Review
Acupuncture for essential hypertension
Jie Wang1,Xingjiang Xiong1,Wei Liu?
Department of Cardiology,Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing100053,China
a b s t r a c t
a r t i c l e i n f o
Article history:
Received24July2013
Accepted2September2013 Available online6September2013
Keywords:
Acupuncture
Blood pressure
Hypertension
Systematic review Background:To systematically assess the current clinical evidence of acupuncture for hypertension.
Search strategy:The PubMed,EMBASE,Chinese Biomedical Literature Database(CBM),Chinese National Knowl-edge Infrastructure(CNKI),Chinese Scienti?c Journal Database(VIP),and Wan-fang Data in the Cochrane Library were searched until January,2013.All the randomized controlled trials(RCTs)based on acupuncture compared with western medicine,sham acupuncture or lifestyle intervention in patients with hypertension were included. RCTs were included as well as combined acupuncture with western medicine compared with western medicine. In addition,RCTs based on acupuncture compared with sham acupuncture combined with western medicine in patients with essential hypertension were included.No language restriction was used.Review Manager5.1 software was used for data analysis.Study selection,data extraction,quality assessment,and data analyses were conducted according to the Cochrane standards.
Results:35randomized trials(involving2539patients)were included.The methodological quality of the included trials was evaluated as generally low.Two trials reported the effect of acupuncture compared with sham acupunc-ture in combinations of western medicine.Acupuncture signi?cantly reduced SBP(?7.47mm Hg,95%CI—10.43 to?4.5,P b0.00001)and DBP(?4.22mm Hg,95%CI—6.26to?2.18,P b0.0001)and no heterogeneity between studies was detected.However,other studies had substantial heterogeneity due to the quality of them was poor,and their sample sizes were not satisfactory as an equivalence study.Five trials described the adverse effects. Conclusions:While there are some evidences that suggest potential effectiveness of acupuncture for hypertension, the results were limited by the methodological?aws of the studies.Therefore,further thorough investigation, large-scale,proper study designed,randomized trials of acupuncture for hypertension will be required to justify the effects reported here.
?2013The Authors.Published by Elsevier Ireland Ltd.
1.Introduction
Hypertension is a well-recognized risk factor for cardiovascular dis-ease and stroke,which are the most frequent cause of deaths all over the world[1,2].It has been estimated that29%of the world's adult population,or≈1.56billion people,will have hypertension by the year of2025[3].Essential hypertension(EH),a complex disease, which accounts for95%of hypertensive cases,is an increasingly serious worldwide public-health challenge and is generally considered as a par-adigmatic multi-factorial disease that is determined by a combination of genetic factors,environmental stimuli and their interaction[4,5].The prevention and management of hypertension are major public health challenges.Evidence from randomized control trials(RCTs)has showed that a small reduction in blood pressure(BP)may result in a large re-duction in the risk of stroke and myocardial infarction[6,7].The antihy-pertensive treatment has made great progress in modern medicine. The therapeutic drugs include six classes of antihypertensive agents and?xed compound preparation[8–10].However,there is concern that the bene?ts demonstrated in RCTs of antihypertensive medication are not implemented in everyday clinical practice and that the long-term use of western medicine will produce some side effects,even pro-duce resistance and affect therapeutic ef?cacy,only53%of patients treated for hypertension had blood pressure actually controlled to ≤140/90mm Hg[11,12].Therefore,seeking for a new effective decom-pression method is an important subject of hypertension treatment.
Complementary and alternative medicine(CAM)is recognized and accepted in Europe and America that have developed a high degree of modern medicine,as an important complement to the western main-stream medicine system[13,14].Recent researches showed that CAM could be regularly recommended for lowering elevated blood pressure (BP)[15–17].Traditional Chinese Medicine(TCM)is a main component of CAM,including herbal medicine,acupuncture,moxibustion,and cup-ping,Taichi and Qigong.Acupuncture has been a component of the
International Journal of Cardiology169(2013)317–326
?Corresponding author at:Department of Cardiology,Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beixiange5#,Xicheng District,Beijing100053, China.Tel.:+861088001817;fax:+861088001229.
E-mail address:lvzyxxg@https://www.doczj.com/doc/3f917024.html,(W.Liu).
1These authors contributed equally in this
paper.
0167-5273?2013The Authors.Published by Elsevier Ireland Ltd.
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Chinese health-care system for at least2500years and is widely prac-ticed in the United States[18].Acupuncture is based on the TCM concept that there are channels(or“meridians”)of energy?ow(“qi”)within the body that help maintain the health of the individual and that dis-ease and pain result from imbalances of qi[19].Acupuncture as a nonpharmacological intervention has been used to treat a wide variety of condition to regulate cardiovascular diseases,and acupuncture ther-apy is used on patients with mild or borderline hypertension who want to avoid treatment cost,adverse effects,and complications[20].Possi-ble mechanisms by which acupuncture reduces blood pressure in hypertensive patients include decreases in plasma renin,aldosterone and angiotensin II activity[21,22],increased excretion of sodium and changes in plasma norepinephrine,serotonin and endorphin levels [23,24].Meanwhile,there have been a large number of clinical trials of acupuncture on hypertension and RCTs[25,26].In addition,several reviews claimed that acupuncture has therapeutic effects on blood pressure in patients with hypertension[27,28].These reviews are,how-ever,non-systematic and are therefore open to bias.The aim of this systematic review is to assess randomized clinical trials(RCTs)rigor-ously testing the effectiveness of acupuncture in human patients with hypertension.
2.Materials and methods
The supporting PRISMA checklist is available as supporting information;see Checklist S1.
2.1.Database and search strategies
Literature searches were conducted in the Cochrane Central Register of Controlled Trials(CENTRAL)in the Cochrane Library(January,2013),the PubMed,EMBASE,Chinese Biomedical Literature Database(CBM),Chinese National Knowledge Infrastructure(CNKI), Chinese Scienti?c Journal Database(VIP),Wan-fang Data.Databases in Chinese were searched to retrieve the maximum possible number of trials of acupuncture for essential hypertension because acupuncture is mainly used and researched in China.All of those searches ended on January,2013.Ongoing registered clinical trials were searched in the website of international clinical trial registry by U.S.National Institutes of Health (https://www.doczj.com/doc/3f917024.html,/).The following search terms were used individually or combined:‘hypertension’,‘blood pressure’,‘essential hypertension’,‘acupuncture’,‘electroacupuncture’(EA),‘clinical trial’,and‘randomized controlled trial’.The bibli-ographies of included studies were searched for additional references.
2.2.Inclusion criteria
All the parallel randomized controlled trials(RCTs)of all the prescriptions based on “acupuncture”compared with western medicine,sham acupuncture or lifestyle interven-tion in patients with hypertension were included.RCTs were included as well,combined “acupuncture”with western medicine compared with western medicine.In addition, RCTs based on acupuncture compared with sham acupuncture combined with western medicine in patients with essential hypertension were included.Studies were excluded if they were nonrandomized studies and/or involving other forms of acupuncture such as transcutaneous electrical nerve stimulation,laser acupuncture.There were no restric-tions on population characteristics,language and publication type.The main outcome measure was blood pressure.Duplicated publications reporting the same groups of partic-ipants were excluded.
2.3.Data extraction and quality assessment
Two reviewers(W.Liu,X.J.Xiong)extracted data and evaluated data's quality and content independently.We conducted data extraction using a standardized procedure. Initially,abstracts were screened to exclude obviously ineligible reports,and then all remaining articles were reviewed.We classi?ed trials and abstracts according to patient characteristics,study design,and therapy duration.Reviewing study design included the following criteria:methods of sequence generation,allocation concealment,complete description of those who were blinded,and use of intention-to-treat analysis and whether the trial was stopped prior to the planned duration,all methodological features in addition capable of impacting effect sizes.The outcome measures included BP and adverse events. The data was entered into an electronic database by the two reviewers separately, avoiding duplicate entries;in the case where the two entries did not match,an inspection will be conducted,and a third person may be involved for veri?cation.In order to obtain full information regarding conference abstracts,we had contacted the study authors by email and/or telephone communication.Disagreement was resolved by discussion and reached consensus through a third party(J.Wang).
The methodological quality of trials was assessed independently using criteria from the Cochrane Handbook for Systematic Review of Interventions,Version5.1.0(W.Liu, X.J.Xiong)[29].The items included random sequence generation(selection bias),allocation concealment(selection bias),blinding of participants and personnel(perfor-mance bias),blinding of outcome assessment(detection bias),incomplete outcome data (attrition bias),selective reporting(reporting bias),and other biases.The quality of all the included trials was categorized to low/unclear/high risk of bias(“Yes”for a low of bias,“No”for a high risk of bias,“Unclear”otherwise).Then trials were categorized into three levels:low risk of bias(all the items were in low risk of bias),high risk of bias(at least one item was in high risk of bias),unclear risk of bias(at least one item was in unclear).
2.4.Risk of bias across studies
Funnel plots were generated to visualize the possible publication bias.
2.5.Data synthesis
We used Revman5.1software provided by the Cochrane Collaboration for data anal-yses.Studies were strati?ed by the type of comparison.Continuous outcome will be presented as mean difference(MD)and its95%CI.Heterogeneity was recognized signi?-cant when I2≥50%.Fixed effects model was used if there is no signi?cant heterogeneity of the data;random effects model was used if signi?cant heterogeneity existed(50%b I2b85%).Publication bias was explored using a funnel plot.
3.Results
3.1.Description of included trials
A?ow chart depicted the search process and study selection(as shown in Fig.1).After primary searches from the databases,1081arti-cles were screened.After reading the titles and abstracts,976articles of them were excluded.Full texts of35articles[30–64]were retrieved, and70articles were excluded with reasons listed as the following: participants did not meet the inclusive criteria(n=34),duplication (n=5),no control group(n=10),Patients complicated with other diseases(n=10)and no data for extraction(n=11).In the end,35 RCTs were included,and all trials had been conducted in four different countries,most of the RCTs were conducted in China and published in Chinese(31trials),a German journal[61],and English journals [60,62,63].The characteristics of included trials were listed in Table1.
