The effect of acupuncture on twenty-four-hour ambulatory blood pressure and circadian rhythm in patients with essential hypertension: A systematic review and meta-analysis of randomised controlled trials

This study aimed to evaluate the effect of acupuncture on 24-hour ambulatory blood pressure (BP) and its circadian rhythm in patients with essential hypertension (EH). A systematic search was conducted across five English databases (PubMed, the Cochrane Library, Embase, Web of Science and The National Library of Medicine) and four Chinese databases (China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Literature Database and VIP Chinese Science and Technology Journal Full-Text Database). The search period for each database was from inception to 31 May 2025. A meta-analysis was performed using RevMan 5.4.1 software. A total of 13 randomised controlled trials, involving 1,080 patients with EH, were included. The meta-analysis results showed that compared with the control group, the experimental (acupuncture) group demonstrated significantly lower values in the following parameters: 24-hour average systolic BP (SBP) (MD = −3.57, 95% confidence interval [CI]: −5.04 to −2.10, p < 0.001), 24-hour average diastolic BP (DBP) (MD = −3.61, 95% CI: −5.12 to −2.10, p < 0.001), 24-hour SBP variability (MD = −1.15, 95% CI: −1.57 to −0.73, p < 0.001), 24-hour DBP variability (MD = −0.96, 95% CI: −1.27 to −0.65, p < 0.001), 24-hour SBP load (MD = −3.47, 95% CI: −5.76 to −1.17, p = 0.003) and 24-hour DBP load (MD = −2.20, 95% CI: −4.08 to −0.31, p = 0.02). Compared with Western medication alone, acupuncture combined with Western medication shows significant advantages in improving ambulatory BP parameters, including 24-hour average BP, 24-hour BP variability, 24-hour BP load and the BP circadian rhythm. This study employed a systematic review and meta-analysis to evaluate the effect of acupuncture on 24-hour ambulatory blood pressure (BP) and circadian rhythm in patients with essential hypertension. The results revealed that, compared with Western medication alone, acupuncture combined with Western medication demonstrated significant advantages in improving ambulatory BP parameters, including 24-hour average BP, 24-hour BP variability, 24-hour BP load and the BP circadian rhythm. An innovative aspect of this study is its use of meta-analysis to synthesise and evaluate clinical research on acupuncture for patients with EH quantitatively, thereby enhancing statistical power. The findings may provide more reliable evidence-based support for clinical practice than individual studies.