A Somatovisceral Reflex of Lowered Blood Pressure and Pulse Rate
OBJECTIVE: A randomized controlled trial (RCT) was designed to test effects of specific thoracic (T1 to T5) manipulations using an Activator instrument for changes in diastolic and systolic blood pressure, blood pressure classification, and pulse rates in 290 normotensive and hypertensive people in El Salvador.
METHODS: Informed consent was obtained from 290 subjects meeting the inclusion criteria.
They were randomly assigned to one of three groups: Control (i.e., no treatment, N=95); Placebo treatment (N=96); or Active treatment (N=99). Subjects’ blood pressure and pulse rates were measured after relaxing for 15 minutes, then before intervention, and again just after treatment.
RESULTS: Systolic and diastolic BP, pulse rate, and BP classification decreased significantly only in the active treatment group. No significant changes occurred in the placebo treatment and control groups. Activator treatment’s effect size in changing hypertension classification as compared to no treatment was a medium d = 0.37, and 0.45 when compared to placebo.
CONCLUSION: Specific thoracic spinal manipulations affected three measures: blood pressure, pulse rate, and changes in hypertension classification only in the active treatment group. Findings may represent in part a rebound effect from treatment anxiety, but this alone did not account for the observations. Activator instrument’s utility for sham settings was supported for future efficacy studies. The decrease was robust across several analyses, but the duration of the effect requires longer-term follow up.
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005 Jan 15-21;365(9455):217-23.
Kearney PM, Whelton M, Reynolds K, Whelton PK, He J. Worldwide prevalence of hypertension: a systematic review. J Hypertens. 2004 Jan;22(1):11-9.
Whitworth JA. World Health Organization, International Society of Hypertension Writing Group. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens. 2003 Nov;21(11):1983-92.
Yates RG, Lamping DL, Abram NL, and Wright C. Effects of chiropractic treatment on blood pressure and Anxiety: A randomized, controlled trial. J Manipulative Physiol Ther. 1988 Dec;11(6):484-8.
Welch A and Boone R. Sympathetic and parasympathetic responses to specific diversified adjustments to chiropractic vertebral subluxations of the cervical and thoracic spine. J Chiropr Med. Sep 2008(7:3): 86-93.
Crawford JP, Hickson GS, Wiles MR. 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.
Bakris G, Dickholtz M Sr, Meyer PM, Kravitz G, Avery E, Miller M, Brown J, Woodfield C, and Bell B. Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study. J Hum Hypertens. 2007 May;21(5):347-52.
Plaugher G, Long CR, Alcantara J, Silveus AD, Wood H, Lotun K, Menke JM, Meeker WC, Rowe SH. 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): 221-39.
Goertz CH, Grimm RH, Svendsen K, Grandits G. Treatment of Hypertension with Alternative Therapies (THAT) Study: a randomized clinical trial. J Hypertens. 2002 Oct;20(10):2063-8.
Morgan JP, Dickey JL, Hunt HH, Hudgins PM. A controlled trial of spinal manipulation in the management of hypertension. J Am Osteopath Assoc. 1985 May;85(5):308-13.
Gemmell HA. Comment on: J Manipulative Physiol Ther. 1988 Dec;11(6):484-8. J Manipulative Physiol Ther. 1989 June;12(3):240.
Nykoliation J. Comment on: J Manipulative Physiol Ther. 1988 Dec;11(6):484-8. J Manipulative Physiol Ther. 1990 Feb;13(2):113.
Osterbauer PJ and Fuhr AW. Comment on J Manipulative Physiol Ther. 1988 Dec;11(6):484-8. J Manipulative Physiol Ther. 1991 Jan;14(1):74-77.
Richards D. Comment in: J Manipulative Physiol Ther. 1988 Dec;11(6):484-8. J Manipulative Physiol Ther. 1992 Mar-Apr;15(3):210-212.
Ostchega Y, Zhang G, Sorlie P, Hughes JP, Reed-Gillette DS, Nwankwo T, M.S.; and Yoon S. Blood pressure randomized methodology study comparing automatic oscillometric and mercury sphygmomanometer devices: national health and nutrition examination survey, 2009–2010. National Health Statistics Reports, October 5, 2012, No. 59:1-16.
Activator IV chiropractic adjusting instrument. Website accessed on May 14, 2015. https://www.activator.com/product/chiropractic-adjusting-instruments/activator-ez-grip-iv-instrument/. Activator Methods International Ltd, Phoenix, AZ.
Activator IV chiropractic adjusting instrument. Website accessed on May 14, 2015. https://www.activator.com/product/chiropractic-adjusting-instruments/activator-iv/. Activator Methods International Ltd, Phoenix, AZ.
Fuhr AW. The Activator Method. Second Edition. Textbook. ISBN-10: 0323048528; ISBN-13: 978-0323048521. 2009, 1997. Mosby/Elsevier.
R programming Language in Crawley MJ. The R Book. ISBN-10: 0470510242; ISBN-13: 978-0470510247. 2007. Wiley.
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. JAMA. May 21; 289(19):2560-71.
Mangum K, Partna L, Vavrek D. Spinal manipulation for the treatment of hypertension: a systematic qualitative literature review. J Manipulative Physiol Ther. 2012 Mar=Apr;35(3):235-43.
Beck RW and Carrick F. Functional Neurology for Practitioners of Manual Therapy. Textbook. ISBN-10: 0443102201; ISBN-13: 978-0443102202; 2008.
Celander E, Koenig AJ, Celander DR. Effect of osteopathic manipulative therapy on autonomic tone as evidenced by blood pressure changes and activity of the fibrinolytic system. J Am Osteopath Assoc. 1968 May;67(9):1037-8.
Greenman PE. Manipulative therapy in relation to total healthcare. In: Korr IM. The Neurobiological Mechanisms in Manipulative Therapy. London: Plenum Press,1978.
Murugaian J, Sundaram K, Krieger A, Sapru H. Relative effects of different spinal autonomic nuclei on cardiac sympathoexcitatory function. Brain Res Bull. 1990 Apr;24(4):537-42.
Kang OS, Chang DS, Lee MH, Lee H, Park HJ, Chae Y. Autonomic and subjective responses to real and sham acupuncture stimulation. Auton Neurosci. 2010 Aug 20.
Mancia G, Omboni S, Parati G. The importance of blood pressure variability in hypertension. Blood Press Monit. 2000;5 Suppl 1:S9-S15.
Menke JM. Do manual therapies help low back Pain? A comparative effectiveness meta-analysis. Spine. April 1, 2014. Volume 39(7):e463-e472.
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