2539patients with essential hypertension were included,with the average number of72per trial,ranging from14to192.There was a wide variation in the age of subjects(18–78years).24trials speci?ed 10diagnostic criteria of hypertension,11trials[34,35,38,41,46–48, 50,52,55,64]used1999WHO–ISH guidelines for the management of hypertension(1999WHO–ISH GMH),3trials[30,40,56]used1998 WHO–ISH guidelines for the management of hypertension(1998 WHO–ISH GMH),3trials[39,42,49]used Chinese Guidelines for the Management of Hypertension—2005(CGMH—2005),one trials[37] used China Guidelines on Prevention and Management of High Blood Pressure—2006(CGPMHBP—2006),3trials[43,44,51]used 2000WHO–ISH guidelines for the management of hypertension (2000WHO–ISH GMH),one trial[58]used the National Forum on Epidemiology of Cardiovascular Diseases in1979,2trials[31,54]used 1978WHO–ISH guidelines for the management of hypertension (1978WHO–ISH GMH),2trials[53,60]used the Seventh Report of the Joint National Committee on Prevention,Detection,Evaluation, and Treatment of High Blood Pressure(JNC7),one trial used the pre-vention and control of hypertension guidelines of China2004,one trial[63]used European Society of Hypertension–European Society of Cardiology Guidelines2003,and7trials[32,33,36,45,57,61,62]only demonstrated patients with essential hypertension.
Interventions included acupuncture or electro-acupuncture alone, or combined with western medicine.Acupuncture was the sole treat-ment in25trials,whereas in10trials,acupuncture was used as an adjunct treatment for medication.The controls included western medi-cine compared alone,sham acupuncture or combined with western medicine,and lifestyle intervention.As for control,sham acupuncture was adopted for control in3trials[61,62],2trials[57,63]used sham acupuncture plus western medicine,whereas29[30–56,58,59]and one trial[64]used lifestyle intervention.Participants received10to 30min per session acupuncture treatments for mean32days(ranged
318J.Wang et al./International Journal of Cardiology169(2013)317–326
from10to90days).The most frequently used acupoints were HeGu (LI4),Tai Chong(LR3),Feng Chi(GB20),Qu Chi(LI11),and Bai Hui (GV20),followed by,Feng Long(ST40)and Nei Guan(PC6).All of the 24trials used the BP as the outcome measure,and5trials described the adverse effect[54,57,60–62].
3.2.Methodological quality of included trials
The methodological quality of most included trials was generally “poor”according to the prede?ned quality assessment criteria (Table2).The randomized allocation of participants was mentioned in all trials;however,only8trials stated the methods for sequence gener-ation including random number table[30,36,37,50,57,59,62]and draw-ing[34].However,insuf?cient information was provided to judge whether or not it was conducted properly.Allocation concealment was only mentioned in4RCTs[57,60,62,63].Double-blind was not mentioned in all trials.However,as the testing acupuncture and con-trolled drug were in different forms,neither the participants nor the investigators were likely to be blinded.Only one trial reported drop-out or withdraw[59].However,the trial did not intend to analyze the cause,and no trials used intention-to-treat analysis.None of the trials had a pre-trial estimation of sample size.Five trails reported information on follow-up[32,53,59,61,62].Selective reporting was generally unclear in the RCTs due to the inaccessibility of the trail protocol.
3.3.Effect of the interventions
35RCTs were included in the group of studies of patients with essen-tial hypertension([30–64]).The effect estimates of acupuncture were shown in the Figs.2–3.
3.3.1.Acupuncture versus western medicine
A total of19trials[30,31,33,34,37,41,42,44–52,54,55,59]reported the effect of acupuncture compared with western medicine on hyper-tension.A change in blood pressure was reported in11trials[37,41, 42,44,45,47,48,50,52,54,59]of the included RCTs.
Only4independent trials did show better effect:Yang[37]demon-strated that electro-acupuncture on Qu Chi(LI11)and Tai Chong(LR3)
Fig.1.PRISMA2009Flow diagram.319
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Table1
Characteristics and methodological quality of included studies.
Study ID Sample(M/F)Age(yrs)Diagnosis standard Intervention Control Course(day)Outcome
measure
Feng and Wu[30]60
T:18/12;C:14/16T:47.35±11.59
C:48.35±10.64
1998WHO–ISH GMH Acupuncture Captopril tablets
(25mg tid)
30(7days/week;
20min per day)
BP
Li and Niu[31]59
T:15/13;C:17/14T:61.4±9.2
C:61.7±9.6
1978WHO–ISH GMH Acupuncture Nimodipine(40mg tid)10(30min per day,
5days/course)
BP
Luo[32]68
T:25/13;C:21/9T:61.2
C:63.2
Hypertension diagnostic
criteria(unclear)
Acupuncture plus
western medicine
Western medicine90(15days/course)BP
Liu[33]50
M/F:18:32;
T:24;C:2618to70
(T/C not reported)
Hypertension diagnostic
criteria(unclear)
Acupuncture Captopril tablets30(once a day,
10days/course)
BP
Yang and Zhou[34]60
M/F:35:25;T1:20
T2:20C:20
35to75
(T/C not reported)
1999WHO–ISH GMH Acupuncture Hydrochlorothiazide
(12.5–25mg bid)
21(once a day,
7days/course)
BP
Liu[35]86
T:25/23;C:22/16T:63.2
C:61.5
1999WHO–ISH GMH Acupuncture plus
western medicine
Captopril tablets
(12.5mg bid or tid)
90(once a day,
15days/course)
BP
Zhang[36]80
T:29/16;C:24/11T:53.62±9.83
C:52.16±10.04
Hypertension diagnostic
criteria(unclear)
Acupuncture plus
western medicine
Benzene sulfonic acid
amlodipine piece
(2.5mg qd)
28(20min per day,
28days/course)
BP
Yang[37]98
T:17/13;C:20/10T:40.4±5.2
C:41.7±4.2
China Guidelines on
Prevention and Management
of High Blood Pressure—
2006(CGPMHBP—2006)
Electroacupuncture Captopril tablets
(12.5mg tid)
14(30min once a day)BP
Wang and Cheng[38]59
34/25
25to60
(T/C not reported)
1999WHO–ISH GMH Electroacupuncture
plus western medicine
Benazepril hydrochloride
tablets(10mg qd)
56(30min once a day,
56days/course)
BP
Jia et al.[39]92
T:32/14;C:30/16T:46.4±5.7
C:44.7±6.8
Chinese Guidelines for
the Management of
Hypertension—2005
(CGMH—2005)
Acupuncture plus
western medicine
Left-hand amlodipine
(5mg qd)
30(30min per day,
28days/course)
BP
Liu et al.[40]106
T:30/23;C:28/25T:46.4±5.2
C:45.2±6.3
1998WHO–ISH GMH Acupuncture plus
western medicine
Captopril tablets
(12.5mg tid)
30(20min per day)BP
Liao et al.[41]90
T:31/28;C:17/14T:56.5±7.9
C:55.6±8.6
1999WHO–ISH GMH Acupuncture Captopril tablets
(12.5mg tid)and
Aspirin enteric-coated
tablets(75mg qd)
14(30min every
time;twice a day,
7days/course)
BP
Ma et al.[42]80
T:25/15;C:22/18T:66.39±5.4
C:64.58±7.1
Chinese Guidelines for
the Management of
Hypertension—2005
(CGMH—2005)
Electroacupuncture Nicardipine piece
(20mg tid)
15(10min once a day,
15days/course)
BP
Hu et al.[43]60
T:20/10;C:22/8T:77.8±4.2
C:77.1±3.4
2000WHO–ISH guidelines
for the management
of hypertension
(2000WHO–ISH GMH)
Acupuncture plus
western medicine
Amlodipine(5mg qd)20(30min once a day,
10days/course)
BP
Chen et al.[44]70
T:19/16;C:19/16T:63.57±8.08
C:65.20±8.86
2000WHO–ISH GMH Acupuncture Nifedipine(10–20mg tid)14(15–30min once a
day,14days/course)
BP
Guo et al.[45]60
T:16/14;C:17/13T:32to64
C:32to65
Hypertension diagnostic
criteria(unclear)
Acupuncture Enalapril maleate
(10mg qd)
30(30min once a day,
28days/course)
BP
Huang et al.[46]60
T:18/12;C:20/10T:54.75±7.12
C:51.72±10.38
1999WHO–ISH GMH Acupuncture Metoprolol(100mg qd)14(30min once a day)BP
Wang et al.[47]60
T:20/10;C:21/9T:54.75±7.1
C:67.8±12.0
1999WHO–ISH GMH Acupuncture Metoprolol(100mg qd)28(30min once a day,
14days/course)
BP
Guo[48]80
T:22/18;C:23/17T:43.84±8.3
C:44.20±8.4
1999WHO–ISH GMH Acupuncture Enalapril maleate
(10mg qd)
30(30min once a day,
30days/course)
BP
Cheng[49]84
T:27/15;C:24/1830to65
(T/C not reported)
Chinese Guidelines for
the Management of
Hypertension—2005
(CGMH—2005)
Acupuncture Levamlodipine besylate
tablets(2.5mg qd)
20(30min every time,
the next day at a time,
10times/course)
BP
Huang et al.[50]60
T:14/16;C:13/17T:56.51±6.28
C:58.12±6.15
1999WHO–ISH GMH Acupuncture Captopril tablets
(25mg tid)
28(30min every time)BP
Zhang et al.[51]60
T:22/8;C:20/10T:56.5
C:55.5
2000WHO–ISH GMH Acupuncture Compound reserpine
tablets(1tablet tid)
15(30min once a day)BP
Ye et al.[52]100
T:28/22;C:26/24T:42to64
C:41to64
1999WHO–ISH GMH Acupuncture Metoprolol sustained
release tablet(12.5mg bid)
14(30min once a day)BP
Shen et al.[53]50
T:15/10;C:16/9T:57.32±8.2
C:58.21±7.3
Seventh Report of the Joint
National Committee on
Prevention,Detection,
Evaluation,and Treatment of
High Blood Pressure(JNC7)
Acupuncture plus
western medicine
Extended release
Nifedipine tablets
(20mg bid)
25(30min once a day,
10days/course)
BP
Dan[54]52
T:19/7;C:18/8T:57.8±10.9
C:58.4±11.6
1978WHO–ISH GMH Acupuncture Nifedipine(10mg tid)21(20–30min once a
day,5days/week)
BP;adverse
effect
Wu et al.[55]60
T1:7/13;
T2;6/14C:11/9T1:55.9±8.1
T2:55.6±6.0
C:55.00±6.4
1999WHO–ISH GMH Acupuncture Captopril tablets
(25mg tid)
5(30min once a day,
5days/course)
BP
Zhang et al.[56]75
T:28/17;C:19/11T:63.60±8.20
C:65.20±8.00
1998WHO–ISH GMH Acupuncture plus
western medicine
Nifedipine(10mg tid)20(30min once a day,
20days/course)
BP
320J.Wang et al./International Journal of Cardiology169(2013)317–326
Table 2
Quality assessment of included randomized controlled trials.Included trials Random sequence generation
