute Effect of NuccaUpper Cervical Adjustment on Patients with Diabetes Type II ChiropracticResearch Journal. 2000 Fal; VII(2): 81
ABSTRACT: Background: Type II diabetes is characterized by elevatedpost-prandial plasma glucose levels and recurrent fasting hypoglycemia. Progression of cardiovascular and renal disease has been demonstrated tocorrelate with hypertension and hyperglycemia in patients with type II diabetes. Objectives: The purpose of this project is to evaluate the acute effectsof chiropractic reduction of upper cervical subluxation using the techniqueestablished by the National Upper Cervical Chiropractic Association (NUCCA)on blood pressure, plasma glucose, and the activity of the autonomic nervoussystem in patients with type II diabetes. Conclusions: These results demonstrate that reduction of upper-cervical subluxations byNUCCA adjustment resulted in a stabilization of plasma glucose levels duringthe three-hour fasting period. Further characterization of these patients,as well as additional patients, will be necessary to assess the mechanismsthrough which this stabilization occurs. Long-term monitoring of thesevariables in these patients will determine if the beneficial effects of thistype of chiropractic care on plasma glucose level are maintained for extendedperiods of time.
Plaugher, G ;Long, CR ;Shelsy, A ;Menke, JM ;Lotun, K ;Meeker, WC ;RandomizedControlled-Comparison Clinical Trial of Chiropractic Adjustments and BriefMassage Treatment In Patients With Essential Hypertension: A Pilot StudyProceedings of the Int'l Conference on Spinal Mani. 1996 Oct: 71-2
ABSTRACT: Background and Objective: Approximately 30-50 million adultsin the United States have high blood pressure. High blood pressureis an extremely common risk factor for cardiovascular-renal disease. It is associated with an increased risk for coronary artery disease, stroke,congestive heart failure, renal insufficiency and peripheral vascular disease. The primary purpose of this pilot study is to determine the feasibility ofconducting a randomized clinical trial that will examine short and long-termeffects of chiropractic adjustments in the treatment of subjects with essentialhypertension compared to soft tissue massage and non- treatment control group. Conclusion: The RCT design of this study was successfully integratedand conducted in a private practitioner's office. This approach hasimplications for the implementation of practice-based research with a RCTstudy design. This pilot study elucidated several procedural issuesbefore undertaking a full scale clinical trial on the effects of chiropracticadjustments in patients with essential hypertension. Among the mostimportant of these are the use of a one week run-in period prior to subjectrandomization and block randomization of subjects based on weight. A multidisciplinary approach may need to be used in any future efforts becauseof the limited subject pool of patients who have hypertensive disease butare not taking medications for its control.
Plaugher, G. ;Meeker, W. ;Shelsy, A. ;Lotun, K. ;Jansen, R. ;RandomizedClinical Trial of Chiropractic Adjustments and Brief Massage Treatment forEssential Hypertension: A Pilot Study Conference ProceedingsOf The Chiropractic Centenn. 1995 Jul: 366-7
ABSTRACT: Introduction: Approximately 30-50 million adults in the U.S. havehigh blood pressure. Hypertension is associated with an increased risk forcoronary artery disease, stroke, congestive heart failure, renal insufficiencyand peripheral vascular disease. There has been some study of the effectivenessof spinal adjustments in the treatment of patients with essential hypertension.However, these studies have either been uncontrolled case studies, singletrial experiments or retrospective cohort studies. A pilot study was initiatedto determine the feasibility of conducting a randomized clinical trial thatwill examine both short and long-term effects of chiropractic adjustmentsin the treatment of patients with hypertension.
Rupert, R. ;Case Reports: A Review of all Chiropractic Peer-Reviewed ResearchJournals Journal Of Chiropractic Case Reports.
