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

Indications and Limitations

The device is indicated by the US Food and Drug Administration (FDA) for the reduction of stress and as an adjunctive therapy in hypertension. It can be combined with standard antihypertensive drugs and other nonpharmacologic interventions. It has similarly been approved and indicated in Europe, Canada, Australia, Korea, Thailand, and China. Based on the available literature,[11,12,13,14,15,16] device-guided breathing appears to be useful for: (1) prehypertensives and white-coat or labile hypertensives who might benefit from reducing stress and sympathetic activity; (2) patients with isolated systolic hypertension; and (3) patients with resistant hypertension (uncontrolled BP despite use of a diuretic and at least 2 other medications at maximum approved doses). Patients should be instructed to use the device routinely in daily 15-minute sessions, aiming to accumulate at least 45 minutes of slow breathing per week; the device can display the cumulative duration of slow breathing to assist in achieving this goal.

There are no known contraindications to the use of the device to guide slow breathing, and no adverse events have so far been reported. As with all nonpharmacologic therapies for hypertension, implementation of the regimen must be continued (typically for a few weeks) before BP lowering is seen; without continued use, any potential benefit would likely be diminished. In clinical trials, patients who did not spend the requisite 15 minutes/day in device-guided breathing did not see a significant reduction in BP. Many patients prefer to spend less than 15 seconds/day to swallow a pill, rather than spend 60 times that long performing breathing exercises. The $300 retail cost of the device (not typically reimbursed by insurance, including Medicare) is higher than many can afford, but it does come with a "money-back guarantee" (should the individual be unable to use it or should BP not be reduced). Lastly, both physicians and patients should be reminded that nonpharmacologic therapies (including device-guided breathing) should not be used in place of therapies (eg, antihypertensive drugs) that have been proven in 37 randomized clinical trials to prevent stroke (by 29 ± 2%), myocardial infarction (by 21 ± 2%), heart failure (by 29 ± 3%), and cardiovascular death (by 14 ± 2%), compared with placebo or no treatment.


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