Chiropractic for Hypertension in Patients (CHiP)

• To determine if patients receiving the low-velocity, non-rotary upper cervical procedure have a different BP outcome when compared to those receiving the high-velocity non-rotary upper cervical procedure. [ Time Frame: 4 weeks, 8 weeks, 12 weeks and 6 months ] [ Designated as safety issue: No ]
• To establish a reliable method of measuring the atlas alignment using plain film x-ray. [ Time Frame: 8 weeks ] [ Designated as safety issue: No ]
• To explore the relationship between atlas alignment change, as measured by x-ray, and blood pressure change [ Time Frame: 4 weeks, 8 weeks, 12 weeks and 6 months ] [ Designated as safety issue: No ]
• To determine the durability of Systolic and Diastolic Blood Pressure reduction in the active treatment group(s) across the 6-month follow up period. [ Time Frame: 6 months ] [ Designated as safety issue: No ]

The investigators propose a prospective randomized 2 arm parallel observer-blinded phase II clinical study comparing a distinct method of upper cervical chiropractic manipulation to a sham technique in 50 individuals with stage I hypertension (systolic blood pressure (SBP): 140-159 mm Hg; diastolic blood pressure (DBP):90-99 mm Hg).

More than 50 million Americans suffer from hypertension, a disease with far-reaching public health impact causing or contributing to 7.1 million deaths yearly at an estimated annual incremental direct cost of $54 billion per year. Common treatments include antihypertensive medications and lifestyle modifications. While these treatments have been shown to be effective, only about 30% of hypertensive patients achieve blood pressure goals. Based on a recently published study (Bakris et al, 2007), one unique non-pharmaceutical approach may be a non-rotary type of upper cervical spinal manipulation to align the first cervical vertebra (atlas) performed by a doctor of chiropractic. We propose to conduct a similar study with a more commonly known chiropractic technique called Toggle Recoil. We propose a prospective randomized 2 arm parallel observer-blinded phase II clinical study comparing a distinct method of upper cervical chiropractic manipulation to a sham technique in 50 (25 in each group) individuals with Stage I hypertension (systolic blood pressure (SBP); 140-159 mm Hg or diastolic blood pressure (DBP):90-99 mm Hg). Patients will be seen by doctors of chiropractic twice each week for 6 weeks and outcomes will be collected at baseline, 3 weeks, and 6 weeks after enrollment. The primary outcome measure will be change in SBP and the primary endpoint will be at the week 6 assessment.

• Other: Spinal Manipulation
  The procedure in its broadest definition describes the application of a load (force or displacement) to specific body tissues (usually vertebral joints) with therapeutic intent. The mechanical characteristics of SM can vary in terms of its duration and amplitude, (hence, the rate at which it is applied), as well as its anatomical location, choice of levers, direction of force application, and the vehicle used to apply the force (manually or mechanically assisted).
  Other Name: Spinal Manipulation
• Other: Sham Spinal Manipulation
  The sham assessment procedures will be the same as those in the high velocity treatment group. The sham intervention is identical to this treatment protocol except for the placement of the treating clinicians pisiform contact. The force and vector applied will be the same.
  Other Name: Sham

• Active Comparator: Spinal Manipulation High Velocity
  This non-rotary upper cervical procedure uses an impulse thrust with a controlled depth (high velocity). The participant's head is supported by a specially designed cushion and the doctor usually approaches the participant from in front of his or her head to contact soft tissue over the atlas transverse process, posterior to the lateral mass or occasionally on the C2 lamina or spinous process, with the pisiform process of one hand. The thrust is delivered by a contraction of the triceps muscles of both arms, which straightens the arms and applies the thrust to the participant.
  Intervention: Other: Spinal Manipulation
• Placebo Comparator: Sham Spinal Manipulation
  The sham assessment procedures will be similar to the active group. It has been developed and validated by Vernon et al.
  Intervention: Other: Sham Spinal Manipulation

Inclusion Criteria:

• Age > 21 and < 75
• Documented Stage I Hypertension

Exclusion Criteria:

• Cardiovascular disorders (Angina pectoris, symptom of CHD; Hemodynamically significant valvular heart disease; Second or Third degree heart block without pacemaker; Stroke, MI, CV surgery within the past 12 months; Claudication, Aortic Coarctation)
• Defibrillator
• Autoimmune Arthropathies
• Pregnancy
• Unwillingness to stop other forms of manual therapy during study
• Unwillingness to sign ICD or preliminary consent
• Intention to move from the area during the next 4 months
• Unwillingness to participate in any of the treatment groups
• Avg SBP<140 or >159mm Hg (AND) Avg DBP<90 or >99mm Hg
• Any single SBP > 160mm Hg or DBP> 100
• BMI > 40
• Prescription medications with increased risk for CVA
• Current use of anti-coagulant medication/blood thinners
• Active drug or alcohol addiction or abstinent < 1 year
• Psychiatric diagnosis that would limit patient compliance
• Serious concomitant medical illness
• Contraindication(s) to treatment
• Electrolyte abnormalities seen on lab test
• Renal Failure w/ creatinine >2.5mg/dL
• Abnormal Liver function tests
• Anemia with hematocrit < 30%
• Glucose in Urine
• Serum potassium <3.4 @ baseline
• S/S Renal artery stenosis
• Quebec Task Force Classification 4-9
• Self-reported Arnold Chiari malformation
• Spinal or paraspinal tumors
• Dx with disorder that exhibit spinal joint hypermobility (Marfan Syndrome, Ehlers-Danlos Syndrome, Osteogenesis imperfecta)
• Unstable endocrine disorders
• Osteoporosis