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Blood pressure lowering effects of non-surgical procedures for vascular decompression: good news to be taken with caution

Journal of Human Hypertension volume 21, pages 341–342 (2007)Cite this article

The notion that the central nervous system participates at the development, maintenance and progression of the essential hypertensive state dates back to almost a century ago and throughout the years it has received a consistent number of experimental and clinical supports. These include the evidence that central neural factors participate at the short- and long-term blood pressure control and that abnormalities in neurogenic modulation of the cardiovascular function characterize the early as well as the more established forms of the essential hypertensive state.1 A further support to the so-called ‘neurogenic hypothesis’ of hypertension comes from the evidence of a close link between some hypertensive states and neurovascular compression of the rostral ventrolateral medulla, that is, an area of the central nervous system with an important efferent pathway of the sympathetic nervous system.2, 3, 4, 5 This association is strengthened by the evidence that in different experimental animal models electrical, chemical or mechanical stimulation of the ventricular medulla triggers a transient pressor response.6, 7 It is also strengthened by the finding that in subgroups of patients with severe and/or resistant hypertension microsurgical decompression at the level of the rostral ventrolateral medulla substantially improves blood pressure control, leading to a long-term blood pressure normalization in a not negligible number of patients.3, 8, 9, 10 The favourable haemodynamic outcome of the surgical intervention is likely to be triggered by a sympathetic deactivation, as several indirect and/or direct markers of adrenergic neural drive, such as plasma and urinary noradrenaline, low-frequency/high-frequency spectral power ratio as well as efferent postganglionic sympathetic nerve firing rate, have all shown a consistent and rather homogeneous reduction of adrenergic cardiovascular drive following surgical decompression.10, 11

In the present issue of the Journal of Human Hypertension, Bakris et al.12 add a new piece of information to the above-mentioned findings, by providing evidence on the favourable blood pressure lowering effects of chiropractic procedures capable to correct misalignment of the Atlas vertebra and thus to induce medullary vascular decompression. According to a double-blind, placebo-controlled study design, hypertensive patients with documented evidence of vertebral misalignment were randomized either to a chiropractic vertebral realignment procedure or to a sham intervention. The primary efficacy end point of the study was represented by the effects of the approach on sphygmomanometric systolic and diastolic blood pressure values, which were reduced at the end of the 8-week follow-up period by about 14 and 8 mm Hg, respectively (placebo-corrected values).12

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  1. Dipartimento di Medicina Clinica, Clinica Medica, Prevenzione e Biotecnologie Sanitarie, Università Milano-Bicocca, Ospedale San Gerardo, Monza (Milan), Italy

    G Grassi

  2. Istituto Auxologico Italiano, Milan, and Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Milan, Italy

    G Grassi

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Grassi, G. Blood pressure lowering effects of non-surgical procedures for vascular decompression: good news to be taken with caution. J Hum Hypertens 21, 341–342 (2007). https://doi.org/10.1038/sj.jhh.1002134

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