L.A. Kalish et al. / Controlled Clinical Trials 25 (2004) 76C103!

re aso ns "er e the ti #e co# #it #ent $or tr ia l % a rtic i%a tion (26 &) and not "ant in' to dis
con ti n(e antih)%ertensi*e #edications (22&).
+e in*esti'ated "hether %artic(lar recr(it#ent so(rces "ere associated "ith di$$erent
screenin' o(tco#es. ,atients o$ the -)%ertension Center %h)sician "ere the #ost li.el) to /e
rando#i0ed (32&). Tele*ision ne"s re%orts also had a hi'h )ield (26& rando#i0ed). The lo"est
)ields "ere a#on' res%ondents to #ass #ailin's (!&) and %rint #edia (11&). 1es%ondents "ere
least li.el) to e2cl(de the#sel*es d(e to the ti#e co##it#ent i$ the) heard a/o(t the st(d) $ro#
a #edical %ractitioner and #ost li.el) to e2cl(de the#sel*es $or this reason i$ the) heard a/o(t
the st(d) $ro# te le * i s i o n o r #a s s #a i l i n ' s . 3 t h er e 2 c l (s io n r ea so n s " e r e $a
ir l ) c o n s t a n t ac r o s s th e d i$$e re n t recr(it#ent so(rces.
A#on' %atients "ho %ro*ided in$or#ed consent4 those on antih)%ertensi*e #edications at the
start o$ screenin' re5(ired an a*era'e o$ 4.7 screenin' *isits to the -)%ertension Center o*er a
#edian o$ 32 da)s. ,atients not on antih)%ertensi*e #edications co#%leted screenin' $aster
(a*era'e 3.0 *isits o*er a #edian o$ 15 da)s).
16. 6isc(ssion
As %atient interest in and (se o$ co#%le#entar) and alternati*e #edicine (CA7) increases4 the
need to de#onstrate e$$icac) and sa$et) o$ these %ractices also increases. 8nade5(ate research
th(s $ar is d(e in %art to 9:9: a lac. o$ ade5(ate or acce%ted research #ethodolo')9;9; <76= . A
%artic(lar challen'e in this real# is achie*in' the %ro%er /alance /et"een ri'oro(s scienti$ic
e*al(ation o$ a treat#ent and adherence to the essence and $(nda#ental %rinci%les (nderl)in'
the CA7 treat#ent. This notion o$ /alance "as a %riorit) in the desi'n o$ the >-A1, trial. The
#ethodolo') (tili0ed research %rinci%les and #ethods t)%icall) (sed to e*al(ate allo%athic
treat#ents (e.'.4 rando#i0ation4 /lindin'4 standardi0ation o$ the ac(%(nct(re 9:9:e2%erience9;9;
across the three treat#ent 'ro(%s and (se o$ a control 'ro(%) ai#in' to ens(re a#%le control and
scienti$icall) #eanin'$(l res(lts. At the sa# e t i #e4 at te nti on " a s d e*o te d t o ( %ho ldi n '
$( nda #e nta l %ri n c i %le s o $ T C 7 (e .' .4 T C 7 dia'noses and dia'nosin' ac(%(nct(rists9;
discretion in %rescri/in' %oints and #ethods o$ sti#(lation $or indi*id(ali0ed treat#ent). +e ho%e
that o(r #ethodolo') can /e ada%ted $or (se in other trials.
8t has /een di$$ic(lt to e2tra%olate clinical 'enerali0ations $ro# %re*io(sl) %(/lished case
re%orts and series /eca(se there has /een inconsistenc) in ter#s o$ n(#/er and location o$
%oints treated4 needlin' techni5(es (sed4 and d(ration and $re5(enc) o$ treat#ents <77= . 8ndeed4
this is a li#itation that %la'(es #ost o$ ac(%(nct(re research. The >-A1, st(d) e2%lores t"o
co##onl) (sed techni5(es4 indi*id(ali0ed thera%) and standardi0ed thera%)4 /oth /ased on the
%rinci%les o$ TC7. The %rotocol "as de*elo%ed "ith the colla/oration o$ ac(%(nct(re clinicians
and theorists and allo"s $or indi*id(ali0ed clinical decision #a.in' "ithin so#e constraints4 "hile
still allo"in' $or *alid co#%arisons /et"een 'ro(%s.
