From peripheral initiation to central integration: a narrative review of the antihypertensive mechanisms of acupuncture in regulating autonomic nervous system homeostasis

Essential Hypertension (EH) is one of the most prevalent chronic cardiovascular diseases, imposing a significant burden on healthcare systems worldwide due to its high rates of disability and mortality. Long-term elevation of blood pressure leads to multi-organ damage in the heart, brain, and kidneys, resulting in severe complications such as coronary heart disease, stroke, and chronic kidney disease. Current treatment for hypertension primarily relies on pharmacological interventions. Although antihypertensive drugs have achieved notable success in controlling blood pressure, challenges remain, including poor long-term medication adherence, side effects, and inadequate blood pressure control in some patients with resistant hypertension. In parallel, acupuncture, a key modality of traditional Chinese medicine, has demonstrated unique advantages in hypertension management in recent years. Characterized by its holistic regulatory effects and minimal side effects, acupuncture is recognized by the World Health Organization as a recommended complementary and alternative therapy for hypertension, although its precise mechanisms remain incompletely understood. This review aims to summarize the "peripheral-central synergy" antihypertensive mechanism of acupuncture in regulating autonomic nervous system (ANS) homeostasis. Studies indicate that acupuncture primarily modulates autonomic homeostasis through the following pathways: (1) activating peripheral nerve fibers to convert physical stimulation into complex bioelectrical signals; (2) regulating synaptic neurotransmitter release and the expression of related membrane receptors; (3) modulating the synaptic microenvironment; (4) regulating the NTS-CVLM-RVLM neural circuit; and (5) modulating the HPA axis neuro-endocrine circuit. Through in-depth analysis, this review elucidates the multi-level and multi-dimensional impact of acupuncture therapy on primary hypertension, providing stronger evidence and a theoretical foundation for its clinical application.