Electrical Stimulation of Acupuncture Points and Blood Pressure Responses to Postural Changes: A Pilot Study

Abstract

Background Application of transcutaneous electrical stimulation over acupuncture points (Acu-TENS) facilitates heart rate recovery after exercise and restores hemodynamic stability after open heart surgery. The role of Acu-TENS on cardiovascular parameters in response to postural changes has not been reported. Objective To investigate (1) the effect of Acu-TENS on blood pressure responses to -10º head-down postural change and (2) whether such effects were associated with modulation by the autonomic nervous system. Method Sixteen healthy volunteers, mean age 22.8 (SD, 3.1) years, were subjected to a -10º head-down tilt from the supine position on 3 separate occasions and received in random order the following 3 intervention protocols for 40 minutes before the postural change: Acu-TENS (over bilateral acupuncture points, PC6), sham-TENS (TENS applied to the skin over the patellae), and control (no electrical output from the TENS device applied at PC6). Mean arterial pressure, large artery elasticity index, cardiac output, and heart rate were recorded and compared at different stimulation protocols in the supine and -10º head-down tilt positions. Spectral analysis of heart rate variability was used to determine any modulation by the autonomic nervous system. Results Change in large artery elasticity index was observed only in the Acu-TENS group (P < .05) and mean arterial pressure appeared most stable during Acu-TENS. Autonomic nervous system modulation was not apparent with spectral analysis, irrespective of intervention. Sympathetic activity predominated in all positions. Conclusion Acu-TENS seems to reduce blood pressure changes with -10º head-down tilt with concomitant changes in arterial vessel tone. (American Journal of Critical Care. 2011; 20:e67-e74) Traditional acupuncture has been used for thousands of years in China, and its effect on hemodynamic responses has been reported. 5 Although acupuncture has demonstrated some beneficial effect on disease, it is an invasive procedure and carries some risks.6,7 Application of transcutaneous electrical stimulation (TENS) over acupuncture points (thus termed Acu-TENS), a noninvasive means of acupoint stimulation, is effective in pain relief 8,9 and enhances heart rate recovery after exercise. 10 Recent reports suggest that Acu-TENS facilitates an earlier return to preoperative heart rate and maintains postoperative blood pressure at a lower rate pressure product in patients after open heart surgery. 11Despite these encouraging data, reports on the physiological effects of Acu-TENS are scanty. The effect of Acu-TENS on mean arterial pressure (MAP) during postural changes has never been reported.MAP is an important clinical sign and index of organ perfusion, often used to assist with therapeutic decision making. A noninvasive intervention that helps to stabilize MAP would be a useful adjunct to management of critically ill patients. For example, if Acu-TENS effectively modulates blood pressure change, it can be used before interventions that require postural alt...

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