Asserted and neglected issues linking evidence-based and Chinese medicines for cardiac rehabilitation

High blood pressure is among the most prevalent chronic disease in adults that impacts on the quality of life of patients, which are often subjected to physical rehabilitation. Chinese medicine intervention in patients with hypertension presents promising albeit inconclu-sive results, mostly due to methodological issues. This paper discusses asserted and neglected issues linking evidence-based and Chinese medicines as related to systemic arterial hypertension, as well as their impact on the physical rehabilitation of those patients. On the one hand, natural history of hypertension, pulse palpa-tion, and herbal therapy are among the asserted issues because of the scientific evidence collected about them, either in favor or against its integration to the current medical practice. On the other hand, anatomical varia-tions of vessels and comparative physiology are among the most commonly neglected issues because previous researches on integrative medicine ignored the pos-sible effects of these issues as related to the study's outcome. The asserted issues highlighted in this paperstimulate the increasing use of Chinese medicine for health care and the continuity of research on integra-tive medicine in the cardiovascular field for rehabilita-tion. The neglected issues poses additional challenges that must not be overlooked in future research on this topic so that the integration of both traditional and cur-rent knowledge may be of benefit to the population with cardiovascular disease.

Traditional Chinese medicine wrist pulse-taking is associated with pulse waveform analysis and hemodynamics in hypertension

BACKGROUND： Pulse wave analysis（PWA） quantifies the phenomenon of pulse waveform propagation in patients with cardiovascular diseases, whereas pulse image analysis（PIA） is a subjective examination in traditional Chinese medicine. OBJECTIVE： This study evaluated the association of PIA with PWA and hemodynamics in patients with hypertension. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： This observational, cross-sectional study enrolled 45 patients（26 men,（55.2± 10.3） years, systolic blood pressure（155± 28） mm Hg, diastolic blood pressure（93± 17） mm Hg） for assessment of clinical and laboratorial data. MAIN OUTCOME MEASURES： Primary outcomes comprised： pattern differentiation based on an automated method; PIA at the radial artery using the ‘simultaneous pressing＇ method for identification of factors such as strength（strong/weak）, depth（superficial/deep）, and speed（fast/moderate/slow）; and PWA at the same artery using a noninvasive system. RESULTS： Significant multivariate main effects were observed for depth（l=0.648, F_（5,29）=3.149, P=0.022, h^2 =0.352）, strength（l=0.608, F_（5,29） =3.736, P=0.010, h^2 =0.392）, and speed（l=0.535, F_（5,29） =5.302, P=0.002, h^2 =0.465）. General effects comprised high values of PWA and blood pressure for superficial, strong, and fast pulse images. A strong pulse was found for pulse pressure ≥ 62.5 mm Hg and systolic blood pressure ≥ 149.5 mm Hg, whereas a superficial pulse was found for heart rate ≥ 58.25 beats/min; a fast pulse was found for heart rate ≥ 69.6 beats/min and pulse wave velocity ≥ 9.185 m/s. CONCLUSION： Associations were explained by La Place＇s law, arterial remodeling in hypertension, alongside the traditional criterion for classifying speed in pulse images. PIA is associated with PWA and hemodynamics in patients with hypertension. Systolic and pulse pressures, heart rate, and pulse wave velocity are quantitative variables that have information to describe the qualitative pulse images such as strength, depth and speed.