Allocation concealment Blinding of participants and personnel Blinding of outcome assessment Incomplete outcome data Selective reporting Other sources of bias Risk of bias Feng [30]Table of random number Unclear Unclear Unclear Yes No Unclear Unclear Li [31]Unclear Unclear Unclear Unclear Yes No Unclear High Luo [32]Unclear Unclear Unclear Unclear Yes No Unclear High Liu [33]Unclear Unclear Unclear Unclear Yes No Unclear High Yang [34]Drawing Unclear Unclear Unclear Yes No Unclear Unclear Liu [35]Unclear
Unclear Unclear Unclear Yes No Unclear High Zhang [36]Table of random number Unclear Unclear Unclear Yes No Unclear Unclear Yang [37]Table of random number Unclear Unclear Unclear No No Unclear Unclear Wang [38]Unclear Unclear Unclear Unclear No No Unclear High Jia et al.[39]Unclear Unclear Unclear Unclear No No Unclear High Liu et al.[40]Unclear Unclear Unclear Unclear No No Unclear High Liao et al.[41]Unclear Unclear Unclear Unclear No No Unclear High Ma et al.[42]Unclear Unclear Unclear Unclear No No Unclear High Hu et al.[43]Unclear Unclear Unclear Unclear No No Unclear High Chen et al.[44]Unclear Unclear Unclear Unclear No No Unclear High Guo et al.[45]Unclear Unclear Unclear Unclear No No Unclear High Huang et al.[46]Unclear Unclear Unclear Unclear Yes No Unclear High Wang et al.[47]Unclear Unclear Unclear Unclear No No Unclear High Guo [48]Unclear Unclear Unclear Unclear No No Unclear High Cheng [49]
Unclear
Unclear Unclear Unclear Yes No Unclear High Huang et al.[50]Table of random number Unclear Unclear Unclear No No Unclear Unclear Zhang et al.[51]Unclear Unclear Unclear Unclear Yes No Unclear High Ye et al.[52]Unclear Unclear Unclear Unclear No No Unclear High Shen et al.[53]Unclear Unclear Unclear Unclear No No Unclear High Dan [54]
Unclear Unclear Unclear Unclear No No Unclear High Wu et al.[55]Unclear Unclear Unclear Unclear Yes No Unclear High Zhang et al.[56]Unclear
Unclear
Unclear Unclear No No Unclear High Yin et al.[57]Table of random number opaque envelopes Unclear Unclear Yes No Unclear Unclear Jiang et al.[58]Unclear
Unclear Unclear Unclear No No Unclear High Wan et al.[59]Table of random number Unclear
Unclear Unclear No No Unclear Unclear Kim et al.[60]Unclear opaque envelopes Unclear Unclear Yes No Unclear Unclear Kraft K.et al.[61]Unclear
Unclear
Unclear Unclear Yes No Unclear High Macklin [62]
Table of random number opaque envelopes Unclear Unclear Yes No Unclear Unclear Flachskampf [63]Unclear opaque envelopes Unclear Unclear Yes No Unclear Unclear Zhao and Fan.[64]
Unclear
Unclear
Unclear
Unclear
Yes
No
Unclear
High
Table 1(continued )Study ID Sample (M/F)Age (yrs)Diagnosis standard Intervention Control
Course (day)
Outcome measure
Yin et al.[57]
41
T:4/11;C:5/10T:49to 56C:51to 57Hypertension diagnostic criteria (unclear)
Acupuncture
Sham acupuncture plus antihypertensive medication
56(30min a day at an easy pace during the 8week period)
BP;adverse effect Jiang et al.[58]
60
T:24/6;C:22/8
T:56.7±10.3C:57.5±9.9
The National Forum on Epidemiology of Cardiovascular Diseases in 1979
Acupuncture plus western medicine
Captopril (12.5–25mg tid)
21(30min a day,once a day,for 6days as one therapeutic course)BP Wan et al.[59]60T:19/1;C:17/13T:63.72±8.23C:65.24±6.412004The prevention and
control of hypertension
guidelines of China
Electroacupuncture
Nicardipine tablets (20mg tid)15(10min once a day,5days/course)BP Kim et al.[60]33T:8/4;C:8/8T:52.08±8.69C:52.38±10.3Seventh report of the Joint
National Committee on
Prevention,Detection,
Evaluation,and Treatment of High Blood Pressure (JNC 7)
Acupuncture
Sham acupuncture
56(20min/time,twice a week)
BP;adverse effect
Kraft K.et al.[61]14(T/C not reported)50.0±4.6(T/C not reported)Hypertension diagnostic
criteria (unclear)
Acupuncture Sham acupuncture 84(20min/day)BP;adverse effect
Macklin [62]192T1:64T2:64C:64T1:56.8±8.4T2:55.9±10.6C:53.2±9.5
Hypertension diagnostic
criteria (unclear)
Acupuncture
Sham acupuncture
70(twice-weekly 30min)BP;adverse events
Flachskampf [63]160T:54/46;C:40/60T:58.8±8.2C:58.0±7.9European Society of
Hypertension –European
Society of Cardiology Guidelines 2003
Acupuncture
Sham acupuncture plus antihypertensive medication
42(each session lasted 30min.during the ?rst 2weeks,5sessions were administered weekly,and in the following 4weeks,3sessions were
administered weekly)BP;adverse events Zhao and Fan.[64]60
T:19/11;C:18/12T:40.3±11.4C:46.1±14.2
1999WHO –ISH GMH Acupuncture Lifestyle intervention
30(20min/day,10days/course)
BP Abbreviations:T,intervention group;C,control group.
321
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has long-term antihypertensive effect and improves effectively day–night rhythm variation in young patients with hypertension(systolic blood pressure[SBP]:mean difference=?6.89mm Hg,95%con?dence intervals=?7.25to?6.53;diastolic blood pressure[DBP]:?1.12,?1.94to?0.30);Liao et al.[41]have shown that“reducing south and reinforcing north”needling method have better effect than oral administration captopril tablets and Aspirin in reducing blood pressure(SBP:?6.89,?5.43to?4.57;DBP:?3.00,?4.31to?1.69); Huang et al.[50]considered that acupuncture treatment has obvious effect of decreasing blood pressure with very signi?cant differences as compared with those before treatment and the control group (SBP:?4.69,?6.64to?2.74;DBP:?3.31,?4.58to?2.04);Ye et al.[52]discovered that acupuncture has obvious antihypertensive effect,and the buck than metoprolol sustained release tablet groups (SBP:?5.28,?6.07to?4.49;DBP:?1.68,?2.30to?1.06).3.3.2.Acupuncture plus western medicine versus western medicine
Ten trials[32,35,36,38–40,43,53,56,58]compared the combination of acupuncture plus medicine compared with medicine compared.A change in blood pressure was reported in7trials[38–40,43,53,56,58] of the included RCTs.Among them,all trials demonstrated acupuncture combined western medicine is better than western medicine alone on SBP,and5trials[38,43,53,56,58]showed there are no statistically signif-icant differences on DBP.Acupuncture plus benazepril hydrochloride tablets[38]showed better effect compared to benazepril hydrochloride tablets.The combinations of acupuncture and left-hand amlodipine[39] had better effect compared to left-hand amlodipine.Acupuncture com-bined with captopril tablets[40,58]is superior to captopril tablets.Acu-puncture plus amlodipine[43]is better than amlodipine used alone.The combination of acupuncture and extended release nifedipine tablets [53,56]surpassed extended release nifedipine tablets.
Fig.2.The forest plot of outcome measure SBP.
322J.Wang et al./International Journal of Cardiology169(2013)317–326
3.3.3.Acupuncture versus sham acupuncture
A total of three trials[60–62]reported the effect of acupuncture individually compared with sham acupuncture.Among them,only one trial[61]discovered the better effect on both SBP and DBP(SBP:?2.60,?3.65to?1.55;DBP:?2.40,?3.45to?1.35).One trial[62] described acupuncture is superior to sham acupuncture to reduce DBP (?1.51,?1.81to?1.21).
3.3.
4.Acupuncture versus sham acupuncture plus western medicine
Two trials reported the effect of acupuncture compared with sham acupuncture in combinations of western medicine.One trial[57]dis-covered the better effect on both SBP and DBP(SBP:?7.00,?10.15 to?3.85;DBP:?4.00,?6.17to?1.83).The other trial[63]described that acupuncture is superior to the combination group to reduce SBP (?11.00,?19.62to?2.38).
3.3.5.Acupuncture versus lifestyle intervention
Only one trial showed acupuncture individually versus lifestyle in-tervention.There are statistically signi?cant differences on the acupunc-ture group to lifestyle intervention using alone(SBP:?13.50,?15.06 to?11.94;DBP:?5.25,?6.01to?4.49).
3.4.Adverse effect
Only six trials[54,57,60–63]described the adverse even.Among them,two trials recorded two speci?c symptoms including transient
Fig.3.The forest plot of outcome measure DBP.323
J.Wang et al./International Journal of Cardiology169(2013)317–326
slight injection-site pain [63]and small bleeding or spot-bleeding [57]in the acupuncture group.One trial reported three cases of serious ad-verse events,in which patients stopped antihypertensive drugs during study period [62],two participants experienced hypertensive urgencies in the acupuncture group and one congestive heart failure in the control group during follow-up.In addition,no adverse events were found in three trials [54,60,61].3.5.Publication bias
The forest plot of comparison of acupuncture versus western medi-cine for the outcome blood pressure was shown in the Figs.4–5.4.Discussion
Hypertension is a major public health problem with serious medical and ?nancial consequences.Medical interventions for those with severe hypertension generally have to use antihypertensive drugs such as diuretics,α-and β-blockers,angiotensin-converting enzyme inhibitors,and long-acting calcium-channel blockers [65].However,barriers to successful conventional pharmacological treatment include side effects,out-of-pocket expenses,patient noncompliance and insuf ?cient dos-ages of prescribed medications [66–69].An advantage of acupuncture is its relatively low incidence of serious or debilitating side effects [70].Two SRs [71,72]of acupuncture on hypertension have been reported,however,most of languages the selected databases of them are English except 4[60–63],much of the acupuncture literature in hypertension is in non-English language publications.Furthermore,electronic literature searches for RCTs to June 2007and September 2008,they might have left out some important studies,and new high-quality RCTs have been recently published.Therefore,we decided to assess the current clinical evidence of acupuncture for hypertension.
