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.