Device - assisted Slow Breathing as a Complementary Treatment for Hypertension

By Robert P. Nolan Guidelines for primary and secondary prevention of cardiovascular disease in Europe and North America suggest that behavioral interventions (relaxation training, stress management, biofeedback or meditation) may assist the treatment of patients for whom psychosocial stress is of clinical concern. Several reviews have evaluated whether these behavioral interventions can be utilized to improve the regulation of blood pressure (BP) among patients with hypertension. With the exception of smoking cessation, exercise training and diet modification, no behavioral treatment has been established as conferring independent benefit on long-term clinical outcomes, including BP reduction. Over the past 15 years there has been considerable research regarding a potential antihypertensive effect of slow, deep breathing, which is a common feature of behavioral training in stressreduction techniques. Paced breathing, between six and 10 breaths per minute, has been reported to evoke short-term reductions in systolic and diastolic BP among patients with hypertension, cardiovascular disease and chronic heart failure. It is hypothesized that slow, deep breathing as a complementary antihypertensive treatment augments vagal-efferent modulation of heart rate, while increasing cardiovagal baroreflex control over BP and sympathetic outflow to peripheral sites, which decreases peripheral resistance. However, a specific depressor mechanism that is linked to treatment with slow, deep breathing has not been clearly demonstrated. Device-assisted training in slow breathing with the RESPeRATE apparatus has been reported to reduce BP of hypertensive subjects with or without antihypertensive medication, following eight weeks of treatment that included 10 to 15 minutes of practice per day. The RESPeRATE intervention consists of a thoracic belt that