Based on the paper and meta-analyses of the outcome on either SBP or DBP,acupuncture may have positive effects for lowing BP.Five
subgroups were analyzed based on methodological variables of acupunc-ture arms and control arms.The BP-lowering effect of acupuncture plus western medicine was signi ?cantly higher than that of western medicine (SBP:?10.20,?14.00to ?6.40,P b 0.0001;DBP:?4.34,?6.79to ?1.90,P =0.0005).The BP also decreased signi ?cantly from baseline with acupuncture than sham acupuncture plus western medicine (SBP:?7.47,?10.43to ?4.5,P b 0.00001;DBP:?4.22,?6.26to ?2.18,P b 0.0001).Acupuncture achieved signi ?cant effect modi ?cation on BP change magnitude compared with lifestyle (SBP:?13.50,?15.06to ?11.94,P b 0.00001;DBP:?5.25,?6.01to ?4.49,P b 0.00001),whereas,compared with western medicine,acupuncture showed no sig-ni ?cant effect modi ?cation (SBP:?0.77,?3.89to ?2.35,P =0.63;DBP:0.10,?1.60to 1.79,P =0.91).Compared with sham acupuncture,acupuncture statistically showed no signi ?cant effect modi ?cation with statistically signi ?cant heterogeneity (SBP:0.26,?2.40to 2.91,P =0.25;DBP:?1.04,?2.56to 0.47,P =0.18).However,according to potential publication bias and low-quality trials,available data are not adequate to draw a de ?nite conclusion of acupuncture for essen-tial hypertension.And the positive ?ndings should be interpreted conservatively.
Before recommending the conclusion of this review to clinical practice,we have to consider the following weaknesses in this review.Firstly,in accordance with previous studies [73],the quality of the included RCTs was generally low.The 35trials included in this paper had risk of bias in terms of design,reporting,methodology.Only 8RCTs stated randomization procedure,for the rest 27trials,they just mentioned that ‘the patients were randomized into two groups ’with no further information.Allocation concealment was only mentioned in 4RCTs [57,60,62,63].A number of trials [32,33,35–37,48,49,54]only have one author,which is impossible for an RCT to be done properly in terms of randomization procedure and the allocation concealment.Therefore,we could suspect the truth of some of these claimed RCTs.In addition,all the trials did not describe the blinding in details.It directly led to performance bias and detection bias due to patients and researchers being aware of the therapeutic interven-tions for the subjective outcome measures.If poorly designed,all the trials would show larger differences compared with well designed trials [74,75].
Secondly,heterogeneity is worthy of being paid attention to.Many factors affect the effects of heterogeneity,such as acupuncture modali-ties,acupoint selection,frequency and duration of the treatment sessions.One of the major limitations was the application of various kinds of acupuncture point treatments used in different trials.More than 30different acupoints were investigated in the 35trials.The acupoints differed in meridians,syndromes,and the clinical ef ?cacy.It is dif ?cult to assess the effect of a particular acupuncture point by means of the evidence synthesis of studies.As a result,it is impossible to conduct meaningful meta-analysis for a speci ?c acupoints,or dif ?cult to undertake subgroup analyses to explore speci ?c factors that may have an impact on the effects of the treatment regimen.In addition,two acupuncture modalities were reported,i.e.manual acupuncture and electroacupuncture.Most of them used manual acupuncture and electroacupuncture was selected in 4RCTs [37,38,42,59].In addition,the differences of frequency and duration of the treatment sessions (10to 30min per session acupuncture treatments,ranged from 10to 90days)affected the effects of acupuncture,thus made contributions to the great heterogeneity.Not only that,all trials speci ?ed 10diagnos-tic criteria of hypertension without 7,selective reporting bias might exist in this conclusion,and reduce the homogeneity of the research objects.All the 24RCTs prohibited us to perform meaningful sensitivity analysis.
Thirdly,only 6trials of 24trials did mention adverse effect.Even for the trials that reported adverse events,their report was very brief,pro-viding limited information.Therefore,a conclusion about the safety of acupuncture cannot be made clearly.Five trails reported information on follow-up,but not mentioned the details.In order to properly assess
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0.5
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1.5
2MD
SE(MD)
https://www.doczj.com/doc/3f917024.html,parison of SBP in acupuncture versus western medicine.
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SE(MD)
https://www.doczj.com/doc/3f917024.html,parison of DBP in acupuncture versus western medicine.
324J.Wang et al./International Journal of Cardiology 169(2013)317–326
the safety of acupuncture,large-scale clinical trials with long-term follow-up are required.
In addition,of the35included trials,most of them were in Chinese language and only3in English language,and one in German language. China generates virtually no‘negative’studies at all.In other word,pub-lication and other biases may play an important role.We tried to take all measures to contact authors to get further information either by tele-phone,letter,or e-mail.Unfortunately,we got no replies,and we are not sure,the trials were conducted as true RCT.
In summary,our study showed that acupuncture could lower SBP and DBP,however,because of the unclear methodological quality of these identi?ed trials,a de?nite conclusion on ef?cacy and adverse events associated with acupuncture cannot be drawn from this review. Therefore,further thorough investigation,large-scale,rational study de-sign,randomized trials of acupuncture for hypertension will be required to justify the effects reported here.Future trials should overcome the limitations of the trials presented in this review;particularly,they should assure adequate concealment of allocation and blinding of out-come assessors and use functional outcome as the primary outcome measured at long-term follow-up.Reports of the trials should conform to the recommendations of the CONSORT statement[76].If reliable RCT results con?rmed acupuncture positive effects for treatment of hypertension,it would be blessing news to use complementary and alternative medicine for hypertension.
Authors'contribution
Jie Wang and Xingjiang Xiong contributed equally to this paper. Acknowledgment
The current work was partially supported by the National Basic Research Program of China(973Program,No.2003CB517103)and the National Natural Science Foundation Project of China(No.90209011). The funders had no role in the study design,data collection and analysis, decision to publish,or preparation of the manuscript.
References
[1]Chobanian AV,Bakris GL,Black HR,et al.Seventh report of the joint national com-
mittee on prevention,detection,evaluation,and treatment of high blood pressure.
Hypertension2003;42(6):1206–52.
[2]Roger VL,Go AS,Lloyd-Jones DM,et al.Heart disease and stroke statistics2011update:
a report from the American Heart Association.Circulation2011;123:e18-209.
[3]Kearney PM,Whelton M,Reynolds K,et al.Global burden of hypertension:analysis
of worldwide https://www.doczj.com/doc/3f917024.html,ncet2005;9455(365):217–23.
[4]O'Shaughnessy KM.The genetics of essential hypertension.Br J Clin Pharmacol
2001;1(51):5–11.
[5]Lloyd-Jones D,Adams R,Carnethon M,et al.Heart disease and stroke statistics—
2009update:a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.Circulation2009;3(119):480–6.
[6]Law MR,Morris JK,Wald https://www.doczj.com/doc/3f917024.html,e of blood pressure lowering drugs in the prevention
of cardiovascular disease:meta-analysis of147randomised trials in the context of expectations from prospective epidemiological studies.Br Med J2009;338:b1665.
[7]Schmieder RE.Optimizing therapeutic strategies to achieve renal and cardiovascular
risk reduction in diabetic patients with angiotensin receptor blockers.J Hypertens 2005;23(5):905–11.
[8]Wang J,Xiong XJ.Control strategy on hypertension in Chinese medicine.Evid Based
Complement Altern Med2012;2012https://www.doczj.com/doc/3f917024.html,/10.1155/2012/284847[Arti-cle ID284847,6pages].
[9]Zheng Zhenfeng,Shi Huilan,Jia Junya,et al.A systematic review and meta-analysis
of candesartan and losartan in the management of essential hypertension.J Renin Angiotensin Aldosterone Syst2011;12(3):365–74.
[10]Xu H,Chen KJ.Progress,dif?culty and countermeasure in treating hypertensive
disease with integrated Chinese and western medicine.Shi Jie Zhong Yi Yao 2007;2(1):3–5.
[11]Levy D,Larson MG,Vasan RS,Kannel WB,Ho KKL.The progression from hyperten-
sion to congestive heart failure.J Am Med Assoc1996;275(20):1557–62.
[12]Burnier M.1999World health Organization/International Society of Hypertension
Guidelines.Blood pressure control and the implementation of guidelines in clinical practice:can we?ll the gap?J Hypertens2002;20(7):1251–3.
[13]Su DJ,Li LF.Trends in the use of complementary and alternative medicine in the
United States:2002–2007.J Health Care Poor Underserved2011;22:295–309.[14]Wang J,Xiong XJ.Current situation and perspectives of clinical study in integrative
medicine in China.Evid Based Complement Altern Med2012:1–11[Article ID 268542].
[15]Chen KJ,Hui KK,Lee MS,Xu H.The potential bene?t of complementary/alternative
medicine in cardiovascular diseases.Evid Based Complement Altern Med2012;2012 [Article ID125029.1pages].
[16]Wang J,Xiong XJ.Outcome measures of Chinese herbal medicine for hypertension:an
overview of systematic reviews.Evid Based Complement Altern Med2012;2012 https://www.doczj.com/doc/3f917024.html,/10.1155/2012/697237[Article ID697237,7pages].
[17]Wang J,Wang PQ,Xiong XJ.Current situation and re-understanding of syndrome
and formula syndrome in Chinese medicine.Intern Med2012;2(3):1–5[Article ID 1000113].
[18]Consensus NIH.Development panel on acupuncture.NIH Consensus Conference.
Acupuncture.JAMA1998;280(17):1518–24.
[19]Kalish LA,Buczynski B,Connell P,et al.Stop Hypertension with the Acupuncture
Research Program(SHARP):clinical trial design and screening results.Control Clin Trials2004;25:76–103.
[20]Chenot JF,Becker A,Leonhardt C,et https://www.doczj.com/doc/3f917024.html,e of complementary alternative medicine
for low back pain consulting in general practice:a cohort study.BMC Complement Altern Med2007;18:42[no.7].
[21]Huang H,Liang S.Acupuncture at otoacupoint heart for treatment of vascular hyper-
tension.J Tradit Chin Med1992;12(2):133–6.
[22]Chiu YJ,ChiA Reid IA.Cardiovascular and endocrine effects of acupuncture in hyper-
tensive patients.Clin Exp Hypertens1997;19:1047–63.