ABSTRACT: Objective: To provide a global review of all case reports publishedchiropractic peer-reviewed journals. To establish a profile of chiropracticresearch as reflected by single subject studies, identify trends, strengths,weaknesses and future research needs. Data Sources: A search of the CHIROLARSonline chiropractic database was performed. In view of the fact that thisdatabase contains all issues from all peer-reviewed chiropractic journals,no other index source was necessary. All case reports are identified in CHIROLARSby the check tag "case report" making it necessary only to combine this termwith a specific journal title to retrieve all case reports for that chiropracticpeer-reviewed journal. All 14 peer-reviewed chiropractic research journalswere included in this review. Study Selection: All studies that were identifiedas case reports per the definition established by the National Library ofMedicine were included in this study. Data Synthesis: A total of 318 casereports have been published in chiropractic peer-reviewed journals. Eachof these reports were critically reviewed, classified and categorized alongseveral dimensions, e.g. age of patient, type of conditions treated, typesof therapeutic intervention employed. The journals themselves were assessedrelative to multiple parameters, e.g. number of case reports by journal,number of case reports by year. Conclusions: This study demonstrates a trendtoward an increase in the number of published case reports. However it isclear that, for the second largest health physician group, the total numberof case reports is small. Many conditions that have been purported to respondto chiropractic care (e.g. migraine, hypertension, colic, vertigo) are poorlyrepresented or documented in case reports. Finally, many therapeutic interventionsused by chiropractors are also not well represented in the published casereports to date. This review identified areas that need to be addressed byfuture single subject and other forms of chiropractic research.
Unger, J. ;Sweat, S. ;Flanagan, S. ;Chudkowski, S. ;An Effect of SacroOccipital Technique on Blood Pressure Proceedings Of TheInt'l Conference On Spinal Mani. 1993 Apr-May: 87
ABSTRACT: Conclusions: These data demonstrate that a single chiropracticintervention can bring about a significant reduction in blood pressure ina hypertensive group of subjects. Not only was the reduction in systolicblood pressure statistically significant, more important was the clinicalsignificance of this effect. Additional studies are in progress to determinethe long term effects of this type of chiropractic intervention on the bloodpressues of hypertensive subjects.
Plaugher G, Bachman TR. Chiropractic management of a hypertensive patient.J Manipulative Physiol Ther. 1993 Oct;16(8):544-9.
Palmer College of Chiropractic/West, San Jose, CA 95134-1617.
OBJECTIVE: Although many chiropractors may treat patients who have concomitanthypertensive disease, there is a paucity of literature on the nuances ofcase management for these patients. We report a patient who underwent a courseof chiropractic care with a previous diagnosis of chronic essential hypertension.CLINICAL FEATURES: A 38-yr-old male presented for chiropractic care with
complaints of hypertension, drug-related side effects and lower back pain.He was also receiving concurrent medical care for his hypertension. INTERVENTIONAND OUTCOME: The patient received specific contact, short lever arm spinaladjustments as the primary mode of chiropractic care. During the course ofchiropractic treatment, the patient's need for hypertensive medication wasreduced. The patient's medical physician gradually withdrew the medicationover 2 months. CONCLUSION: Specific contact short lever arm spinal adjustmentsmay cause a hypotensive effect in a medicated hypertensive patient that maylead to complications (e.g., hypotension). Since a medicated hypertensivepatient's blood pressure may fall below normal while he or she is undergoingchiropractic care, it is advised that the blood pressure be closely monitoredand medications adjusted, if necessary, by the patient's medical physician.
Jamison JR, McEwen AP, Thomas SJ. Chiropractic adjustment in the managementof visceral conditions: a critical appraisal. J Manipulative PhysiolTher. 1992 Mar-Apr;15(3):171-80.
Department of Diagnostic Sciences, Phillip Institute of Technology, Bundoora,Victoria, Australia.
