Compiled by Joseph Brady MSTCM, L.Ac., Dipl. OM

Contact: taichiproj@earthlink.net | joe.brady@faculty.ccmu.edu

1529 York Street, Denver, CO 80206

Acknowledgements

Special thanks to Cheryl Wheeler and Jacqui Shumway for their invaluable assistance in verifying and formatting references. Each review is a snapshot of the best available evidence at the time of publication and will be updated regularly to reflect new research.

Author’s Note on AI Use

Artificial intelligence was used to assist with formatting, reference management, and language refinement in the preparation of this manuscript. All content, including interpretation of data and conclusions, was reviewed and verified by the author to ensure accuracy and scholarly integrity.

Chinese Medicine for Hypertension: Evidence Review

Hypertension affects over 1.28 billion adults worldwide and is a leading risk factor for cardiovascular disease. While conventional pharmacological therapy is effective, side effects, adherence issues, and residual cardiovascular risk have prompted interest in complementary strategies. Traditional Chinese Medicine (TCM) offers a multi-modal, individualized approach, incorporating acupuncture, Tai Chi, Qigong, meditation, and Chinese herbal medicine (CHM). This review synthesizes high-quality evidence using the GRADE framework.

Acupuncture

The Cochrane review by Yang et al. (2018; 22 RCTs, 1,744 participants) found that acupuncture modestly reduced systolic and diastolic blood pressure (BP) versus sham, with benefits diminishing after treatment cessation (GRADE: Moderate). Chen et al. (2018) and Lu et al. (2022) meta-analyses confirmed greater BP reductions when acupuncture was combined with antihypertensive drugs compared to drugs alone—mean systolic reduction of 8.6 mmHg and diastolic reduction of 1.45 mmHg. Large pooled analyses (46 RCTs, 3,859 participants) also report higher antihypertensive efficacy rates for combination therapy (RR = 1.27) versus medication alone, with significantly fewer adverse events. Proposed mechanisms include autonomic modulation, hypothalamic regulation, and improved vascular compliance.

Tai Chi

Tai Chi has one of the strongest evidence bases among TCM modalities for BP reduction. Pan et al. (2021; SR of 24 RCTs) found significant systolic (SMD −1.05) and diastolic (SMD −0.91) BP reductions, along with improvements across all SF-36 quality-of-life domains (GRADE: Moderate to High). Optimal protocols involved >12 weeks of practice, <60-minute sessions, ≥5 days/week, most often using Yang style 24-form. In a 12-month RCT of 342 prehypertensive patients, Li et al. (2024) reported a 2.40 mmHg greater systolic BP reduction with Tai Chi versus aerobic exercise, plus improved ambulatory BP metrics.

Qigong

A 2015 meta-analysis by Xiong et al. (20 RCTs, 2,349 participants) found that Qigong reduced systolic BP by 17.4 mmHg and diastolic BP by 10.1 mmHg versus no treatment (GRADE: Low–Moderate). Dong et al. (2021) similarly found significant reductions (SBP −8.90 mmHg; DBP −6.76 mmHg) in 14 RCTs (n = 829). Combined with antihypertensive medication, Qigong achieved further BP reductions, though study quality was variable. Mechanisms include increased nitric oxide, decreased endothelin-1, improved lipid profiles, and enhanced parasympathetic tone.

Meditation

Shi et al. (2017) meta-analysis of 19 RCTs found that non-transcendental meditation reduced systolic BP by 5.09 mmHg and diastolic BP by 2.57 mmHg (GRADE: Moderate), supporting its use for stress-related hypertension and as an adjunct to other interventions.

Chinese Herbal Medicine (CHM)

CHM demonstrates potential as both monotherapy and adjunctive therapy. Qiju Dihuang Decoction (QDD) was 1.45× more effective than antihypertensive drugs alone and improved endothelin levels, renal function, and quality of life (Zhang et al., 2020; 19 trials). Meta-analysis of 13 RCTs showed CHM plus conventional therapy improved BP variability, normalized circadian BP patterns, and reduced nighttime BP. However, a methodology overview (Zhang et al., 2016) found most evidence to be low quality, with 61% of systematic review outcomes rated low and 29% very low, primarily due to risk of bias and heterogeneity in formulas.