8n the ?nited >tates4 the 'eneral standard o$ ac(%(nct(re %ractice is to treat %atients t"ice
"ee.l) d(rin' the earl) %hases o$ treat#ent. @eedle insertion ti#e 'enerall) ran'es $ro# 15 to
30 #in. Aor treatin' h)%ertension4 the research tea# decided (/ased on %(/lished h)%ertension
st(dies and in%(t $ro# a tea# o$ e2%erienced ac(%(nct(rists in the Boston area) that the 30C
#in sessions t"ice "ee.l) $or 6 "ee.s "o(ld /e a reasona/le ti#e4 $re5(enc) and len'th to
o/ser*e an) %otential thera%e(tic /ene$its
.
L.A. Kalish et al. / Controlled Clinical Trials 25 (2004) 76C103
This sched(le "o(ld also #ini#i0e the de#ands %laced on the s(/Dects9;
sched(les4 there/) $acilitatin' recr(it#ent.
The %rotocol r e5(ired t he in*ol*e#ent o$ t"o s e%arate t )%es o$ ac(%(
nct( ri sts4 d ia ' nosin' ac(%(nct(rists (#as.ed to treat#ent ar#) and
treatin' ac(%(nct(rists (#as.ed to /lood %ress(re res%onses). 3/*io(sl)4
t"o ac(%(nct(rists "or.in' in these se%arate roles "o(ld not ordinaril) /e
(sed in clinical %ractice4 /(t "ere needed to #aintain the #as.in'
constraints o$ this controlled trial. Altho('h se*eral %roced(res had to /e
de*elo%ed to %rotect the 9:9:se%arateness9;9; o $ the t"o 'ro(%s o$
ac(%(nct(rists4 the lo'istics %ro*ed to /e 5(ite #ana'ea/le and the %rocess
"as not o/Dectiona/le to st(d) %atients.
+e (sed an in*asi*e sha# control treat#ent that in*ol*ed needlin' o$
nonCac(%(nct(re %oints "ith #ini#al sti#(lation. 3ther in*asi*e sha#
inter*entions incl(de needlin' o$ ac(%(nct(re %oints that are not e2%ected to
a$$ect the clinical %ro/le# at hand and needlin' rele*ant ac(%(nct(re %oints
/(t at shallo"er de%ths and/or "ith li#ited sti#(lation <4!46547!=. 3thers
ha*e ar'(ed that control conditions in ac(%(nct(re trials sho(ld not in*ol*e
%enetration o$ the s.in4 re$erred to as nonC or #ini#all) in*asi*e sha#
ac(%(nct(re <4!= . >%ecial retracta/le needles ha*e /een de*elo%ed $or
research %(r%oses "ith the 'oal o$ deli*erin' a control "hile .ee%in' the
%atient /linded <74!0=. 3ther a%%roaches ha*e incl(ded %ressin' "ith a
$in'ernail <!1= or tooth%ic. <!24!3= and ta%%in' "ith the ri'id %lastic
9:9:'(ide t(/e9;9; that is o$ten (sed to $acilitate insertion o$ ac(%(nct(re
needles <!4= .
+e $elt that (sin' less in*asi*e or nonin*asi*e control conditions co(ld
introd(ce con$o(ndin' into the desi'n. Aor e2a#%le4 i$ s.in %enetration alone
is e$$icacio(s and o(r control treat#ent did not in*ol*e %enetration4 "e "o(ld
not /e a/le to distin'(ish the e$$ect o$ %enetration $ro# an) e$$ect o$ TC7C
/ased ac(%(nct(re. There$ore4 o(r choice o$ an in*asi*e sha# ac(%(nct(re
control is a relati*el) conser*ati*e one. 8t incl(des the nons%eci$ic
%h)siolo'ical e$$ects associated "ith act(al %enetration o$ the s.in4 "ith its
attendant %s)cholo'ical reactions4 /(t (ses anato#ical locations that are not
acti*e accordin' to TC7 %rinci%les. +e are li#ited in o(r a/ilit) to st(d)
nons%eci$ic e$$ect s a nd other %s)chosocia l c o#% onents a ssociat ed "it h
9:9: %la ce/o9;9; e $$ ect s <63= . 1i'oro(s in*esti'ation o$ the %lace/o
res%onse "o(ld ha*e re5(ired a #ore co#%le2 trial desi'n "ith #(lti%le
control 'ro(%s.
+e also did not thin. that a con*entional %har#acolo'ic thera%) control
'ro(% "o(ld ha*e addressed the ai#s o$ o(r st(d). 8 $ ac(%(nct(re has an
e$$ect relati*e to the sha# control4 it #i'ht then /e a%%ro%riate to co#%are
ac(%(nct(re "ith #edication in a s(/se5(ent trial.