[23]Yao T.Acupuncture and somatic nerve stimulation:mechanism underlying effects
on cardiovascular and renal activities.Scand J Rehabil Med1997;29:7–18.
[24]Zhou Wei,Longhurst JC.Neuroendocrine mechanisms of acupuncture in the treatment
of hypertension.Evid Based Complement Altern Med2012;2012https://www.doczj.com/doc/3f917024.html,/10.
1155/2012/878673[Article ID878673,9pages].
[25]Park Jung-Mi,Shin Ae-Sook,Park Seong-Uk,et al.The acute effect of acupuncture on
endothelial dysfunction in patients with hypertension:a pilot,randomized,double-blind,placebo-controlled crossover trial.J Altern Complement Med2010;16(8):883–8.
[26]Chen J,Li J,Wang ZR.Therapeutic effect on essential hypertension treated with com-
bined therapy of acupuncture and medication.Zhongguo Zhen Jiu2010;30(11):896–8.
[27]Kraft K.Die behandlung der arteriellen hypertonie mit akupunktur:eine einfach-
blinde,randomisierte,placebokontrollierte pilotstudie und meta-analyse.J Hypertens 2000;4:16–21.
[28]Ren YE.Acupuncture in the treatment of hypertension and stroke.Acupunct Med
2000;18:54–60.
[29]Higgins JPT,Green S.Cochrane handbook for systematic reviews of interventions,
version5.1.0[updated March2011].The Cochrane collaboration.Available:http:// https://www.doczj.com/doc/3f917024.html,/;2009.
[30]Feng Guoxiang,Wu Qingming.Clinical study treatment of essential hypertension
with acupuncture at“Siguan”points Pinus warming acupuncture-moxibustion at Baihui(GV20)point.Zhongguo Zhen Jiu2003;23(4):193–5.
[31]Li Dongchao,Niu Chunfeng.Effect of acupuncture on essential hypertension.Chin J
Gerontol2008;28(19):1963–4.
[32]Luo Yuntao.Effect of acupuncture and western medicine on68patients with hyper-
tension.Pract Clin Comb Tradit Chin West Med2009;9(4):49–50.
[33]Liu Shuo.Effect of acupuncture on hypertension.Health2012;6(1):9–10.
[34]Yang Yue,Zhou Guitong.A comparative study of the acupuncture formula in the
treatment of hypertension.Acta Chin Med Pharmacol2010;38(5):106–7.
[35]Liu Wei.Clinical effect of acupuncture and western medicine on hypertension.J Med
Forum2012;33(10):114–5.
[36]Zhang Yan-bing.Clinical research of acupuncture and medicine in the treatment
of liver yang hyperactivity type hypertension.China J Chin Med2011;26(162): 1397–8.
[37]Yang Xianhui.Effect of electroacupuncture on Quchi(LI11)and Taichong(LR3)on
blood pressure variability in young patients with hypertension.Zhongguo Zhen Jiu 2010;30(7):547–50.
[38]Wang Chun,Cheng Zhiqing.Clinical effective valuation and its mechanical analysis
of acupuncture on obese hypertensive patients.Liaoning Tradit Chin Med Mag 2006;33(10):1327–8.
[39]Jia Xuemei,Chen Jinghuan,Zheng Meilan.Observation of effect on acupuncture
treatment for46patients with high blood pressure.J Qiaihar Univ Med 2012;33(1):1472–3.
[40]Liu Caijin,He Xiaofeng,Yuan Liuxian.Effect of acupuncture and western medicine
on106patients with hypertension.Chin Foreign Med Res2011;9(14):137–8. [41]Liao Hui,Li Danping,Chen Qiang,et al.Observation on therapeutic effect of
“reducing south and reinforcing north”,needling method on hypertension of type of yang-hyperactivity due to yin-de?ciency.Zhongguo Zhen Jiu2006;26(2):92–3.
[42]Ma Chaoyang,Wang Yanfu,Wan Wenjun,et al.Effect of electroacupuncture on
Quchi(LI11)on concentration of plasma NPY and NT in the patients with essential hypertension.J New Chin Med2011;43(4):89–91.
[43]Hu Lihua,Yan Wei,Zhou Gongmin,et al.Observation of effect on acupuncture treat-
ment and western medicine for60patients with high blood pressure.Chin J Cardiovasc Rehabil Med2007;16(2):184–6.
[44]Chen Yuefeng,Qian Hong,Li Lan.Effects of acupuncture on contents of plasma
endothelin and angiotensin II in the patient of hypertension.Zhongguo Zhen Jiu 2000;11:691–3.
[45]Guo Yuhong,Teng Xiuying,Zhang Chunfang.Effect of acupuncture on insulin resis-
tance and blood serum TNF-αin the treatment of essential hypertension.Acta Chin Med Pharmacol2009;137(15):76–8.
[46]Huang Jinfen,Wei Cuie,Hei Jianping,et al.Clinical effect of acupuncture on Fengchi
in the treatment of essential hypertension.Chin J Integr Med Cardiovasc Cerebrovasc Dis2007;5(11):1130–2.
325
J.Wang et al./International Journal of Cardiology169(2013)317–326
[47]Wang Ling-yun,Chen Bang-guo.Clinical study on therapeutic effect and adjustment
to plasma ET and Serum TNF-αin the patients of essential hypertension with acu-puncture at“Fengchi”point.J Hubei Coll TCM2006;8(1):8–10.
[48]Guo Yuhong.Clinical effect of acupuncture on insulin resistance in the treatment of
essential hypertension.ACMP2007;35(6):51–3.
[49]Cheng Xuehong.Clinical effect of acupuncture on hypertension.J China Health Mon
2011;30(8):106–8.
[50]Huang Fan,Yao Guo-xin,Huang Xiao-li,et al.Clinical observation on acupuncture for
treatment of hypertension of phlegm-stasis blocking collateral type.Zhongguo Zhen Jiu2007;27(6):403–6.
[51]Zhang Zhao-Hui,Zhou Jie,Wang Qiang,et al.Acupuncture for treatment of primary
hypertension and effect on functions of vascular endothelium.Zhongguo Zhen Jiu 2004;24(8):539–41.
[52]Ye Meifeng,Jiang Xiaojun,Xu Dongmei.Clinical observation on acupuncture Taixi
and Jiangya for treatment of hypertension.IMHGN2011;17(1):80–2.
[53]Shen Zhikun,Shao Cihui,Jiang Peiyu,et al.Clinical observation on acupuncture
Zusanli and western medicine for treatment of25patients with resistant hyperten-sion.Shaanxi J Tradit Chin Med2007;28(10):1377–9.
[54]Dan Yu.Clinical observation on acupuncture for treatment of hypertension with
ambulatory blood pressure.Chin J Integr Med1998;18(1):26–8.
[55]Wu Yuanhua,Zhu Guangqi,Lin Xingyou,et al.Effect of needling Quchi and Taichong
points on blood levels of endothelin and angiotension converting enzyme in patients with hypertension.Chin J Integr Med2004;24(12):1080–3.
[56]Zhang Yanling,Li Chuangpeng,Peng Min,et al.Effect of acupuncture combined with
medicine on neuropeptide Y in the patient of hypertension.Zhongguo Zhen Jiu 2005;25(3):155–8.
[57]Yin ChangShik,Seo ByungKwan,Park Hi-Joon.Acupuncture,a promising adjunctive
therapy for essential hypertension:a double-blind,randomized,controlled trial.
Neurol Res2007;29(Suppl.1):S98–S102.
[58]Jiang.Effects of magnetic needle acupuncture on blood pressure and plasma ET-1
level in the patient of hypertension.J Tradit Chin Med2003;23(4):290–1.
[59]Wan Wenjun,Ma Chaoyang,Xiong Xiuan,et al.Clinical observation on therapeutic
effect of electroacupuncture at Quchi(LI11)for treatment of essential hypertension.
Zhongguo Zhen Jiu2009;29(5):349–52.
[60]Kim Hye-Mi,Cho Seung-Yeon,Park Seong-Uk.Can acupuncture affect the circadian
rhythm of blood pressure?A randomized,double-blind,controlled trial.J Altern Complement Med2012;18(10):1–6.[61]Kraft K,Coulon S.Der Ein?uss einer standardisierten Akupunkturbehand-lung auf
Beschwerden,Blutdruck und Serumlipide hypertensiver,postmenopausaler Frauen.
Forsch Komplementaèrmed1999;6:74–9.
[62]Macklin Eric A,Wayne Peter M,Kalish Leslie A,et al.Stop Hypertension with the
Acupuncture Research Program(SHARP)results of a randomized,controlled clinical trial.Hypertension2006;48:838–45.
[63]Flachskampf Frank A,Gallasch Joachim,Gefeller Olaf,et al.Randomized trial of
acupuncture to lower blood pressure.Circulation2007;115:3121–312.
[64]Zhao Dongjie,Fan Qunli.Effect of acupuncture on insulin resistance in the patient of
hypertension.Zhongguo Zhen Jiu2003;23(3):165–7.
[65]Zhou Wei,Longhurst John C.Review of trials examining the use of acupuncture to
treat hypertension.Future Cardiol2006;2(3):287–92.
[66]Chobanian AV,Bakris GL,Black HR,et al.The seventh report of the Joint National
Committee on prevention,detection,evaluation,and treatment of high blood pressure:the JNC7report.JAMA2003;289:2560–72.
[67]Oliveria SA,Lapuerta P,McCarthy BD,et al.Physician-related barriers to the effective
management of uncontrolled hypertension.Arch Intern Med2002;162:413–20.
[68]Berlowitz DR,Ash AS,Hickey EC,et al.Inadequate management of blood pressure in
a hypertensive population.N Engl J Med1998;339:1957–63.
[69]Caro JJ,Salas M,Speckman JL,et al.Persistence with treatment for hypertension in
actual practice.CMAJ1999;160:31–7.
[70]Mayer DJ.Acupuncture:an evidence-based review of the clinical literature.Annu
Rev Med2000;51:49–63.
[71]Lee Hyangsook,Kim Song-Yi,Park Jongbae,et al.Acupuncture for lowering blood
pressure:systematic review and meta-analysis.Am J Hypertens2009;22(1):122–8.
[72]Kim Leo-Wi,Zhu Jiang.Acupuncture for essential hypertension.Altern Ther Health
Med2010;16(2):18–29.
