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

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

Disclosures
In This Article

Case Report

A 67-year-old white woman with an 11-year history of chronic obstructive pulmonary disease and migraine headaches presented with uncontrolled hypertension for 6 months. Hypertension was initially diagnosed at age 40, and had been treated with an increasing number and doses of antihypertensive drugs. At presentation, she took hydrochlorothiazide 25 mg/day, doxazosin 1 mg/day, metoprolol succinate 50 mg/day, and felodipine 10 mg/day. In addition, aspirin 81 mg/d and sumatriptan 100 mg as needed, were prescribed. She is a nondrinker, nonsmoker, performs strenuous physical exercise twice weekly, and was otherwise healthy and without complaints. She credits her exercise program and healthy eating habits to helping her maintain her weight at 175 lb over the last 3 years, which was 25 lb less than her peak weight.

After informed consent was obtained, she was enrolled in an 8-week study that evaluated the RESPeRATE device.[11] Her initial office BP was 147/91 mm Hg (average of 3 readings, right arm, seated position, using the adult-sized cuff); heart rate of 68 and a body-mass index of 30.5 kg/m2. She was asked to use the device for one 15-minute session every afternoon or evening, and to take 3 consecutive readings of her BP at home, every morning, using a previously-validated BP monitor with a digital readout (Omron model HEM-747 IC, Omron Healthcare, Vernon Hills, Illinois).

After 2 months, her office BPs declined from 147/91 mm Hg to 130/77 mm Hg (a difference of 17/14 mm Hg). Four weeks after the end of the study, the patient's data were uploaded from both the device and home BP monitor into a specialized Web-based reporting system designed for this study. Figure 1 shows typical minute-by-minute changes of the patient's breathing pattern during a single session (#20). The figure demonstrates a reduction in her breathing rate from a normal value of 16 breaths/min (bpm) down to 6 bpm, while doubling the ratio of exhalation to inhalation time. Because she enjoyed the breathing exercise, she continued to use the device after the end of the study.

Typical changes in breathing rate and the ratio between exhale time (Tex) to inhale time (Tin) during a 15-minute session (#20) calculated from data stored in the patient's device, and uploaded to a Web-based reporting system used in research.

Figure 2 shows a different Web-based report from the same patient displaying day-by-day variations in BP over the first 3 months of use. The adherence of the patient to the treatment recommendation (of 15 minutes/day) is expressed by the time spent breathing fewer than 10 bpm during the preceding 7 days ("weekly effective time"). The mean home BP during the first 10 days of use was 161/99 mm Hg; 157/96 mm Hg between days 20-29; 151/89 mm Hg between days 50-59 and 146/85 mm Hg between days 80-89. The net BP reduction from baseline was 10/10 mm Hg after 2 months and 15/14 mm Hg after 3 months of treatment. These values showed a significant trend for BP reduction (P < .05/ P < .001). The heart rate (68 ± 5 beats/min, mean ±standard deviation) did not show any significant change. The corresponding systolic load (ie, the percentage of systolic BP readings >140 mm Hg), was 95%, 95%, 70%, and 65%, respectively over the same time periods cited above. Figure 2 also shows the "weekly effective time" to be above the recommended level (45 minutes/week), demonstrating the patient's adherence to the instructions for use. During the observation period she had no change in medication, lifestyle modifications, or body-mass index, and no complaints about the device or its use.

A Web-based plot of data from the case reported, including 3-month follow-up of home BP and adherence to the recommendation for using the device, using data logged automatically by the devices. The points mark daily averages of BP readings and the patient's concordance with the treatment (by "weekly effective time"). The goals for BP (<120/80 mm Hg) and concordance (> 45 min/week) are colored. The table at the top shows monthly averages of BP and heart rate.

In this patient, the lowering of home BP measurements began about 2 weeks after she initiated device-guided breathing. As in other clinical trials,[12,13] her home BPs continued to drop after the 8-week study period, as she continued to use the device.

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