1 e cr ( i t # e n t a n d s c re e n i n ' $ or th e t ri a l %r o * e d t o / e a c
h a ll e n ' e . A lt h o ( ' h #a n ) % o t e n ti a l %artici%ants "ere *er)
#oti*ated4 the ti#e co##it#ent and t he re5(ire#ent o$ discontin(in'
#edications "ere deterrents $or so#e. The ti#e co##it#ent "as #ore o$
a /arrier $or those "ho heard a/o(t the st(d) $ro# tele*ision ne"s re%orts
or #ass #ailin's. 8t "as less o$ an iss(e $or %atients re$erred /) a #edical
%ractitioner4 /(t the *ast #aDorit) o$ these %atients "ere alread) a %art o$
the 7E- 9:9:s)ste#9;9; and this $a#iliarit) "ith the st(d) site #a) ha*e
/een in$l(ential. 8n addition to actin' as a deterrent to recr(it#ent4 the
re5(ire#ent that %artici%ants /e o$$ o $ antih)%ertensi*e #edications at the
start o$ the rando#i0ed trial also #ade screenin' considera/l) #ore
di$$ic(lt. A $i$th o$ %otential %artici%ants "ho dro%%ed o(t o$ screenin' $or
lac. o$ interest did so /eca(se the) did not "ant to discontin(e
#edications. A#on' those "ho consented $or $(ll screenin'4 the #edian
ti#e to screen %atients on #edications "as t"ice as lon'4 and re5(ired
57& #ore screenin' *isits4 than $or those not on #edications
.
L.A. Kalish et al. / Controlled Clinical Trials 25 (2004)
76C103100
8n s(##ar)4 this re%ort descri/es a care$(ll) %lanned %ilot rando#i0ed
clinical trial e*al(atin' TC7C/ased ac(%(nct(re $or the control o$
h)%ertension. 3ne o$ o(r ai#s in desi'nin' the >-A1, trial "as to address
#ethodolo'ic $la"s in %re*io(s trials. +e %resent an a%%roach necessitatin'
the close a nd coordinated e $$ orts o$ a # (ltidisci%linar) t ea#. +e a lso
doc(#ent details o$ the ac(%(nct(re treat#ents and controls4 "ith
rationales4 so that the res(lts can /e inter%reted and re%licated. The
adherence to strict #ethodolo'ical techni5(es and the #aintenance o$
traditional ac(%(nct(re %rece%ts are co#/ined to %ro*ide a #odel $or $(t(re
e*al(ations o$ co#%le#entar) and alternati*e thera%ies.
Ac.no"led'e#ents
This "or. "as s(%%orted /) Coo%erati*e A'ree#ent ?01 AT002104
a"arded /) the @ational Center $or Co#%le#entar) and Alternati*e
7edicine4 @ational 8nstit(tes o$ -ealth.
A%%endi2 A. >t(d) or'ani0ation
@e" Fn'land 1esearch 8nstit(tes4 +aterto"n4 7A G Leslie A. KalishH4 >c6
(>teerin' Co##ittee Chair)I >te%hanie >te*ensH4 764 7,-I ,atricia
ConnellH4 7,-I Allison Ee##el4 BAI 1(th Fisen/(d4 BAI Fric A. 7ac.lin4
,h6I J(lie @annicelli4 7,-I La(ra 3rti0.
-)%ertension Center4 7assach(setts Eeneral -os%ital4 Boston4 7AG
1andall K(s#anH4 76I Be*erl) B(c0)ns.iH4 1@I >haron 7a'innis4 1@I
La(ra >tanle)4 1@I Jean >(lli*anI 7ildred +asiles.i.
Ac(%(nct(re Center4 7assach(setts Eeneral -os%ital4 Boston4 7AG
Ja#es Tho#%sonH4 76I 7a) ,ianC>#ithH4 764 7>I Kate Billin's4 7AcI
Fd"ard Chi(4 7AcI Christian Connors4 7AcI A#) -(ll4 7A37I 6iane
8(liano4 7AcI Khi ,in' Li4 7B4 7AcI @icole >toc.hol#4 7AcI ,eter
Lalas.at'is4 7AcI M(n -ao Khan'4 ,h6.
@ationa l C enter $ or Co #%le#entar) an d Alternati* e 7 edicin e4
@ational 8nstit( t es o $ -ealth4 Bethesda4 76 G Christine Eoert0H4 6C4 ,h6.