[73]Tang JL,Zhan SY,Ernst E.Review of randomised controlled trials of traditional
Chinese medicine.BMJ1999;319:160–1.
[74]Kjaergard LL,Villumsen J,Gluud C.Reported methodological quality and discrepan-
cies between large and small randomized trials in meta-analyses.Ann Intern Med 2001;135:982–9.
[75]Schulz KF,Chalmers I,Hayes R,Altman D.Empirical evidence of bias.JAMA1995;273:
408–12.
[76]Moher D,Hopewell S,Schulz KF,et al.CONSORT2010explanation and elaboration:
updated guidelines for reporting parallel group randomised trial.BMJ2010;340: c869.
326J.Wang et al./International Journal of Cardiology169(2013)317–326
德语日常词汇大全 essen und trinken etwas 一些die Banane 香蕉 der Zucker 糖das Br?tchen 小面包 die Speisekarte 菜单der Durst 口渴 die Rechnung 帐单die Flasche 瓶子 der Apfel 苹果das Getr?nk 饮料 das Brot 面包der Kaffee 咖啡 die Disko 迪厅die Lebensmittel 食物，食品 der Fisch 鱼das Obst 水果 der Gast 客人die Sahne 奶油 der Hunger 饿die Wein 葡萄酒 der Kuchen 蛋糕das Bier 啤酒 die Milch 牛奶die Butter 黄油 die Pommes frites 薯条das Ei 蛋 der Saft 果汁das Fleisch 肉 der Schinken 火腿das Glas （玻璃）杯 das Wasser 水die Kartofel 土豆 das Lieblingsessen 最喜欢的食物das Frühstück 早餐 der Reis 大米das H?hnchen 童子鸡 der Salat 沙拉der Kiosk 小亭子 der Tee 茶das Lokal 饭馆，酒店 die Zigarette 香烟das ?l 油 die Birne 梨das Restaurant 酒店 das Cafe 咖啡das Salz 盐 das Essen 吃die Tomate 西红柿 bestellen 预订kochen 烹饪 bitter 苦的rauchen 抽烟 sü?甜的schmecken （+DAT）美味的ein bisschen 一点点trinken 喝 essen 吃wunderbar （指菜肴）精美的wenig 少量的 wohnen der Stuhl 椅子der Kühlschrank 冰箱 das Bett 床das Sofa 沙发 das Bild 画die Uhr 钟 der Fernsehen 电视der Bücherschrank 书柜 der Eletroherd 电子炉der Schreibtisch 书桌 der Schrank 柜子der Tisch 桌子 die Adreese 地址das Feuer 火 der Balkon 阳台der Herd 炉灶 das Doppelzimmer 双人房das Licht 明亮的，光明的das Einzelzimmer 单人房der Ort 地点，位置
关于公司各部门名称德语词汇 (1) 关于营销的德语词汇 (1) 关于会展业的相关词汇 (3) 经济德语词汇-创建公司 (4) 关于公司各部门名称德语词汇 die Abteilung 部门 die Gesch?ftsführung 公司领导 das Sekretariat 秘书处 die Produktion (≈ die Fertigung) 生产部 die Montage 组装 die Verpackung 包装 die Beschaffung (≈ der Einkauf) 采购 der Absatz（≈der Verkauf）销售 das Personalwesen 人事处 die Buchhaltung 会计部 关于营销的德语词汇 der Markt 市场 der Verk?ufermarkt 卖方市场（供小于求，厂家占主导地位） der K?ufermarkt 买方市场（供大于求，消费者占主导地位） das Angebot 供给 die Nachfrage需求
der Preis 价格 der Marktteilnehmer 市场参与者 der K?ufer买方 der Verk?ufer 卖方 der Konkurrent 竞争者 der Gro?h?ndler 批发商 der Einzelh?nder 零售商 der Absatz 销路 der Umsatz 销售额 das Marketing 营销 das Marketinginstrument( die Marketingstrategie )营销策略 die Marktanalyse市场分析 die Marktprognose 市场预测 das Marktvolumen 市场总额（指一段时间内由所有卖家实现的某种产品的总销售额）der Marktanteil 市场份额（指某一卖家占有的市场比例） das Marktpotential 市场潜力 die Kaufkraft 购买力 der Marktführer市场领导者 der Marktverfolger 市场追赶者 der Markthherausforderer 市场挑战者 der Marktmitl?ufer市场追随者 der Nischenbesetzer 市场补缺者 die Nische 利基市场（指容易被其他生产者忽略的市场部分） das Me-too-Produkt 易模仿产品 der Kundendienst 客户服务（包括咨询、维护等等） die freiwillige Garantieleistung 免费包修包换等
国际班双语教学《电路原理》专业词汇 V okable 词汇Newton 牛顿 Weg 距离、路程Grundlagen 基础 Ma?system 测量单位置Elektronik 电子技术 bestehen aus 由。。。组成Elektrotechnik 电工技术 deffinieren 定义基本概念Grundbegriff Begriffsystem Telekommunikationstechnik 通信技术概念体系 Mechanik 机械学传输\、传递übertragung Geometrie 几何学Energie 能量Kinematik 运动学Licht 光Dynamik 电机动力学Elektrische Maschine L?nge 长度Energietechnik 能源技术 Basiseinheit 基本单位、量纲Beleuchtung 光abgeleitete Ger?Messtechnik ?en 推导出的数值测试技术 Thermodynamik （自动热力学Regelungstechnik 自动调节技术Chemie 控制理论）化学 Lichttechnik 传感器技术Sensorik 光学技术 abs. Signalwandlung 信号变换absolute 绝对的 Stoffmenge 材料数量、元素的质量控制（调节回路）Regelkreise Lichtst?elektromagnetisch vertr?glichkeit rke 光强（度） Kelvin 开尔文医疗技术Medizntechnik mol Informationgssystemtechnik 信摩尔统息系cd = Candela 烛光 技术 Candela 烛光Gestetze 定理、定律 Ladung 电荷质量Ma?einheite geeignet 适合的Dimensionsanalyse 计算分析 Elementarladung 单位电荷定尺寸，大小，计算大小，Dimension Elektron 量纲电子 quantifizierbar pfen Verknü联系、连结可计量的 quantifizien 确定。。数量、数据?Gr?en 。量、用数量表示 vereinbar 可以结合的Zahlenwert 数值Zeiteinheit Einheitfunkzitionell 时间单位单位作用 Ladungstransport 电荷移动Masse 质量 Messwesen 测量方面加速度Beschleunigung SI Systems 国际标准单位系统Widerstand 电阻 genormt 标准的电压Sapannung dezimal 十分之一的Strom 电流Vielfachen 磁的magenetisch 十进制数Koh?Flu?dichte rrent 相关的磁密、磁感应强度 genormete dezimale Teil und Vielfache 密度Dichte 标注的十进制和十进制倍数rke Feledst?磁场强度 koh?rente abgeleitete Einheiten 相关引强度rke St?出（推导）的单位
德语入门：从零开始学德语（50篇）〖德语常识〗 ·德语10大基本常识 ·世界上有哪些国家使用德语？ ·德语在世界各国语言中的位置 ·初学德语的经验之谈 ·德语的形成与德语历史 ·德国留学考试TestDaF“德福” ·大学入学德语考试（DSH）难度如何？ ·中德对照22大人生哲理（推荐）~ ·为什么选择学德语？学习中有何感触？·九大小语种：哪个语种的就业形势更好！ 〖德语字母〗 ·德语字母（Flash发音版）[] ·德语字母歌（视频） ·德语特殊字母在线输 ·如何安装德语输入法？ ·德语键盘对照表 ·德语字母乱码问题的形成及处理 ·德语字母和字母组合发音 ·德语字母书写的改写等6大规则 ·为何有些德语单词的字母上加两个点 〖入门词汇〗更多>>>>> ·德语我爱你怎么说[] ·德语生日快乐的读法写法[ ] ·德语入门十大标志性词汇短语[] ·最常用的德语10大祝福语[]
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关于企业的相关词汇总结 1. 关于企业类型的词汇 das Unternehmen (≈die Frima, der Betrieb) 公司，企业ein Unternehmen gründen 成立一家公司 ein privates Unternehmen 私人公司 ein staatliches Unternehmen 国营公司 das Gro?unternehmen 大型企业 mittelst?ndisches Unternehmen 中型企业 das Kleinunternehmen 小型公司 2. 关于企业生产的词汇 der Unternehmer 企业主 der Mitarbeiter 员工 der Produzent (≈der Hersteller)生产厂家 der Lieferant 供货商 der Kunde 客户 der Konsument (≈der Verbraucher) 消费者 das Produkt （≈das Erzeugnis）产品 das Fertigprodukt 成品 das Halbfertigprodukt 半成品 der Werkstoff 生产材料 der Rohstoff 原材料 der Hilfsstoff 辅料 der Betriebsstoff 运转材料 das Lager 仓库 die Kapazit?t 生产能力，产量 die Produktivit?t 生产率 der Produktionsbetrieb 生产型企业
der Dienstleistungsbetrieb 服务性企业 die Produktionsgüter (Pl.) 生产物资 die Konsumgüter (Pl,) 消费物资 3. 关于公司各部分名称 die Abteilung 部门 die Gesch?ftsführung 公司领导 das Sekretariat 秘书处 die Produktion (≈ die Fertigung) 生产部 die Montage 组装 die Verpackung 包装 die Beschaffung (≈ der Einkauf) 采购 der Absatz（≈der Verkauf）销售 das Personalwesen 人事处 die Buchhaltung 会计部 4. 关于德国公司的法律形式 die GmbH ( Gesellschaft mit beschr?nkter Haftung) 有限责任公司 die OHG ( Offene Handelsgesellschaft) 无限公司 die KG ( Kommanditgesellschaft )两合公司 die AG ( Aktiengesellschaft ) 股份公司 die KGaA ( Kommanditgesellschaft auf Aktien) 两合股份公司 关于会展业的相关词汇总结 会展的类型 在德语中Messe 和Ausstellung都是展会的意思，但其实两者还是有一点细微差别的，Messe 更指专门对专业人士举行的展览会，而Ausstellung则是对大众开放的、专业性不强的各种展览会。 展会按照才参观的观众的地域划分，可以分为 internationale Messe/Ausstellungen 国际性会展
