PMC:6927068 / 22316-26473 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/6927068","sourcedb":"PMC","sourceid":"6927068","source_url":"https://www.ncbi.nlm.nih.gov/pmc/6927068","text":"Discussion\nThis systematic review of auricular therapy for patients with hypertension provides a comprehensive summary of such therapy as an alternative and adjunct to routine treatment. The results indicate that there were no consistent results neither in reducing BP nor in efficacy rate between auricular acupressure and ADs. However, auricular acupressure showed favorable changes in efficacy rate compared with sham acupoint and statistically significant changes in BP compared with no intervention. In addition, AAPADs manifest a significantly higher efficacy rate than that of ADs alone. Although the characteristics of included trials varied substantially in both the auricular acupoint options and duration of the intervention, all of the included trials except for the comparison between auricular therapy and ADs demonstrated at least one benefit in terms of achieving better BP control.\nThe auricular therapy included in this systematic review was in diverse forms. Bloodletting in the auricle had better immediate effects than no intervention on both efficacy rate and lowering of BP and bloodletting in the auricle plus ADs showed a favorable difference in efficacy rate compared with ADs alone, while there was no statistical difference between bloodletting in the auricle and ADs in terms of efficacy rate. It is worth mentioning that the safety of bloodletting in the auricle should draw our attention, as it is a kind of traumatic intervention, despite the fact that such therapy has been applied in China for a long period of time.\nThis review identifies the evidence on effectiveness of auricular therapy based on 44 included trials, and presents a rigorous illustration of the findings, according to the protocol we had registered in PROSPERO, an international prospective register of systematic review, which has also been published. Furthermore, the GRADE summary is presented to assess the quality of the evidence for outcomes, which could contribute to increasing the possibility of adding this kind of therapy to the international guideline for preventing and management of hypertension.\nThe lack of evaluation of the long-term effectiveness and safety in the included trials limits the finding of such therapy for the primary outcome of hypertension management. In fact, the aim of both non-pharmacological and pharmacological treatment is to prevent adverse outcomes for which high BP is a risk factor, and to achieve better BP control. However, we could not draw a conclusion about the effects of preventing adverse outcomes for auricular therapy, which might be crucial when both the practitioners of this therapy and patients with hypertension weigh the potential benefits and harms before taking the decision to apply such therapy.\nThis review also has further limitations, partially due to poor methodological quality and insufficient reporting of procedures in the clinical trials that we included. Moreover, we could not make the subgroup analyses detecting the effects of age, disease duration, target auricles, or treatment course because of insufficient data, and a funnel plot for the majority of the included studies was unable to be used to detect potential publication bias due to insufficient number of trials in every comparison and outcome. However, evidence of immediate and long-term effectiveness from auricular therapy could not be found, which was limited mainly to absence of immediate observation and follow-up performance.\nIn the future, results from studies of high methodological quality which report sufficient outcomes are needed to draw definitive conclusions in terms of the effectiveness of auricular therapy. In further trials, data on all-cause mortality, cardiovascular mortality, cardiovascular morbidity (non-fatal stroke, myocardial infarction, heart failure) are highly recommended for assessment of effectiveness of treatment of hypertension, while BP after bloodletting in the auricle may be measured immediately for assessment of its instant effectiveness. In addition, the possible effects of auricular therapy for sexual dysfunction caused by routine ADs needs more trials to evaluate.","divisions":[{"label":"title","span":{"begin":0,"end":10}},{"label":"p","span":{"begin":11,"end":898}},{"label":"p","span":{"begin":899,"end":1550}},{"label":"p","span":{"begin":1551,"end":2113}},{"label":"p","span":{"begin":2114,"end":2763}},{"label":"p","span":{"begin":2764,"end":3475}}],"tracks":[]}