Cons(ltantsG 1onald -. ,rineas4 764 ,h64 +a.e Aorest ?ni*ersit)I ,eter
Lalas.at'is4 7Ac4 @e" Fn'land >chool o$ Ac(%(nct(reI ,eter 7. +a)ne4
,h64 @e" Fn'land >chool o$ Ac(%(nct(re.
H>teerin' Co##ittee #e#/ers.
1e$erences
<1= B(rt LL4 +helton ,4 1occella FJ4 et al. ,re*alence o$ h)%ertension in the ?> ad(lt
%o%(lation. 1es(lts $ro# the Third @ational -ealth and @(trition F2a#ination >(r*e)4 1!!
C 11. -)%ertension 15I25G305 C 13.
<2 = C ho /an ian AL4 Ba .r is EL4 B lac. -14 et a l. The > e* ent h 1e %o rt o$ the J oi nt
@ationa l C o##ittee o n ,r e* ent ion4 6etection4 e*al(ation4 and treat#ent o$ hi'h /lood
%ress(reG the J@C 7 re%ort. JA7A 2003I2!G2560 C 72.
<3= 7ensah EA. The 'lo/al /(rden o$ h)%ertensionG 'ood ne"s and /ad ne"s. Cardiol Clin
2002I20G1!1 C 5 . <4= A#erican -eart Association. 2002 heart and stro.e statistical (%date.
A#erican -eart Association. 6allas4 Te2asI
2001. <5= B(rt LL4 C(tler JA4 -i''ins 74 et al. Trends in the %re*alence4 a"areness4
treat#ent4 and control o$ h)%ertension in the
ad(lt ?> %o%(lation. 6ata $ro# the health e2a#ination s(r*e)s4 160 to 11.
-)%ertension 15I26G60 C
.
L.A. Kalish et al. / Controlled Clinical Trials 25 (2004) 76C103
101
<6= Ketola F4 >i%ila 14 7a.ela 7. F$$ecti*eness o$ indi*id(al li$est)le inter*entions in red(cin'
cardio*asc(lar disease and ris. $actors. Ann 7ed 2000I32G23 C 51.
<7 = > a c .s A 7 4 > * e t . e ) L ,4 Lol l # er +7 4 e t a l . F$$ ec t s on /l oo d % r e s s ( r e
o$ re d( ce d d i e t a r ) s o di (# a n d t h e 6 i et a r ) A%%roaches to >to% -)%ertension
(6A>-) diet. @ Fn'l J 7ed 2001I344G3 C 10.
<!= @eal B4 7ac7ahon >4 Cha%#an @. F$$ects o$ ACF inhi/itors4 calci(# anta'onists4 and
other /loodC%ress(reClo"erin' dr('sG res(lts o$ %ros%ecti*el) desi'ned o*er*ie"s o$
rando#ised trials. Lancet 2000I356G155 C 64.
<= Leterans Ad#inistration Coo%erati*e >t(d) Ero(% on Antih)%ertensi*e A'ents. F$$ects o$
treat#ent on #or/idit) in h)%ertension. 88. 1es(lts in %atients "ith diastolic /lood %ress(re
a*era'in' 0 thro('h 11 4 # # -'. JA7A 170I213G1143 C 52.
<10= Leterans Ad#inistration Coo%erati*e >t(d) Ero(% on Antih)%ertensi*e A'ents. F$$ects o$
treat#ent on #or/idit) in h)%ertension. 3. 8n$l(ence o$ a'e4 diastolic %ress(re4 and %rior
cardio*asc(lar diseaseI $(rther anal)sis o$ side e$$ects. Circ(lation 172I45G1 C 1004.
<11= Berlo"it0 614 Ash A>4 -ic.e) FC4 et al. 8nade5(ate #ana'e#ent o$ /lood %ress(re in a
h)%ertensi*e %o%(lation. @ Fn'l J 7ed 1!I33G157 C 63.
<12= Caro JJ4 >alas 74 >%ec.#an JL4 1a''io E4 Jac.son J6. ,ersistence "ith treat#ent $or
h)%ertension in act(al %ractice. C7AJ 1I160G31 C 7 .
<1 3= 7c 8n n e s E T. 8n t e 'r a t ed a % % r oa c h e s t o # a n a 'e # e n t o$ h ) % e rt e n s i
on G % ro # o t i n ' t r e a t # e n t a c c e %t a n c e . A # - ea rt J 1I13!G>252 C 5 .
<14= 3li*eria >A4 La%(erta ,4 7cCarth) B64 et al. ,h)sicianCrelated /arriers to the e$$ecti*e
#ana'e#ent o$ (ncontrolled h)%ertension. Arch 8ntern 7ed 2002I162G413 C 20.