OBJECTIVE: To establish whether Australian chiropractors regard spinal adjustmentas an intervention option for patients presenting with visceral conditionsand to ascertain the preferred level of adjustment for patients presentingwith migraine, asthma, hypertension or dysmenorrhea. DESIGN AND SETTING:A survey of all chiropractors registered in Australia. OUTCOME MEASURE: Practitioners'opinions regarding the usefulness of spinal adjustment in the managementof patients with visceral conditions were canvassed. Based upon their personalclinical experience, practitioners were requested to comment on the appropriatelevel of adjustment in the management of various visceral conditions. MAINRESULTS: Twenty-two percent of the 1311 chiropractors registered in Australiaresponded to the survey. More than half of the respondents favored a rolefor spinal adjustment in the management of patients with visceral conditions.The perceived usefulness of spinal adjustment varied according to the conditionbeing managed, as did the preferred level of adjustment. CONCLUSIONS: Chiropractorscontinue to use spinal adjustment in the management of visceral conditionsdespite this intervention being regarded as an obstacle to the recommendationof public finding for chiropractic services in Australia. Further investigationinto the validity of the chiropractic management of visceral conditions isrecommended.
McGee, D. Hypertension: A Case Study Chiropractic:The Journal Of Chiropractic Research. 1992 Jan; 7(4): 98-9
ABSTRACT: Hypertension is one of the major risk factors for coronary arteryand cerebrovascular accidents. The early detection of hypertension is importantbecause it may be asymptomatic until target organ damage occurs. Early interventionmay reduce the morbidity and mortality of hypetension before complicationsarise. A case of hypertension is presented using the Pierce-Stillwagon adjustingtechnique.
Goodman, R. ;Hypertension and the Atlas Subluxation Complex Chiropractic: The Journal Of Chiropractic Research. 1992 JUL;8(2): 30-2
ABSTRACT: This report represents observations on eight patients presentingwith hypertension. A multiple baseline across subjects deisgn is used inthis study. Changes or relief of symptoms is affected by adjusting the occipito-atlanto-axialsubluxation complex. The author suggests a relationship between the displacedskull and the cervical spine with hypertension.
Plaugher, G. ;Bachman, T. ;Chiropractic Management of Hypertension: ACase Study Transactions Of The Consortium For Chiropractic Re.1992 Jun; 7th: 284-5
ABSTRACT: There is little data on the chiropractic managment of patientswith hypertension. One small scale clinical trial using activator methodologies(short lever, mechanical force manually assisted instrument) demonstratedbenefits of this approach (1). The patients in that trial would be classifiedas mildly hypertensive. We report a case, where, after numerous pharmacologicalattempts, the patient eventually was able to have his hypertension stabilizedwith various combinations of anti hypertensive medication during a ten yeartime period. The patient was medicated with 120 mg Corgard b.i.d. and 2 mg.Minipress b.i.d. This 38 year old caucasion male patient also had continuedcomplaints of bloating sensations, mental depression, fatigue and impotency. The patient underwent a course of chiropractic care which consisted primarilyof manual short lever specific contact procedures. Since the patient's bloodpressure was stabilized with various medications, before care began, hispressure was monitored closely by the attending chiropractic and his medicalpractitioners. Both diastolic and systolic values began dropping below normalduring treatment, and the patient's medications were cut 25% by the medicaldoctor at approximately one month intervals. After five months of care, thepatient was off medications. His blood prssure has continued to remiain normalat six months follow-up. The patient's blood pressure was recorded priorto and after each chiropractic treatment. The presence of a small scaleclinical trial of chiropractic care (1) in the management of hypertensivepatients and the case report presented here should provide the impetus forlarge scale clinical trials or cohort studies for chiropractic care and themanagement of hypertension. Since a medicated hypertensive patient's bloodpressure may fall below normal while he or she is undergoing chiropracticcare, it is advised that the blood pressure be closely monitored and medicationsadjusted, if necessary, by the patient's medical physician.
