External treatment methods of Traditional Chinese Medicine for Insomnia in Patients with hypertension: Network Meta-analysis

Insomnia is a mutual comorbidity in hypertensive patients, complicating the management of both conditions. Traditional Chinese medicine (TCM) offers various external treatments, including acupuncture, acupressure, and cupping, which have demonstrated the potential to improve sleep quality and regulate blood pressure. The goal of the network meta-analysis is to compare the efficacy of various external TCM interventions in treating insomnia in patients with hypertension. Comprehensive research for RCTs published between January 2019 and December 2025 is shown in a number of databases, such as PubMed, the Cochrane Library, Web of Science (WoS), and others. The analysis focused on trials evaluating the impact of external TCM treatments on insomnia and blood pressure in hypertensive patients. Utilizing a network meta-analysis methodology, the relative efficacy of acupressure, acupuncture, and cupping in alleviating insomnia symptoms and reducing blood pressure is compared. The Cochrane Risk of Bias tool is used to evaluate the quality of analyses. The analysis included 35 RCTs with a total of 3,200 patients. According to the data, acupuncture is the greatest treatment for treating sleepiness and decreasing both systolic and diastolic blood pressure levels. Acupressure and cupping were also effective but to a lesser extent than acupuncture. The meta-analysis suggests that external TCM treatments, especially acupuncture, provide significant benefits for managing insomnia and improving blood pressure in hypertensive patients. However, further research is necessary to refine treatment protocols and optimize outcomes.