NEW YORK — Spinal manipulation reduced the systolic pressure in selected patients with hypertension in a controlled pilot study with 50 patients.
Realignment of the atlas vertebra seemed to lower the systolic blood pressure of 25 patients during 8 weeks of follow-up without drug therapy. A control group of 25 patients who underwent a mock realignment had no reduction in their systolic pressure, Dr. George L. Bakris and his associates reported in a poster at the annual meeting of the American Society of Hypertension.
“We're now writing a proposal to submit to the National Center for Complementary and Alternative Medicine to get funding for a larger study to look at this treatment in greater detail,” said Dr. Bakris, professor of preventive medicine and director of the Hypertension/Clinical Research Center at Rush University in Chicago.
It is unclear why atlas realignment has this effect. Anatomical abnormalities of the cervical spine at the level of the atlas vertebra are associated with relative ischemia of the brainstem circulation and increased blood pressure. Impaired blood supply to the brain may affect the sympathetic nervous system and sympathetic tone, Dr. Bakris said in an interview.
The pilot study enrolled patients with stage 1 hypertension who had no neck pain and evidence of atlas misalignment on preliminary screening. The patients were either withdrawn from their antihypertensive medications or had been treatment naive at entry to the study.
The atlas realignment procedure used was the standard treatment of the National Upper Cervical Chiropractic Association. Briefly, the patient's head is placed on a curved, mastoid support, which acts as a fulcrum. The clinician pushes on a “corner” of the atlas's transverse process, using nudges to cause the atlas vertebra to recoil into a normal alignment. All of the realignments were done by chiropractor Marshall Dickholtz Sr., who practices in Chicago.
The control patients underwent a sham procedure so that correct alignment wasn't achieved.
At baseline, average systolic BP was 150 mm Hg in the control patients and 147 mm Hg in the patients who then underwent a real realignment procedure.
The average systolic pressure of the actively treated patients began to show a significant drop relative to the control patients at 3 weeks after treatment, and their systolic pressure steadily declined during the next 5 weeks. By 8 weeks, the average systolic pressure in the treated group was less than 130 mm Hg.
By contrast, the control group had no drop in pressure throughout follow-up. At 8 weeks after their sham procedure, the average systolic pressure was unchanged, at about 148 mm Hg.
It is not clear how many patients are potentially eligible for this treatment. Dr. Bakris guessed that in the United States perhaps as many as 5 million people with hypertension have an atlas misalignment.
On the basis of what is currently known about this misalignment, an ideal candidate for realignment would have hypertension with no neck pain, no family history of hypertension, and no other obvious cause of his or her high blood pressure. And when lying flat, one of the patient's legs would be about 0.2-1.0 cm shorter than the other.
Atlas realignment, performed here by chiropractor Marshall Dickholtz Sr., significantly reduced systolic BP in a pilot study. Courtesy Dr. Marshall Dickholtz Sr.