Maloney, P. ;Rambacher, L. ;Owens, P. ;Johnston, V. ;Jackson, M. ;Assessingthe Effectiveness of Chiropractic Adjustment for Lowering Blood Pressure Proceedings Of The Int'l Conference On Spinal Mani. 1990 May: 356-8
Yates, R. ;Lamping, D. ;Abram, N. ;Wright, C. ;Effects of chiropractictreatment on blood pressure and anxiety: a randomized, controlled trial Journal of Manipulative and Physiological Therapeutics. 1988 Dec; 11(6): 484-8
ABSTRACT: This study examined the effects of chiropractic adjustments ofthe spine (T1-T5) on blood pressure and state anxiety in 21 patients withelevated blood pressure. Subjects were randomly assigned to one of threetreatment conditions: active treatment, placebo treatment, or no treatmentcontrol. The adjustments were performed by a mechanical chiropractic adjustingdevice. Dependent measures obtained pre- and post- treatment included systolicand diastolic blood pressure, and state anxiety. Results indicated that systolicand diastolic blood pressure decreased significantly in the active treatmentcondition, whereas no significant changes occurred in the placebo and controlconditions. State anxiety significantly decreased in the active and controlconditions. Results provide support for the hypothesis that blood pressureis reduced following chiropractic treatment. Further study is needed to examinethe long-term effects of chiropractic treatment on blood pressure.
McKnight, M. ;DeBoer, K. ;Preliminary study of blood pressure changesin normotensive subjects undergoing chiropractic careJournal of Manipulativeand Physiological Therapeutics. 1988; 11: 261-6
ABSTRACT: The purpose of this study was to evaluate the reliability of clinicalpressure readings and to begin a series of experiments to determine if chiropracticadjustments cause any significant changes in blood pressure. Seventy-fivestudents undergoing routine chiropractic health care at Palmer College ofChiropractic Clinic volunteered to participate in the blood pressure measurementprotocol in one 10-min visit. These subjects were placed into one of twogroups, based on the clinical findings from the chiropractic examination.One group, the Experimental group, was formed on the basis that they hadsubluxations in the cervical spine and also were adjusted specifically forthem. The Control group was similar but lacked manipulable cervical subluxationson that particular day and were not adjusted. Clinical and experimental procedureswere carried out identically on each group. Subjects were examined by standardGonstead palpatory methods after 5 min of quiet sitting in a cervical chair.Blood pressure was recorded by right arm cuff sphygomanometer by an experiencedchiropractor immediately before and again immediately after either the specificcervical adjustment or the control procedure, which was simply motion palpation.The doctors measuring blood pressures did not know to which group the subjecthad been assigned. Both systolic and diastolic blood pressures were statisticallysignificantly lowered in the Experimental but not on the Control group (p<0.01).The difference in the mean blood pressures was small and was brought aboutby 14 of the Experimental subjects who experienced a clinically relevant10-20 mm hg drop. Reliability of blood pressure measurements by two doctorswas established under similar conditions in an additional 25 subjects. InterclassCorrelation Coefficients for both intra-and interexaminer reliability werehighly significant, indicating that our blood pressure measures were reproducible.
Jamison, JR. ;Hypertension case finding and management in chiropracticclinics European Journalof Chiropractic. 1987 Dec; 35(4): 151-5
ABSTRACT: The diagnosis of hypertension depends on the repeated detectionof a blood pressure. The appropriateness of such a diagnosis is determinedby the accuracy with which the blood pressure is recorded. Common errorswhich may arise in the monitoring of a patient's blood pressure are discussed.It is suggested that chiropractors routinely screen their patients for hypertension.It is both feasible and clinically justifiable for chiropractors to implementnon-drug intervention in the management of cases of mild essential hypertension-providedappropriate care has been taken prior to labeling a patient as a case ofhypertension.
Crawford JP, Hickson GS, Wiles MR. The management of hypertensivedisease: a review of spinal manipulation and the efficacy of conservativetherapeusis. J Manipulative Physiol Ther. 1986 Mar;9(1):27-32.