<1 5= @ 8 - C o n s e ns (s 6 e *e l o %# e n t , a n e l on A c (% ( n c t ( r e . @ 8 - C o n s e
n s (s C o n $ er e n c e . A c ( % ( nc t ( re . J A 7 A 1 !I 2! 0G 151! C 24.
<16= Kendall 6F. A scienti$ic #odel $or ac(%(nct(re. ,art 88. A# J Ac(%(nct 1!I17G343 C
60. <1 7= Ee r# an A c ( % ( n c t (r e > o c i e t ). 6 (s se ld or $ a c ( % ( n c t ( r e s ) # % o
s i ( # r e % o r t G t h e s c ien t i $ i c /a s e s o $ a c ( % ( n t (r e. A # J
Ac(%(nct 1!!I16G362 C 5 . <1!= -a##erschla' 1. The %h)siolo') o$ ac(%(nct(re. 8nG
Cassid) C4 editor. Conte#%orar) chinese #edicine and ac(%(ncC
t(reG Ch(rchill Li*in'stone. @e" Nor.I 2002. %. 203 C 22. <1= Lan'e*in -74 Ch(rchill
6L4 Ao2 J14 et al. Bio#echanical res%onse to ac(%(nct(re needlin' in h(#ans. J A%%l ,h)siol
2001I1G2471 C ! . <20= Lan'e*in -74 Ch(rchill 6L4 Ci%olla 7J. 7echanical si'nalin'
thro('h connecti*e tiss(eG a #echanis# $or the therC
a%e(tic e$$ect o$ ac(%(nct(re. AA>FB J 2001I15G2275 C !2. <21= -(an' - 4 L ia n' >.
Ac(%(nct(r e a t otoac (%oint he art $ or tre at#ent o$ *asc (lar h)%ertension. J Tradit Chin
7 ed
12I12G133 C 6 . <2 2= C h i ( NJ 4 C h i A4 1e i d 8A . C a r d i o* asc (l ar an d end oc ri
ne e$$e ct s o $ a c ( % ( n c t (re in h)% er t e n s i* e %at i e n t s . Cl in F2 %
-)%ertens 17I1G1047 C 63. <23= A.h#edo* T84 Lasil9;e* 8( 74 7asliae*a LL. The
he#od)na#ic and ne(roh(#oral correlates o$ the chan'es in the stat(s
o$ h)%ertension %atients (nder the in$l(ence o$ ac(%(nct(re. Te r Ar.h 13I65G22 C 4 .
<24= Anshele*ich 8L4 7erson 7A4 A$anas9;e*a EA. >er(# aldosterone le*el in %atients "ith
h)%ertension d(rin' treat#ent /)
ac(%(nct(re. Te r Ar.h 1!5I57G42 C 5 . <25= Na o T. Ac(%(nct(re and so#atic ner*e
sti#(lationG #echanis# (nderl)in' e$$ects on cardio*asc(lar and renal acti*ities.
>cand J 1eha/il 7ed >(%%l 13I2G7 C 1!. <26= Li ,4 >(n AN4 Khan' AK. The e$$ect o$
ac(%(nct(re on /lood %ress(reG the interrelation o$ s)#%athetic acti*it) and
endo'eno(s o%ioid %e%tides. Ac(%(nct Flectrother 1es 1!3I!G45 C 56. <27= Kho( N4
+an' N4 Aan' K4 et al. 8n$l(ence o$ ac(%(nct(re on /lood %ress(re4 contents o$ @F4 6A and 5C
-T o$ >-1 and the
interrelation /et"een /lood %ress(re and "hole /lood *iscosit). Khen Ci Na n Ji(
15I20G55 C 61. <2!= Bo/.o*a A>4 Ea%oni(. ,4 Koro*.ina FE4 >her.o*ina T4 Leono*a 7L.
The e$$ect o$ ac(%(nct(re on endocrine re'(lation
in h)%ertensi*e %atients. Lo%r K(rortol Ai0ioter Lech Ai0 K(lt 11I1G2 C 32. <2= Chao
674 >hen LL4 TDen AL>4 et al. @alo2one re*erses inhi/itor) e$$ect o$ electroac(%(nct(re on
s)#%athetic cardioC
*asc(lar re$le2 res%onses. A# J ,h)siol 1I276G-2127 C 34. <30= Li ,4 ,itsillides KA4
1endi' >L4 ,an -L4 Lon'h(rst JC. 1e*ersal o$ re$le2Cind(ced #)ocardial ische#ia /) #edian
ner*e
sti#(lationG a $eline #odel o$ electroac(%(nct(re. Circ(lation 1!I7G11!6 C 4. <31= Li
,4 TDen' AL>4 Lon'h (rst JC. 1ostra l *entrola teral #ed(ll ar) o%ioid rece %tor s(/t)%es in
the inh i/itor) e$$ect o$
electroac(%(nct(re on re$le2 a(tono#ic res%onse in cats. A(ton @e(rosci 2001I!G3! C 47
.
