Blood Pressure and Your Spine

Main complications of persistent high blood pr...
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Journal of Human Hypertension 2007 (May);   21 (5):   347–352 ~ FULL TEXT

Bakris G, Dickholtz M, Meyer PM, Kravitz G, Avery E, Miller M, Brown J, Woodfield C, Bell B

Department of Preventive Medicine, Rush University Hypertension Center, Chicago, IL, USA

Anatomical abnormalities of the cervical spine at the level of the Atlas vertebra are associated with relative ischaemia of the brainstem circulation and increased blood pressure (BP). Manual correction of this mal-alignment has been associated with reduced arterial pressure. This pilot study tests the hypothesis that correcting mal-alignment of the Atlas vertebra reduces and maintains a lower BP. Using a double blind, placebo-controlled design at a single center, 50 drug naive (n=26) or washed out (n=24) patients with Stage 1 hypertension were randomized to receive a National Upper Cervical Chiropractic (NUCCA) procedure or a sham procedure. Patients received no antihypertensive meds during the 8-week study duration. The primary end point was changed in systolic and diastolic BP comparing baseline and week 8, with a 90% power to detect an 8/5 mm Hg difference at week 8 over the placebo group. The study cohort had a mean age 52.7+/-9.6 years, consisted of 70% males. At week 8, there were differences in systolic BP (-17+/-9 mm Hg, NUCCA versus -3+/-11 mm Hg, placebo; P<0.0001) and diastolic BP (-10+/-11 mm Hg, NUCCA versus -2+/-7 mm Hg; P=0.002). Lateral displacement of Atlas vertebra (1.0, baseline versus 0.04 degrees week 8, NUCCA versus 0.6, baseline versus 0.5 degrees , placebo; P=0.002). Heart rate was not reduced in the NUCCA group (-0.3 beats per minute, NUCCA, versus 0.5 beats per minute, placebo). No adverse effects were recorded. We conclude that restoration of Atlas alignment is associated with marked and sustained reductions in BP similar to the use of two-drug combination therapy.

From the Full-Text Article:


The findings of this pilot study represent the first demonstration of a sustained BP lowering effect associated with a procedure to correct the alignment of the Atlas vertebra. The improvement in BP following the correction of Atlas misalignment is similar to that seen by giving two different antihypertensive agents simultaneously. [11, 12] Moreover, this reduction in BP persisted at 8 weeks and was not associated with pain or pain relief or any other symptom that could be associated with a rise in BP.

Other studies support the notion that changes in the cerebral circulation that is related to the position of the Atlas vertebra can affect BP. Coffee et al. [9] reviewed MR images and demonstrated a significant association between pulsatile arterial compression of the ventrolateral medulla and presence of hypertension. They concluded that subjects with hypertension should have an evaluation of their posterior fossa for evidence of anatomic abnormalities. [9 ] In fact, data linking changes in Atlas anatomy and posterior fossa circulatory changes associated with hypertension date back more than 40 years and are reviewed by Reis. [4]

The mechanism as to why this improvement in BP occurs is unknown and cannot be determined by this study. What is clear is that a significant change in sympathetic tone is probably not a major contributing mechanism as heart rate was not significantly changed. The data presented, however, raises a number of important questions including: (a) how does misalignment of C1 affect hypertension? (b) If there is a cause and effect relationship between C1 misalignment and hypertension is malposition of C1 an additional risk factor for the development of hypertension?

What is clear is that misalignment of the Atlas vertebra can be determined by assessment of the alignment of the pelvic crests. This should be considered in those who have a history of hypertension and require multiple medications for treatment. Additionally, it should be considered in those with refractory hypertension and a history of neck injuries, independent of the presence of pain. Note that pain was not present in any of the patients randomized in this study.

As discussed in the Methods section of this paper, techniques are now available to screen for atlas misalignment. This type of screening should be the responsibility of the primary care physician and should be performed on patients who have a history of head and neck trauma even if it is deemed insignificant. Those patients who present with pain related to head and neck trauma should not be screened. At a time when the prevalence of hypertension is increasing and its control more difficult due to a variety of factors, linking the correction of C1 misalignment to the subsequent lowering of BP may represent an important advancement in the screening of such patients.

This pilot study has limitations including the fact that it was dependent on the skill of one practitioner to do the manipulation. It was designed, however, to test the concept that nonsurgical manipulation can alleviate elevations in BP, thus it cannot be generalized until confirmed in a larger trial, which is being planned.