新求精德语词汇 Lektion 2 die Lektion, -en 课，单元 der Flughafen，‥—机场(复数变元音) auf den Flughafen 在机场 der Text，-e 课文 der Zoll，‥—e 海关 am Zoll 在海关处 der Chinese，-n 中国人 hei?en（hei?t，hie?，hat gehei?en）叫，称呼 wie 怎样 wie hei?t。。。。。。叫什么名字？ er 他 woher 从哪儿来 kommen（kommt，kam，ist gekommen）来 was 什么 sein（ist，war，ist gewesen）是 der Koffer，- 箱子(单复同形) im Koffer 在箱子里 die Zollbeamtin，-nen 海关官员（女） gut 好的 Guten Tag！你好！ der Pass，‥—e 护照 bitte 请 Bitte sch?n 请吧,别客气 Sie 您(S大写) der Moment，-e 片刻（重音在后） der V orname，-n，-n 名 der Familienname，-n，-n 姓 die Entschuldigung，-en 对不起（ung结尾绝大多阴性）der Herr，-n，-en 先生 China 中国 aus China 来自中国 die Kleidung 服装（不可数） das Buch，‥—er 书 die Anrede，-n 称呼 die Frau，-en 女人，夫人 in China 在中国 in Deutschland 在德国 sie 她，她们 du 你 ich 我 es 它 wir 我们ihr 你们 der Deutsche，-n 德国人 das Lehrbuch，‥—er 教科书 die Chinesin，-nen 中国人（女） studieren（studiert，studierte，hat studiert）（大学）学习 lernen（lernet，lernte，hat gelernt）学习 brauchen（braucht，brauchte，hat gebraucht）需要üben（übt，übte，hat geübt）练习 lehren（lehrt，lehrte，hat gelehrt）教 diskutieren（diskutiert，diskutierte，hat diskutiert）讨论 wohnen（wohnt，wohnte，hat gewohnt）住 das Chinesisch 汉语 die USA 美国 das Deutsch 德语 Deutschland 德国 das Englisch 英语 England 英国 der Engl?nder，- 英国人 das Land，‥-er 国家 die Leute 人们(本身就是复数) die Sprache，-n 语言 die V olksrepublik China 中华人民共和国 die Bundesrepublik Deutschland 德意志联邦共和国die Engl?nderin，-nen 英国人（女） Japan 日本(重音在前) das Japanisch 日语（重音在后） der Japaner，- 日本人（重音在后） die Japanerin，-nen 日本人（女）（重音在后）Korea 韩国，朝鲜 das Koreanisch 朝鲜语（重音在a） der Koreaner，- 韩国人 die Koreanerin，-nen 韩国人（女） Frankreich 法国 das Franz?sisch 法语 der Franzose，-n 法国人 die Franz?sin，-nen 法国人（女） Amerika 美国，美洲 der Amerikaner，- 美国人 die Amerikanerin，-nen 美国人（女） das Flugzeug，-e 飞机 Hallo！喂，你好 Wie bitte？什么
初级1册德语单词-阳性
der Flughafen, die Flugh?fen der Text, die Text der Zoll, die Z?lle der Koffer, die Koffer der Pass, die P?sse der Betreuer, die Betreuer der Name, die Namen der Lehrer der sohn, die s?hne der Unterricht der Bruder, die Brüder der K?se der Beruf, die Berufe der Arzt, die ?rzte der Physiker, die Physiker der Arbeiter, die Arbeiter der Verk?ufer, die Verk?ufer der Koch, die K?che der Professor, die Professoren der Student, die Studenten der machinenbau der Besuch, die Besuche
der Freund, die Freunde der Vater, die V?ter der Pullover, die Pullover der Bleistift, die Bleistifte der Kugelschreiber, die Kugelschreiber der Satz, die S?tze der Schüler, die Schüler der Einwohner, die Einwohner der Zucker der Hunger der Durst der Ball, die B?lle der Vati, die Vatis der Opa, die Opas der Gro?vater, die Gro?v?ter der Onkel, die Onkel der Cousin, die Cousins der Schwiegersohn, die Schwiegers?hne der Enkel, die Enkel der Ehemann, die Ehem?nner der Markt, die M?rkte der Samstag, die Samstage
2001-03-15 16:15:25 ◎基础名词和形容词800 Abend m,-e 晚上 Abschied m,-e 告别，分别 Absicht f,-en 意图 Achtung f 尊敬，注意 Adresse f,-n 地址 allein adv,adj 单独，独自 alles pron 所有，全部 alt adj 老的，旧的 Alter n,- 老年；年龄 Amt n,-:er 职位，职务；局，厅，处，所Anfang m,-:e 开始 Angelegenheit f,-en 事，事情 angenehm adj 适意的，愉快的；欢迎的Angriff m,-e 进攻，攻击 Angst f,-:e 害怕 Ansicht f,-en 看法，观点，意见 Antwort f,-en 回答 Anzeige f,-n 广告 Anzug m,-:e 西服 Apparat m,-e 器械，仪器；（等）机件；机构Arbeit f,-en 工作，劳动 Arbeiter m,- 工人 Arm m,-e 臂 arm adj 贫穷的，可怜的 Arznei f,-en 药，药剂，药物 Arzt m,-:e 医师 Atem m 呼吸 Atom n,-e 原子 Aufgabaufmerksam adj 注意的，专心的Auge n,-n 眼睛 Ausland n 外国 Ausnahme f,-n 例外 auβen adv 在外面，外部 Ausstellung f,-en 展览会；展览，列Ausweis m,-e 证件，凭证 Auto n,-s 汽车 Automat m,-en,-en 自动装置；自动售货机Bad n,-:er 洗澡，澡堂，游泳池 Bahn f,-en 铁路；跑道 bald adv 不久 Ball m,-:e 球，舞会 Bank f,-en 银行 -:e长凳，工作台、机床
1.发音的规律性，不需要注音标，看字母组合可发音 2.语法较复杂，但严谨，不会产生歧义。 3.本课程内的“交际德语”部分既适用商务人员，也适用于留德学生，对德福考试 （TestDaF ）的听力部分和口语部分，其内容也有很好的借鉴意义。 德语语音及常用单词 德语字母 1德语字母与英语字母基本相同，但名称不同。在字母表中以红色标明的是德语的特殊字母，其中？？，??和ui为变音（Umlaut）, Mu nchen = Muenchen , 3在瑞士写成ss.字母名 称按德语发音规律。
2其中元音五个Aa Ee Ii Oo Uu ;半元音一个Yy; 变音三个：? ? uu 德语语音
德语发音规律： 德语单词第一音节一般为重读音节；德语里没有连读。 元音发音规律： 1.元音在下列情况下发长音： a.双元音和复合元音ie 发长音，如Saal, See, Boot, wie ; b.元音在不发音字母h前发长音，如Bahn, Sohn, ihnen, Uhr, gehen ; c.元音字母后没有辅音或只有一个辅音时，一般发长音，如Tag, gut, wer, ?l, du, ja 2.元音在双辅音或两个以上辅音之前时，发短音。如esse n, Post 3.元音字母e在词尾时发轻音(？)。女口Name, Hose 4.元音在sch, ng, nk 之前发短音，如Tisch, la ng, danke 辅音发音规律： 1?浊辅音b, d, g 在词尾时发相对应的轻辅音(p), (t), (k), dt 在词尾发(t), th 组合只发一个辅音(t) 2.辅音s的发音较多： a.s 在元音前发浊音(z), 女口sagen, See, Hose, suchen b.s 在辅音前及词尾发轻音(s), Skizze, skeptisch, Gas, Bus c.ss/ 3永远发轻音，B 前的元音为长元音。Sessel, essen, hei 3 en, Fu 3 d.st/sp 组合在词头和重读音节里发(t)/ ( p), Staat, verstehe n, spare n, besprechen,但是Fenster 中,st 发(st) e.sch 组合发一个辅音( ),schreiben, schlafen f.ts, ds 发一个辅音(ts), 相当于汉语拼音的"毗c,音，abends, abeitslos g.tsch发一个辅音(t ),相当于汉语拼音的"吃ch ,音，Deutsch, Quatsch
Vokable 词汇 Grundlagen 基础 Elektronik 电子技术 Elektrotechnik 电工技术Grundbegriff 基本概念Telekommunikationstechnik 通信技术übertragung 传输\、传递 Energie 能量 Licht 光 Elektrische Maschine 电机Energietechnik 能源技术Beleuchtung 光 Messtechnik 测试技术Regelungstechnik 自动调节技术（自动控制理论） Sensorik 传感器技术Signalwandlung 信号变换Regelkreise 控制（调节回路）elektromagnetisch vertr?glichkeit Medizntechnik 医疗技术Informationgssystemtechnik 信息系统技术 Gestetze 定理、定律 Ma?einheite 质量Dimensionsanalyse 计算分析Dimension 定尺寸，大小，计算大小，量纲 Verknüpfen 联系、连结 Gr??en 数量、数据 Zahlenwert 数值Einheitfunkzitionell 单位作用 Masse 质量 Beschleunigung 加速度 Widerstand 电阻 Sapannung 电压 Strom 电流 magenetisch 磁的 Flu?dichte 磁密、磁感应强度 Dichte 密度 Feledst?rke 磁场强度 St?rke 强度 qualitiv 质量的、性质的 quantitativ 数量的、定量的 ausdrücken sich 表示 dim。Dimension 尺寸、大小、量纲charakterisieren 描述。。。特性 Quantit?t 质量 Newton 牛顿Weg 距离、路程 Ma?system 测量单位置 bestehen aus 由。。。组成 deffinieren 定义 Begriffsystem 概念体系 Mechanik 机械学 Geometrie 几何学 Kinematik 运动学 Dynamik 动力学 L?nge 长度 Basiseinheit 基本单位、量纲abgeleitete Ger??en 推导出的数值Thermodynamik 热力学 Chemie 化学 Lichttechnik 光学技术 abs. absolute 绝对的 Stoffmenge 材料数量、元素的质量Lichtst?rke 光强（度） Kelvin 开尔文 mol 摩尔 cd = Candela 烛光 Candela 烛光 Ladung 电荷 geeignet 适合的 Elementarladung 单位电荷 Elektron 电子 quantifizierbar 可计量的 quantifizien 确定。。。量、用数量表示vereinbar 可以结合的 Zeiteinheit 时间单位Ladungstransport 电荷移动Messwesen 测量方面 SI Systems 国际标准单位系统genormt 标准的 dezimal 十分之一的 Vielfachen 十进制数 Koh?rrent 相关的 genormete dezimale Teil und Vielfache 标注的十进制和十进制倍数 koh?rente abgeleitete Einheiten 相关引出（推导）的单位 erlaubt 说明 elekstrische Stromst?rke 电流强度thermodynamisch 热力的 Lichtst?rke 光强 Ampere 安培 Koh?rent zusammenh?ngend 相关的关系
德语基础:字母、音素、元音、辅音、音节、单词 Grundlagen 简言 语法即语言规则。语言由单词组成。单词由字母组成，聚集在一起成为了语句，实现了语言的表达。这是如何形成的？在需要按语法正确地组织（bilden）词与句时，什么是需要注意的？简单的问题，但却需要许多详细的答案来解答。 Buchstaben und Laute 字母与音素 德语中包含30个字母（Buchstaben），其中26个与字母表（Alphabet）相对应，书写时有小写（Kleinbuchstaben）与大写（Gro?buchst aben）之分：a b c d e f g h i j k l m n o p q r s t u v w x y z A B C D E F G H I J K L M N O P Q R S T U V W X Y Z 字母表之外还有4个字母： ? ? ü?? ? ü 其中?没有对应的大写，需要时可以双写S（Doppel-S）。
名词（Substantiven od. Hauptw?rtern）, 专有名词（Eigennamen），以及称谓词（又叫呼格代词）（Anredefürw?rtern）的首字母需大写。句首首字母也需大写。其余情况应小写。但某些时候，譬如标题中的单词通过大写（Versalien）可起着突显的作用。 字母构织了书面语言，那么口头语言则是由音素（Lauten）组织而成。朗读的时候会发现，虽一个字母常常对应一个音素，但非一直只对应一个音素：3个字母sch只构成一个音素，字母组合ck和ch也只构成一个音素；字母x包含了2个音素。 Vokale und Konsonanten 元音与辅音 元音在德语中也称为Selbstlaute，因为其发音时，不需要其他的音素辅助发音。辅音在德语中即是Mitlaute。大多数其发音时，需要缀加一个元音，譬如音素b，f，g，h，j，需借助于元音be，ef，ge，ha，jat实现发音。 Vokale 元音 元音组包含以下几部分：
德语基础词汇例句
德语基础词汇例句 ab (down off) 1. - Die Fahrt kostet ab Hamburg 200,- DM. 2. - Ab n.chster Woche bleibt unser Gesch.ft samstags geschlossen. 3. - Er besucht uns ab und zu. abbiegen, biegt ab, bog ab, ist abgebogen 1. - An der n.chsten Kreuzung müssen Sie nach links abbiegen. aber 1. - Der Stoff ist von guter Qualit.t, aber nicht billig. 2. - Heute geht es nicht, aber morgen. 3. - Doch, das hat sie aber gesagt. 4. - Das dauert aber lange! 5. - K.nnen Sie das für mich erledigen? - Aber gern! abfahren, f.hrt ab, fuhr ab, ist abgefahren - Unser Zug ist pünktlich abgefahren. die Abfahrt - Abfahrt 15.30 Uhr. abfliegen, fliegt ab, flog ab, ist abgeflogen - In Frankfurt sind wir schon mit einer Stunde Versp.tung abgeflogen.