L.A. Kalish et al. / Controlled Clinical Trials 25 (2004)
76C103102
<32= 6on' J. Ac(%(nct(re treat#ent o$ h)%ertensionG a re%ort o$ 70 cases. 8nt J Clin Ac(%(nct
16I7G173 C 5 . <3 3= 6o *' i a l l o 3 E4 1a /. i n 7> 4 T .a ch en .o E . 1 e s ( l t s o $ ( s
i n ' a c ( % ( n c t (r e a n d t h e r a % e( ti c % h) si ca l e 2e rc i s e $ o r
%re*entin' the de*elo%#ent o$ arterial h)%ertension in %ersons "ith /orderline arterial
%ress(re. Te r Ar.h 1!7I 5G16 C .
<34= 8onesc(CTir'o*iste C4 Bi'( L4 6anci( A4 Cheta 6. 1es(lts o$ ac(%(nct(re in the treat#ent
o$ essential arterial h)%ertension. A# J Ac(%(nct 17!I6G1!5 C 0.
<35= 8(rene* A,4 ,atr(she*a 8A4 Ai*a0ian TA 4 Kaitse* L,4 Krol LA . ?se o$ *ario(s nonC
%har#acolo'ical #ethods in the treat#ent o$ %atients in the earl) sta'es o$ arterial
h)%ertension. Te r Ar.h 1!!I60G123 C 6 .
<36= Jin N4 Jin N4 Jin A. 7atri2 ac(%(nct(re $or h)%ertension. 8nt J Clin Ac(%(nct 1!IG361 C
4 . <37= Kan' B4 7oon >4 Ko C4 et al. Clinical research on the de%ressin' e$$ect o$
ac(%(nct(re thera%) at Ko.chi and Choc.C
sa#ni in ac(te stro.e %atients "ith h)%ertension. J 3rient 7ed 1!I3G43 C 50. <3!=
7onaen.o* A74 Le/ede*a 364 Aisen.o LA. 1e*ersal o$ le$t *entric(lar h)%ertro%h) d(rin'
ac(%(nct(re thera%) in
%atients "ith initial sta'es o$ essential h)%ertension. A# J Ac(%(nct 1!4I12G313 C 20.
<3= 1ad0ie*s.) >A4 Le/ede*a 364 Aisen.o LA4 7aDs.aDa >A. A(nction o$ #)ocardial
contraction and rela2ation in essential
h)%ertension in d)na#ics o$ ac(%(nct(re thera%). A # J Chin 7ed 1!I17G111 C 7 .
<40= >('io.a K4 7ao +4 +oods J4 7(eller 1A. An (ns(ccess$(l atte#%t to treat h)%ertension
"ith ac(%(nct(re. A# J Chin
7ed 177I5G3 C 44. <41= Ta/ee*a 674 >ha'ie*a LK. Co#%arati*e anal)sis o$ the
e$$icac) o$ di$$erent #ethods o$ ac(%(nct(re in the h)%erC and
h)%o.inetic t)%es o$ circ(lation in h)%ertensi*e %atients. Kh @e*rol ,si.hiatr 8# > >
Korsa.o*a 1!4I!4G47 C 50. <42= Ta # KC4 Ni ( --. The e$$ect o$ ac(%(nct(re on essential
h)%ertension. A# J Chin 7ed 175I3G36 C 75. <43= +illia#s T4 7(eller K4 Corn"all 7+.