Integration and Safety

The strongest evidence supports TCM as an adjunct rather than a replacement for conventional therapy. Combining acupuncture or CHM with medication yields additive BP reductions, while Tai Chi and Qigong can be safely integrated with pharmacologic regimens. Safety profiles are favorable: Tai Chi/Qigong have minimal adverse events; acupuncture has fewer side effects than medications; CHM is generally well tolerated but requires monitoring for herb–drug interactions.

Conclusion

Among TCM modalities for hypertension, Tai Chi has the most consistent and highest-quality evidence, followed by acupuncture and Qigong. Meditation and CHM also show promise, particularly as part of multi-modal interventions. While effect sizes are generally smaller than those of antihypertensive drugs, the favorable safety and quality-of-life benefits support TCM’s role as a complementary approach. Future large-scale, rigorously designed RCTs with standardized protocols are needed to strengthen the evidence base and inform clinical guidelines.

Key References (Ordered by Evidence Strength)

High-quality systematic reviews and meta-analyses (GRADE: Moderate to High)

Yang, J., Chen, J., Yang, M., Yu, S., Ying, L., Liu, G. J., Ren, Y. L., Wright, J. M., & Liang, F. R. (2018). Acupuncture for hypertension. Cochrane Database of Systematic Reviews, 11, CD008821. https://doi.org/10.1002/14651858.CD008821.pub2

Pan, X., Tian, L., Yang, F., Sun, J., Li, X., An, N., Xing, Y., Su, X., Liu, X., Liu, C., Gao, Y., & Xing, Y. (2021). Tai Chi as a therapy of Traditional Chinese Medicine on reducing blood pressure: A systematic review of randomized controlled trials. Evidence-Based Complementary and Alternative Medicine, 2021, 4094325. https://doi.org/10.1155/2021/4094325

Xiong, X., Wang, P., Li, X., & Zhang, Y. (2015). Qigong for hypertension: A systematic review. Medicine (Baltimore), 94(1), e352. https://doi.org/10.1097/MD.0000000000000352

Shi, L., Zhang, D., Wang, L., Zhuang, J., Cook, R., & Chen, L. (2017). Meditation and blood pressure: A meta-analysis of randomized clinical trials. Journal of Hypertension, 35(4), 696–706. https://doi.org/10.1097/HJH.0000000000001217

Ma, J., Ma, L., Sun, Y., & Bao, H. (2023). The effect of traditional Chinese exercises on blood pressure in patients with hypertension: A systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2023, 2897664. https://doi.org/10.1155/2023/2897664

Moderate-quality systematic reviews and meta-analyses (GRADE: Low to Moderate)

Chen, H., Shen, F. E., Tan, X. D., Jiang, W. B., & Gu, Y. H. (2018). Efficacy and safety of acupuncture for essential hypertension: A meta-analysis. Medical Science Monitor, 24, 2946–2969. https://doi.org/10.12659/MSM.909995

Zhang, S., Bai, X., Chen, Z. L., Li, J., Chen, Y. Y., & Tang, Y. (2020). Qiju Dihuang Decoction for hypertension: A systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2020, 9403092. https://doi.org/10.1155/2020/9403092

Dong, X., Shi, Z., Ding, M., & Yi, X. (2021). The effects of Qigong for hypertension: A meta-analysis of randomized controlled trials. Evidence-Based Complementary and Alternative Medicine, 2021, 5622631. https://doi.org/10.1155/2021/5622631

Lu, Y., Li, L., Wang, Z., Huang, Y., Zhong, R., Xu, J., Liu, H., Wu, H., Cheng, L., & Wu, L. (2022). Randomized controlled trials of acupuncture for the treatment of essential hypertension: A meta-analysis. Journal of Acupuncture and Tuina Science, 20, 330–338. https://doi.org/10.1007/s11726-022-1330-8

Lower-quality or preliminary evidence (GRADE: Low to Very Low)

Wang, J., & Xiong, X. (2013). Evidence-based Chinese medicine for hypertension. Evidence-Based Complementary and Alternative Medicine, 2013, 978398. https://doi.org/10.1155/2013/978398

Li, X., Chang, P., Wu, M., et al. (2024). Effect of Tai Chi vs aerobic exercise on blood pressure in patients with prehypertension: A randomized clinical trial. JAMA Network Open, 7(2), e2354937. https://doi.org/10.1001/jamanetworkopen.2023.54937