When considering the ailments that plague mankind, certainly one of the enigmaticconditions is hypertensive disease. This perplexing disorder is recognizedinsidiously in the clinical setting. It is believed to occur because of thecomplex interactions of a variety of factors which act on the componentsof the blood vasculature. Although afflicted individuals may appear relativelyasymptomatic, the additive influences of such factors eventually culminatein deleterious sequelae. Overall, hypertension appears to be related to stress,diet and lifestyle. The autonomic nervous system, particularly its sympatheticcomponent, appears to mediate such accumulated factors, affecting the overallclinical scenario of hypertension. Although generally aligned with the agingprocess, this condition also may affect younger individuals. Hypertension,therefore, may be regarded as a prime condition warranting specialized carethat includes proper education during the formative years, modification ofdietary habits in conjunction with daily exercise regimens, and regular spinalmaintenance, all of which are covered by modern chiropractic clinical practice.
Wagnon, R. ;Rupert, R. ;A neurogenic origin of essential hypertension:Part I: an hypothesis Today's Chiropractic. 1984 Mar; 13(2): 29-30
Wagnon, R. ;Rupert, R. ;A neurogenic origin of essential hypertension:Part II: the evidence Today's Chiropractic.1984 May; 13(3): 23-24
Wagnon, R. ;Rupert, R;A neurogenic origin of essential hypertension: PartIII: conclusion Today's Chiropractic. 1984 Jul; 13(4): 23
Wagnon, R. ;Rupert, R. ;Thomason, P. ;The spine as the source of essentialhypertension; Part I: An hypothesis European Journal ofChiropracti. 1984 Dec; 32(4): 215-218
Wagnon, R. ;Rupert, R. ;Thomason, P.. ;The spine as the source of essentialhypertension; Part II: The evidence European Journalof Chiropracti. 1984 Dec; 32(4): 219-230
Wagnon, R. ;Rupert, R. ;;Gier, D. ;A retrospective study of spinal lesionsin hypertensive patients at Cleveland Chiropractic Clinic European Journal of Chiropracti. 1983 Mar; 31(1: 24-31
Terhune, J. ;Thurman, C. ;Santoro, C. ;Further evidence for an anti-hypertensiveeffect of basic technique International Review Of Chiropractic.1981; 35(3): 41-42
Dulgar, G. ;Hill, D. ;Sirucek, A. ;Davis, B. ;Evidence for a possibleanti-hypertensive effect of basic technique apex contact adjusting ACAJournal of Chiropractic. 1980; 17(9): S97-102
ABSTRACT: Evidence is presented for a reduction in systolic blood pressureadministration of Logan Basic technique apex contact but not after a non-specificsham contact. Other parameters which were measured but not affected by eithertreatment included diastolic blood pressure, pulse rate and respiration rate.Clinical implications are discussed.
Hosek, R. ;Miller, B. ;Myers, J. ;Spinal Misalignment Patterns Associatedwith Hypertension and Low Back Pain Biomechanics ConferenceOn The Spine. 1980 Dec: 161-171
Tran, T. ;Kirby, J. ;The effects of upper cervical adjustment upon thenormal physiology of the heart ACA Journal Of Chiropractic.
ABSTRACT: Physiological alterations in the cardiovascular system of "normaland healthy" individuals have been recorded and demonstrated as an effectof an upper cervical adjustment. The etiology remains undetermined, however,alterations of the autonomic nervous system have been implicated. Evidenceis presented that the adjustment or the "thrust" alone can induce hypertensionin which the diastolic pressure and pulse pressure are most affected. Therecorded electrocardiogram patterns show no significant changes and somedegree of variations in the heart rate is noted. Caution in adjusting nonsubluxatedvertebrae is indicated.
Hood R. ;Blood pressure Digest of Chiropractic Economics.1974 ;16: 36-8
Goodheart, G. ;Hypertension Digest of Chiropractic Economics.1968; 11: 20-3
Welberry, A. ;Chiropractic management of the hypertensive Journalof the National Chiropractic Association. 1963; 33(10): 26-8
1993 Jan; 1(1): 1 1977 Jun; 14(6): S58-62