F$$ect o$ ac(%(nct(reC%oint sti#(lation on diastolic /lood %ress(re in h)%ertensi*e
s(/DectsG a %reli#inar) st(d). ,h)s Ther 11I71G523 C . <44= +( C4 Jin K4 Na n A 4
Non' B. >cal% ac(%(nct(re in treatin' h)%ertension in the elderl). 8nt J Clin Ac(%(nct
17I!G2!1 C 4 . <45= Ni n K . Ac(%(nct(re treat#ent o$ h)%ertension. 8nt J Clin Ac(%(nct
1!IG57 C 60. <46= Fisen/er' 674 6a*is 1B4 Fttner >L4 et al. Trends in alternati*e
#edicine (se in the ?nited >tates4 10 C 17G res(lts o$
a $ollo"C(% national s(r*e). JA7A 1!I2!0G156 C 75. <47= 6iehl 6L4 Ka%lan E4
Co(lter 84 Eli. 64 -(r"it0 FL. ?se o$ ac(%(nct(re /) A#erican %h)sicians. J Altern
Co#%le#ent
7ed 17I3G11 C 26. <4!= Birch >4 -a##erschla' 14 Trinh K4 Kasla"s.i C. The nonC
s%eci$ic e$$ects o$ ac(%(nct(re treat#entG "hen and ho" to
control $or the#. Clin Ac(%(nct 3rient 7ed 2002I3G20 C 5 . <4= >ha%er AE4 ,hilli%s A@4
,ococ. >J4 +al.er 74 7ac$arlane ,+. 1is. $actors $or stro.e in #iddle a'ed British #en.
B7J
11I302G1111 C 5 . <50= Kan nel +B. -i stor ic %ers% ecti*e s o n t he rela ti*e contri/
(tio ns o$ diast olic and s)s tolic /lo od %ress (re ele*a tion t o
cardio*asc(lar ris. %ro$ile. A# -eart J 1I13!G205 C 10. <51= Basile J@. >)stolic
/lood %ress(re. B7J 2002I325G17 C ! . <52= 1o/erts J4 1o"land 7. -)%ertension in ad(lts
25 C 7 4 )ears o$ a'e4 ?nited >tates4 171 C 175. @ational Center $or -ealth
>tatistics. Lital -ealth >tat >eries 1!1I11(221)G(42)4 4! C 50. <53= Carleton 1A4 Lasater
T74 Assa$ A14 Aeld#an -A4 7cKinla) >. The ,a"t(c.et -eart -ealth ,ro'ra#G co##(nit)
chan'es in cardio*asc(lar ris. $actors and %roDected disease ris.. A# J ,(/lic -ealth
15I!5G777 C !5. <54= Chen' O4 editor. Chinese ac(%(nct(re and #o2i/(stion. 1e*ised edG
Aorei'n Lan'(a'e ,ress. BeiDin'I 1. <55= 3leson T6. A(ric(lothera%) #an(alG chinese and
"estern s)ste#s o$ ear ac(%(nct(re. 2nd ed. -ealth Care Alternati*es.
Los An'elesI 16. <56= -(an' LCC. A(ric(lar thera%)G dia'nosis and treat#ent.
Lon'e*it) ,ress. Bellaire4 Te2asI 16. <57= 7ancia E4 ,arati E4 ,o#idossi E4 et al. Alertin'
reaction and rise in /lood %ress(re d(rin' #eas(re#ent /) %h)sician and
n(rse. -)%ertension 1!7IG20 C 15. <5!= @orhei# AJ. Ad*erse e$$ects o$ ac(%(nct(reG
a st(d) o$ the literat(re $or the )ears 1!1 C 14. J Altern Co#%le#ent 7ed
16I2G21 C 7 . <5= Na#ashita -4 Ts(.a)a#a -4 Tanno N4 @ishiDo K. Ad*erse e*ents
related to ac(%(nct(re. JA7A 1!I2!0G1563 C 4 . <60 = 7 i t che l l >- 4 L a(r en t C L 4 de
+i t - . 8nt era ct io n o $ e 2 %ec t anc ) a n d t h e % h a r #ac ol o' i cal e$$e cts o$ dC a#% he
ta# in eG
s(/Decti*e e$$ects and sel$Cad#inistration. ,s)cho%har#acolo') (Berl.) 16I125G371 C
! . <61= Alaten 7A4 >i#onsen T4 3lsen -. 6r('Crelated in$or#ation 'enerates %lace/o and
noce/o res%onses that #odi$) the dr('
res%onse. ,s)choso# 7ed 1I61G250 C 5
.
L.A. Kalish et al. / Controlled Clinical Trials 25 (2004) 76C103
103
<62= Kirsch 8. -o" e2%ectancies sha%e e2%erience. A#erican ,s)cholo'ical Association.
