Device-Guided Breathing to Lower Blood Pressure: Case Report and Clinical Overview

William J. Elliott, MD, PhD; Joseph L. Izzo, Jr, MD

In This Article


Elevated BP is a major risk factor for adverse cardiovascular events, including myocardial infarction, stroke, heart failure, and death.[1] Antihypertensive drug therapy reduces the risk of all these endpoints,[1] but many drugs cause side effects (eg, gout, asthma, cough, pedal edema with diuretics, beta-blockers, angiotensin converting-enzyme inhibitors, and dihydropyridine calcium antagonists, respectively) and can be costly. Reduction of high BP by nonpharmacologic means (ie, lifestyle modifications) is widely recommended, either in primary prevention, or as therapy with or without antihypertensive drugs.[1,2] Unfortunately, diet and exercise alone have rarely been effective in long-term control of high BP.[3,4,5] In spite of the many treatment options, 50% to 80% of treated hypertensives in economically developed countries still have inadequately controlled BP.[6] Therefore, new nonpharmacologic treatment modalities for reducing high BP are of great interest.

Slow and deep breathing ("paced breathing") has been traditionally associated with meditation and healing for hundreds of years.[7] Paced breathing plays a prominent role in behavioral methods of treating hypertension that have reported some short-term successes.[8,9,10] However, asking patients to perform paced breathing sessions on their own may be impractical. Apart from the prolonged training, practicing, skill, and motivation needed, effortlessly performed paced breathing involves individualized breathing patterns that typically require personal coaching. The physiological origin of the hypotensive effects of paced breathing has traditionally been attributed to the "relaxation response."[8] While relaxation is a widely accepted, beneficial outcome of slow breathing, the antihypertensive effect of paced breathing may have a more direct physiological origin.


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