Refractory Hypertension Controlled with the Niemtzow Dry Mouth Acupuncture Protocol

Introduction

Acupuncture for the treatment of hypertension is clearly not in the mainstream of allopathic medicine. Even literature about acupuncture energetics, neuroanatomical acupuncture, and western medical acupuncture do not mention treatment of hypertension. There are many modalities to treat Sympathetic Excess and to provide sedation and relaxation, but there has not been an easy or user-friendly breakthrough for something as common as hypertension. The Helms Medical Institute, in Berkeley, CA, suggests some Traditional Chinese Medicine (TCM) points locally (CV 17, CV 14, GV 20), distally (LR 3, HT 7, LU 9), and N—>N+1 per the patient's biopsychotype. ¹ Ma et al. also suggested GB 20 was the best single point for addressing hypertension. ² Generally, however, standard hypertensive treatments involve the use of allopathic medicines, which are usually successful.

Case

A 48 year-old female was well-known in one of the current authors' family practice clinic. She presented for acupuncture treatment for dry mouth.

Concurrently, she had refractory hypertension that was completely uncontrolled despite six pharmaceutical medicines and recommendations from cardiology on her management. At the time of her acupuncture treatment, she had been on 10 mg of amlodipine daily, 0.2 mg of clonidine daily, 100 mg of losartan daily, 50 mg of metoprolol twice daily, 25 mg of spironolactone daily, and 40 mg of furosemide daily all together for >5 months after maximal thiazide diuretics and angiotensin converting enzyme inhibitor therapy failed within the treatment combination. Secondary causes of hypertension were assessed with normal laboratory tests to include complete blood count; a complete metabolic panel with full electrolytes, including calcium, urinalysis, thyroid-stimulating hormone, brain naturetic peptide, and sedimentation rate; and an antinuclear antibody panel. Her electrocardiogram showed a normal sinus rhythm, and an abdominal computed tomography scan indicated normal renal vasculature. A magnetic resonance angiogram (MRA) result was benign other than 50% left inferior renal artery narrowing with primary right and left renal arteries widely patent on the MRA scan. Her other significant medical conditions included migraines, prior Helicobacter pylori ulcer, anxiety, chronic pain, peripheral edema with a normal echocardiogram, allergic rhinitis, and a fatty liver. She had tobacco use history of <5 cigarettes per day.

Overall, blood pressure (BP) readings were taken by trained medical assistants during 21 prior clinic visits between November 12, 2015, and October 17, 2016. By May of 2016, she had discontinued ineffective maximal hydrochlorothiazide and maximal lisinopril doses and was on the above six-medication hypertension treatment with cardiology input with mediocre results and average clinic BP readings over 5 months of 156.5/88.5. She had received acupuncture for headache on December 9, 2015, and for low-back pain on January 7, 2016 and no subsequent BP normalization occurred.

In October 2016, she was noting dry mouth with associated mild-to-moderate mouth pain related to dentures after multiple tooth extractions. She requested acupuncture to alleviate her dry mouth symptoms. This acupuncture procedure was performed using the Niemtzow dry mouth protocol on October 17, 2016, and on October 19, 2016. Hard candy was used to dissolve slowly in her mouth during treatment. Points used included SEIRIN® needles to the Salivary Gland 2′ on the external auditory canal opening at the 6 o'clock position on the right, then the right LI 1′, left LI 1′, left Salivary Gland 2′, left auricular Shen Men and Point Zero, then right Shen Men and Point Zero. After 10 minutes, needles were then placed bilaterally ∼1.0 cm proximal to LI 1′ near the distal interphalangeal joints bilaterally. The total treatment was 45 minutes. ³ The patient noted an excellent return of salivary function and alleviation of her dry mouth symptoms. No side-effects were noted.

She followed-up on two subsequent occasions with very painful pyelonephritis; thus, fortuitously, extra BP readings were obtained.