+ashin'ton4 6CI 1. <63= Ka%tch(. TJ. The %lace/o e$$ect in alternati*e #edicineG can the
%er$or#ance o$ a healin' rit(al ha*e clinical si'ni$iC
canceP Ann 8ntern 7ed 2002I136G!17 C 25. <64= Bor.o*ec T64 @a( >6. Credi/ilit) o$
analo'(e thera%) rationales. J Beha* Ther F2% ,s)chiatr) 172I3G257 C 60. <65= Lincent C4
Le"ith E. ,lace/o controls $or ac(%(nct(re st(dies. J 1 >oc 7ed 15I!!G1 C 202. <66=
Lincent CA. Credi/ilit) assess#ent in trials o$ ac(%(nct(re. Co#%le#ent 7ed 1es 10I4G!
C 11. <67= +are Jr JF4 >her/o(rne C6. The 73> 36Cite# shortC$or# health s(r*e) (>AC36).
8. Conce%t(al $ra#e"or. and ite#
selection. 7ed Care 12I30G473 C !3. <6!= La"rence +A4 Ar)/ac. 6E4 7artin ,A 4
Klein 14 Klein BF. -ealth stat(s and h)%ertensionG a %o%(lationC/ased st(d).
J Clin F%ide#iol 16I4G123 C 45. <6= Barda'e C4 8sacson 6E. -)%ertension and
healthCrelated 5(alit) o$ li$e. An e%ide#iolo'ical st(d) in >"eden. J Clin
F%ide#iol 2001I54G172 C !1. <70= Fric.son >14 +illia#s BC4 Er(%%en L6. ,ercei*ed
s)#%to#s and healthCrelated 5(alit) o$ li$e re%orted /) (nco#%liC
cated h)%ertensi*e %atients co#%ared to nor#al controls. J -(# -)%ertens 2001I15G53
C 4!. <71= 71C +or.in' ,art). 7edical 1esearch Co(ncil trial o$ treat#ent o$ h)%ertension in
older ad(ltsG %rinci%al res(lts. B7J
12I304G405 C 12. <72= ,iantadosi >. Clinical trials. A #ethodolo'ic %ers%ecti*e. +ile).
@e" Nor.I 17. <73= Laird @74 +are J-. 1ando#Ce$$ects #odels $or lon'it(dinal data.
Bio#etrics 1!2I3!G63 C 74. <74= +hite 814 Chat(r*edi @4 7cKei'(e ,7. 7edian anal)sis
o$ /lood %ress(re $or a sa#%le incl(din' treated h)%ertensi*es.
>tat 7ed 14I13G1635 C 41. <75= >tataCor%.4 >tata >tatistical >o$t"are4 1elease 7.0.
Colle'e >tation4 Te2asG >tata Cor%orationI 2001. <76= +orld -ealth 3r'ani0ation. Eeneral
'(idelines $or #ethodolo'ies on research and e*al(ation o$ traditional #edicine.
+orld -ealth 3r'ani0ation. Eene*aI 2000. <77= Ka%tch(. TJ. Ac(%(nct(reG theor)4
e$$icac)4 and %ractice. Ann 8ntern 7ed 2002I136G374 C !3. <7!= -a##erschla' 1. 7
ethodolo'ical and e thica l iss(es in clin ic al trials o$ ac(%(nct(re . J Alte rn Co#% le #e nt
7ed
1!I4G15 C 71. <7= >treit/er'er K4 Kleinhen0 J. 8ntrod(cin' a %lace/o needle into
ac(%(nct(re research. Lancet 1!I352G364 C 5 . <!0= ,ar. J4 +hite A4 Lee -4 Frnst F.
6e*elo%#ent o$ a ne" sha# needle. Ac(%(nct 7ed 1I17G110 C 2 . <!1= J(nnila >N.
Ac(%(nct(re thera%) o$ %rolon'ed %ain. 6(odeci# 1!2I!G!71 C ! . <!2= +hite A14
Fddleston C4 -ardie 14 1esch KL4 Frnst F. A %ilot st(d) o$ ac(%(nct(re $or tension headache4
(sin' a no*el
%lace/o. Ac(%(nct 7ed 16I16G567 C 72. <!3= >her#an KJ4 -o'e/oo# CJ4 Cher.in
6C4 6e)o 1A. 6escri%tion and *alidation o$ a nonin*asi*e %lace/o ac(%(nct(re
%roced(re. J Altern Co#%le#ent 7ed 2002I!G11 C . <!4= Lao L4 Ber'#an >4
Lan'en/er' ,4 +on' 1-4 Ber#an B. F$$icac) o$ Chinese ac(%(nct(re on %osto%erati*e oral
s(r'er)
%ain. 3ral >(r' 3ral 7ed 3ral ,athol 3ral 1adiol Fndod 15I7G423 C ! .