Managing Hypertension with Upper Cervical Chiropractic Manipulation

Report By: Kevin J. Curtin, D.C. - Instructor of Clinical Sciences
Search checked by Edward Bifulco, D.C. - Instructor of Clinical Sciences
Institution: National University of Health Sciences
Date Submitted: 11th April 2012
Last Modified: 11th April 2012
Status: Blue (submitted but not checked)

Three Part Question

IN [adults with Hypertension] IS [Upper Cervical Manipulation] effective in [lowering blood pressure].

Clinical Scenario

A 55 yr old male presents with a 10 year history of hypertension. The patient has been taking a combination of Lisinopril and Hydrochlorithiazide for the past 5 years. The patient has heard that chiropractic manipulation may have a lowering effect on blood pressure and would like to know if there is any evidence to support this.

Search Strategy

Database: PubMed with MeSH for chiropractic and hypertension
Keywords: chiropractic, hypertension
Limits: Human, English, Clinical Trial, Randomized Control Trial, Adult
Full Query: (("chiropractic"[MeSH Terms] OR "chiropractic"[All Fields]) AND ("hypertension"[MeSH Terms] OR "hypertension"[All Fields])) AND ("loattrfull text"[sb] AND "humans"[MeSH Terms] AND (Clinical Trial[ptyp] OR Randomized Controlled Trial[ptyp]) AND English[lang] AND "adult"[MeSH Terms])

Search Outcome

3 Papers were identified all of which were randomized controlled trials. The article by Bakris G. et.al. was chosen because it addressed chiropractic manipulation of the upper cervical spine and its effect on blood pressure.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Bakris 2007 USA	50 drug naïve patients with Stage 1 Hypertension	Randomized,Double Blind,with Placebo Control	Systolic Blood Pressure, Diastolic Blood Pressure, Pulse Rate, and Atlas Measurement	-17+or-9 mmHg change in Systolic blood pressure and – 10+or-11 mmHg change in Diastolic blood pressure	The study was dependent upon the manipulation skills of 1 practitioner. The sample size was relatively small given that it was a pilot study

Clinical Bottom Line

In patients with Stage 1 Hypertension, there is evidence to suggest that upper cervical chiropractic manipulation can provide long-term amelioration in blood pressure.

References

G Bakris, M Dickholtz Sr, PM Meyer, G Kravitz, E Avery, M Miller, J Brown, Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study Journal of Human Hypertension (2007)1–6