德语初级词汇表[1] ================================== das Abenteuer, = 冒险 das Aber, opl. 异议；困难 das Abitur, e 中学毕业考试（毕业证） das Alter, = 年龄，年纪 das Arbeitsamt, :er 雇主 das Asthma, opl. 气喘 das Ausland, opl. 外国 das Baby, s 婴儿 das Bad, :er 浴室 das Baf?g, opl. 学生助学金 das Bargeld, opl. 现金 das Barthaar, e 胡子；胡须 das Bett, en 床 das Bild, er 图画；照片；画像 das Blatt, :er 书页；报纸 das Bombenwetter, opl. 极好的天气 das Bootfahren, opl. 航行 das Buch, ?r 书 das Bundesland, :er 联邦 das Büro, s 办公室
das Dach, :er 屋顶 das Denkmal, :er 纪念碑 das Dorf, :er 村庄 das Eichh?rnchen, = 小松鼠 das Erntedankfest, e 收获节 das Feld, er 田地 das Fenster,= 窗户 das Fest, e 节日 das Fieber, opl. 发烧 das Fischen, opl. 鱼 das Foto, s 照片，图片 das Freie, opl. 郊外 das Futter, opl. 饲料 das Gebiet, e 地区；区域 das Geburtsdatum, Geburtsdaten 生日 das Gefühl, e 知觉；感觉；感情 das Geheimnis, se 秘密 das Grab, :er 死亡 das Guthaben, = 结余；结存款 das Gymnasium, Gymnasien 高级文科中学das Haar, e 头发 das Halsweh, opl. 咽喉炎
abgeben I.(vt) ①交给,交还,交出②交给...保存,寄存③分给④说出,发表⑤(廉价)出卖,出 售;出租⑥传⑦发射,开⑧放出⑨装扮,扮演;适宜于充当 ablegen Vt ①放下,脱下②摆脱,抛弃③作出④产卵,Vi ①插枝②启航 abh?ngen+von Vi 依赖,取决于,Vt ①取下,摘下(悬挂物) ②挂断(电话) ③把(比赛对手)摔在后面abholen Vt ①取,拿②接(人) abmachen der ①去掉②讲定,约好③解决,结束 ausmachen I.(vt) ①<地区>从地里挖出,刨出②关掉③商定,约定④澄清,解决,了结⑤认出,识 别,发现⑥具有重要性,是要紧的⑦构成,形成,是⑧共计 Ausnahmen[die] pl.Ausnahmen 例外 ausnahmsweise Adj 破例的 abmelden Vt 注销(户口),通知离开 anmelden Vt ①宣布,通知②申报,为...报到③说明,表示④牌叫牌,Vr ①通知②报名,登记 registrieren(vt) I.(vt) ①登记,注册②(仪器等自动)记下,记录③[转,口]注意到,理会到,II.(vi)拉 (管风琴)音栓 abschlie?en Vt ①锁上②结束③缔结,订立④结算,结清⑤隔绝,封闭,Vi 结束 abschlie?bar adj. 可以锁的。可以上锁的。 Abschied der -e ①离别,告别②退职,免职 Bescheid der -e ①告知,消息 ②答复,决定 bescheiden(adj) ①谦虚的②朴素的,简朴的③微薄的,微少的 Bescheidenheit(f) -s,kein pl. 谦虚(的性格或态度);知足,简朴 Sicht die ①能见度 ②视界,视野 ③期限 sichtbar Adj ①看得见的,能见的 ②显然的,明显的 Sichtweise n. opinion, attitude, point of view Absicht die -en 意图,打算,企图,愿望,目的 absichtlich Adj 故意的,有意的 Ansicht die -en ①观点,看法②外观③风景画 Auffassung die -en 见解,观点,看法 mit/ohne Absicht故意的/无意的 absolut adj. adv. 绝对的。完全的。 abziehen Vt ①脱下,取下②拔出,吸出③摄印④撤回⑤转移⑥数减去 ausziehen Vt ①拔出,拔掉,拉出②脱去③给...脱衣④摘录⑤化提取...的精华⑥抢劫,Vi (sein) ①搬出②出发,外出③消失 anziehen Vt ①穿,穿上②拉近,内收③吸收④拉紧,拧紧⑤吸引,Vr 穿衣,Vi ①拉动,开动② (物价,股票)上涨③(棋局)开棋 achten Vt 尊敬,尊重,Vi 注意,照顾 beachten Vt 注意,重视 verachten Vt 蔑视,唾弃 Verachtung[die]轻视。 Selbstverachtung自卑的，self contempt Missachtung die蔑视,轻视 ehren v. 尊敬。信任。 verehren v. 崇拜。尊敬。 Ehre die -n ①尊敬,声望②荣誉 ehrlich Adj ①诚实的,可靠的 ②正直的 ③清白的 Ehrung(f) -en ①荣誉②尊敬,敬意③表示敬意的物品 Ehrlichkeit(f) -s,kein pl. ①诚实 ②真诚
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1Boy[b??]男孩Junge 2girl[g?:l]女孩M?dchen 3Mother[?m?e?(r)]母亲Mutter 4Father[?fɑ:e?(r)]父亲Vater 5Grandpa[?gr?npɑ:]爷爷Opa 6Grandma[?gr?nmɑ:]奶奶Oma 7Grandmother[?gr?nm?e?(r)]祖母Gro?mutter 8Grandfather[?gr?nfɑ:e?(r)]祖父Gro?vater 9Dad[d?d]爸爸Papa 10Mum[m?m]妈咪Mama 11sister[?s?st?(r)] 妹妹Schwester 12brother[?br?e?(r)]哥哥Bruder 13son[s?n]儿子Sohn 14daughter[?d?:t?(r)]女儿Tochter 15watch[w?t?]看Uhr 16bike[ba?k]自行车Farrad 17onion[??nj?n]洋葱Zwebel 18pre-school['pri:sku:l]学前班Kindergarten 19Toy[t??]玩具Spielzeug 20child[t?a?ld] 儿童Kind 21children[?t??ldr?n]孩子们Kinder 22people[?pi:pl]人Menschen 23family[?f?m?li] 家庭Familie 24uncle[???kl] 叔叔Onkel 25teacher[?ti:t??(r)] 老师Lehrer 26principal[?pr?ns?pl]校长schulleiter 27body[?b?di] 身体K?rper 28hair[he?(r)] 头发Haar 29head[hed]头Kopf 30eye[a?]眼睛Auge 31face[fe?s]面对Gesicht 32neck[nek]颈部Hals 33arm[ɑ:m]臂Arm 34leg[leg]腿Bein 35hand[h?nd] 手Hand 36foot[f?t]脚丫子Fuss 37toe[t??]脚趾Zehe 38finger[?f??g?(r)]手指Finger 39ear[??(r)] 耳Ohr 40nose[n??z]鼻子Nase 41mouth[ma?θ]口Mund 42shoulder[????ld?(r)]肩Schulter 43knee[ni:]膝盖Knie 44Color['k?l?(r)]颜色Farbe 45red[red] 红色rot 46Blue[blu:] 蓝色Blau 47Yellow[?jel??] 黄色Gelb 48Green[gri:n]绿色Grün 49Black[bl?k]黑色Schwarz 50White[wa?t] 白色Wei? 51Purple[?p?:pl] 紫色Lila 52Orange[??r?nd?] 橙子Orange 53Car[kɑ:(r)]汽车Auto 54bus[b?s]总线Bus 55jeep[d?i:p]吉普车Jeep 56motorcycle[?m??t?sa?kl]摩托车Motorrad