What is known about this topic:

  • The relationship between hypertension and presence of circulatory abnormalities in the area around the Atlas vertebra have been known for more than 40 years [3–5]
  • Recent studies by Akimura et al. [8] noted compression of the ventrolateral branches of the vertebral artery in the area around the Atlas vertebra in 90.6% hypertensive cases
  • Thus, alterations in Atlas anatomy can generate changes in the vertebral circulation that may be associated with elevated levels of blood pressure

What does this study add

  • This pilot study provides evidence that nonsurgical interventions to align the Atlas vertebra provide long-term amelioration in blood pressure
  • It provides the first nonsurgical approach to alleviating elevations in blood pressure


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Why Health Care Costs for LBP Are So High

Initiating care with an MD for back pain results in much higher health care costs than going to a DC, says study.

By Peter W. Crownfield

With the much-touted Choudhry/Milstein study already putting insurers and other health care stakeholders on notice that chiropractic care for back pain “is highly cost-effective [and] represents a good value in comparison to medical physician care and to widely accepted cost-effectiveness thresholds,” along comes “Cost of Care for Common Back Pain Conditions Initiated With Chiropractic Doctor vs. Medical Doctor / Doctor of Osteopathy as First Physician.”

Published in the December 2010 issue of JMPT, the study, a retrospective claims analysis of Blue Cross Blue Shield of Tennessee’s intermediate and large group fully insured population, determined that paid costs for episodes of care were 40 percent lower when care was initiated with a doctor of chiropractic compared to an allopathic provider. Even when risk-adjusting each patient’s costs to account for severity, paid costs for chiropractic patients were 20 percent lower than medical patients treated for low back pain.

“Our results support a growing body of evidence that chiropractic treatment of low back pain is less expensive than traditional medical care,” stated the study authors in their conclusion. “We found that episode cost of care for LBP initiated with a DC is less expensive than care initiated through an MD. … Our results suggest that insurance companies that restrict access to chiropractic care for LBP may, inadvertently, be paying more for care than they would if they removed these restrictions.”

Health Care Cost In their study, the researchers identified Blue Cross Blue Shield of Tennessee members with an LBP claim based on the presence of any of the following ICD-9 codes on a paid claim: 722 Intervertebral disk disorders, 724 Other and unspecified disorders of back, 729 Other disorders of soft tissues, 739 Nonallopathic lesions not elsewhere classified, 846 Sprains and strains of sacroiliac region, and 847 Sprains and strains of other and unspecified parts of back. Of more than 650,000 members during the two-year period analyzed (Oct. 1, 2004 – Sept. 30, 2006), 85,402 had been diagnosed using one of the above codes.

Plan members had open access to MDs and DCs through self-referral (ER visits were categorized as MD-initiated care), without any limit to the number of visits. Co-pays did not vary between provider type.

Total episode costs for each episode of LBP were determined by calculating the cost paid by the insurer for all services provided during the episode by the same and other providers. Costs per episode were $452.33 (paid) for patients initiating care with a chiropractor and $1,037.04 for patients initiating care with a medical provider; risk-adjusted paid costs were $532.54 (DC) vs. $661.10 (MD).

“As doctors of chiropractic, we know firsthand that our care often helps patients avoid or reduce more costly interventions such as drugs and surgery. This study supports what we see in our practices every day,” said ACA President Rick McMichael, DC, in an ACA release reporting on the study findings. “It also demonstrates the value of chiropractic care at a critical time, when our nation is attempting to reform its health care system and contain runaway costs.”

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Forward Head Posture…The Missing Link to Health!

Many people are unaware of the consequences from neglecting the spine. It requires attention. If you lack the proper spinal care, you will pay the price.

Look at just a few of the things that forward head posture creates:

According to Rene Cailliet MD, director of the Department of Physical Medicine and Rehabilitation at the University of Southern California, forward head posture can add up to 30 pounds of abnormal leverage on the cervical spine. This can pull the entire spine out of alignment. FHP results in loss of vital capacity of the lungs by as much as 30 percent. This shortness of breath can lead to heart and blood vascular disease. The entire gastrointestinal system is affected; particularly the large intestine. Loss of good bowel peristaltic function and evacuation is a common effect of FHP.

It causes an increase in discomfort and pain because proprioceptive signals from the first four cervical vertebrae are a major source of the stimuli which create the body’s pain controlling chemicals (endorphins). With inadequate endorphin production, many otherwise non-painful sensations are experienced as pain. FHP dramatically reduces endorphin production.

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