Results

BP readings were taken per clinic routine on her four visits after the dry eye protocol was first conducted over the course of 3.5 weeks' follow-up. On the first session after that first acupuncture treatment, the patient's BP dropped from 182/106 to 132/78 and it was lowered to an average of 134.5/82 over the next four office visits over the 3.5 weeks. The 21 BP recordings before acupuncture treatment averaged 162.2/93.7 with a standard deviation (SD) of 17.8/12.9 and on the 4 sessions after treatment the mean was 134.5/82 with an SD of 3.0/7.3. Figure 1 is a graph of all of the BP levels the patient had in her clinic history. Note that a stable 6-medicine treatment was present after reading number 13 and the treatment with dry mouth acupuncture occurred after reading number 21 (Fig. 1).

OPEN IN VIEWER

FIG. 1.

Chronologic systolic and diastolic blood pressure (BP) readings. Y-axis: Systolic BP readings (dark bars) and diastolic BP readings (light bars). X-axis: Sequential BP readings.

Discussion

There are voluminous data in the literature involving hypertension treatment with allopathic medicines. There is a paucity of evidence in acupuncture literature demonstrating that BP can be controlled over time with acupuncture.

In 2013, Cevik and Iseri published a small study of 34 patients using the TCM points KI 3, LR 3, SP 9, LI 4, HT 7, ST 36, SP 6, KI 7, and LU-9 every other day for 15 sessions and found good overall reductions in systolic BP (SBP) and diastolic BP (DBP), but the confidence intervals were wide and did not reach statistical significance. ⁴ Wang, et al. analyzed 35 randomized trials with a total of 2539 patients and found that there was a general reduction in SBP by −7.47 mm Hg (–10.43 to −4.5; P < 0.0001) and DBP by −4.22 mm Hg (−6.26 to −2.18; P < 0.0001). Unfortunately, the reviewers noted limitations of their analysis because of significant flaws in study designs. ⁵ More recently Li, et al. found that 8 weekly treatments with MH 5–6 + ST 36–37 reduced peak and average SBPs after 4 weeks of weekly treatment by 8 and 6 mm Hg. This treatment was significantly more effective than a sham control acupuncture treatment with LI 6–7 + GB 37–39 and reduced norepinephrine, renin, and aldosterone levels. ⁶

Richard C. Niemtzow, MD, PhD, MPH, developed a very effective acupuncture treatment for dry mouth ⁷ that was presented here as used in this patient's case. What had not been previously described is the powerful effect that this treatment might have on hypertension. Dr. Niemtzow has seen BP respond to this treatment (Dr. Niemtzow, personal communication, November 14, 2016), but a BP history was not available as in the current case, other than what was noted on the day of treatment and the next day.

What is unique in this case is the severity of the BP and the difficulty with which control had been even on extreme medical therapy. The only difference in therapy prior to the last four BP readings was the fact that the dry mouth treatment protocol was only performed twice (on October, 2016, and October 19, 2016). The treatment with six simultaneous hypertensive medications had been stable for 5 months, and the benefit of the response to just two treatments with the Niemtzow dry mouth acupuncture protocol has lasted at least 3.5 weeks as of this writing. The average change noted before and after the acupuncture treatment was 22 mm Hg SBP and 6.5 mm Hg DBP, compared to the prior 8 readings on exactly the same medication regimen. If one takes all prior BP readings of this patient—which included those prior to May of 2016, and which were taken while she was still on 3–5 antihypertension medicines—the difference was 27.7 mm Hg SBP and 11.7 mm Hg DBP.

This is a single case that may be a fortuitous outcome, but, given the degree of change that occurred, the current authors felt that this should be reported.

Conclusions

This case is noteworthy for the radical numerical changes found in this patient's BP readings before and after two acupuncture treatments for dry mouth. The initial response was clearly evident after just one treatment and was sustained 3.5 weeks after just two initial treatments. In a situation like this, dealing with a single case, it is obvious that hypertension treatment in the setting of dry mouth should be verified. The logical next step suggested is a clinical trial to assess if the treatment outcomes are consistent and reproducible, and if they can be standardizable. It would be much more practical for patients and clinicians to treat hypertension monthly or less rather than weekly or multiple times per week. If the results of this case bear out in further research, this could pave the way toward a shift in acupuncture geared toward finding more best-practices to treat specific conditions, even internal medicine conditions.