Early Detection of Possible Hypertension in a Solo Acupuncture Clinic: A Single Case Report Using an AI-Supported Escalation Pathway

Background Elevated blood pressure is often asymptomatic, yet delayed recognition may contribute to stroke, myocardial infarction, heart failure, and kidney disease. Community-based nonphysician clinics may encounter such findings during routine care, but often lack a clear process for repeat measurement, referral, and hand-off. Objective To describe a practical workflow for early recognition of possible hypertension in a solo acupuncture clinic, using artificial intelligence (AI) to support information organization and documentation. Setting Solo acupuncture and moxibustion clinic in urban Japan. Intervention The workflow included red-flag screening, standardized repeat blood pressure measurement, and a three-route structure: R1 (same-day urgent referral), R2 (planned physician evaluation added while local conservative care continued), and R3 (continued local care with reassessment). The R1/R2/R3 structure was designed as a general escalation framework for nonphysician practice and, in this case, was applied to repeated elevated blood pressure without acute red flags. A large language model was used to help structure red-flag prompts, organize serial measurements, and summarize referral information, with full human review and editing. Case A man in his 70s presented with right shoulder pain and stiffness. No urgent red flags were identified. However, post-session blood pressure remained in the hypertensive range across repeated visits, prompting R2 referral to his primary care physician while conservative acupuncture care continued. Results The workflow supported consistent recognition of repeated abnormal readings, explicit referral to physician care, and documented hand-off without diagnostic overreach by the clinic. According to the patient’s report, the physician recommended home blood pressure monitoring and follow-up evaluation. Because the patient did not already have a home blood pressure monitor, the clinic assisted with the practical setup of home monitoring while conservative acupuncture care continued. No acute deterioration occurred during the observation period. Conclusions A simple escalation pathway may help a solo nonphysician clinic act as a safe point for early recognition of possible hypertension. In this setting, AI improved consistency of red-flag organization, documentation, and referral preparation, but final clinical decisions remained human. Plain Language Summary Hypertension (high blood pressure) can be difficult to recognize because patients may not show any other symptoms; however, it can still progress and lead to serious problems, such as stroke, heart failure, and kidney disease. Early recognition of hypertension is key to preventing these health conditions and harm. As trusted community settings outside of medical clinics have opportunities to measure blood pressure (BP), a nonphysician practitioner at a solo acupuncture and moxibustion clinic in Japan developed a practical workflow to track BP and symptoms and determine whether repeated high BP might warrant referral to a doctor for further diagnosis. In this workflow, if the patient has an elevated BP on arrival at the clinic, a second measurement is taken after the session. If their BP remains high over three subsequent visits, without any red flags (urgent symptoms such as chest pains) indicating the need for immediate medical intervention, they are referred to a physician for evaluation. Otherwise, local care continues with later reassessment. This case report describes a man in his 70s who had pain and stiffness in his right shoulder, which prompted red-flag screening. Although the acupuncture clinician identified no urgent health concerns, high BP readings over several visits triggered referral and hand-off to a primary care physician, who recommended home BP monitoring and follow-up evaluation. Artificial intelligence supported consistent documentation and organization of information for human clinical judgement and communication.