Tai Chi Intervention Improves Hypertension by Reshaping the Neuro-Endocrine-Immune Network via the Acetylcholine-Cortisol-TNF-α Pathway.

Hypertension is a common chronic disease whose core pathological mechanism involves dysregulation of the neuro-endocrine-immune (NEI) network. In recent years, Tai Chi has been considered a potentially valuable intervention for chronic diseases; however, the biological mechanisms by which it regulates the NEI network remain unclear. This randomized controlled trial evaluated the effects of standardized Tai Chi training on blood pressure and NEI-related biomarkers in patients with primary hypertension and compared these effects with those of an equivalent aerobic exercise intervention. A total of 105 patients were randomly assigned to a Tai Chi group, an aerobic exercise group, or a control group, and underwent a 24-week intervention. Multiple statistical approaches, including linear mixed-effects models, principal component analysis (PCA), and structural equation modeling (SEM), were applied to systematically analyze intervention effects. Intention-to-treat (ITT) analysis showed that Tai Chi intervention significantly reduced blood pressure while concurrently improving key NEI indicators such as acetylcholine, GABA, cortisol, and TNF-α, demonstrating a coordinated "stress-reduction-anti-inflammatory" effect. Structural equation modeling further confirmed "acetylcholine → cortisol → TNF-α → SBP" as a key mediating pathway. These findings indicate that Tai Chi exerts significant advantages in the non-pharmacological management of hypertension by reshaping the NEI network, highlighting its important scientific and practical significance. Trial Registration: International Traditional Medicine Clinical Trial Registry: ITMCTR2024000813.