Effects of mental relaxation and slow breathing in essential hypertension☆
Introduction
A variety of stress management techniques have been shown to lower the blood pressure.1 Recently, a number of studies showed that device-guided breathing exercise, which lowers the respiratory rate and modifies respiratory patterns, can also lower blood pressure2, 3, 4, 5 and a sustained reduction in high blood pressure has been demonstrated with slow breathing practiced routinely.5 Breathing exercises guided by the breathe with interactive music (BIM) device for 10 min daily is an effective non-pharmacological modality to reduce blood pressure.4 Resistant hypertensives also have been shown to benefit from and are compliant with self-treatment by device guided slow breathing.2 Breathing pattern modification appears to be an important component in this reduction.3
Non-drug measures like mental relaxation is a proven measure in lowering blood pressure to some extent.6 Relaxation therapy results in greater reduction of blood pressure than placebo or other control procedures. Relaxation therapies share the features of muscular relaxation, regular practice, mental focussing and task awareness.7 An evaluation of the effect of mental relaxation treatment on endogenous opioid activity and vascular reactivity in patients with labile hypertension has demonstrated that mental relaxation treatment is associated with the improvement of the patient's psychological status, lesser psychophysiological and vascular reactivity and a smaller beta-endorphin increment under emotional stress.8 The use of relaxation therapy as autotraining is associated with a slower progress of the disease, as compared to the controls as evidenced by lower blood pressure values, more limited growth of left ventricular hypertrophy and shorter essential hypertension-related temporary disability periods.9
However, there is no study which has compared the effects of mental relaxation and slow breathing in patients of essential hypertension. Therefore, this study was undertaken to compare mental relaxation and slow breathing as adjunctive treatment in cases of essential hypertension by observing their short-term effects on blood pressure and other autonomic parameters like heart rate, respiratory rate, peripheral skin temperature, electromyographic activity and skin conductance.
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Methods
One hundred patients (age range 28–72 years; mean age 43 ± 11.2 years) with essential hypertension of varying severity were included in the study. Patients were selected randomly among the patients visiting the Medical Out-Patient Department of the Himalayan Institute Hospital, Dehradun, situated at the foothills of Garhwal Himalayas in the hilly state of Uttaranchal, India. Eligible patients were of 18 years of age and above with diagnosis of essential hypertension. Both newly diagnosed patients
Results
Baseline characteristics of the patients are shown in Table 1.
Sixty-four (64/100) patients were old hypertensives on antihypertensive drugs for the last 2–30 years and were mostly taking diuretics, beta-adrenergic blockers, calcium channel blockers and ACE inhibitors either alone or in combination. 31.25% (20/64) of the patients on antihypertensive drugs had uncontrolled hypertension. Thirty-six patients were newly diagnosed hypertensives, out of which 61.11% (22/36) patients had stage 1
Discussion
Slow controlled breathing has been shown to be associated with potentiation of both the depressor and the cardio-inhibitory components of the arterial baroreflex.12 In one study, increased parasympathetic activity and decreased sympathetic activity were observed in slow breathing group in healthy volunteers.13 Several studies have shown that 10–15 min of daily breathing exercise for 8 weeks lowered the blood pressure in hypertensive patients.2, 3, 4 But in one study, even without training,
Conclusions
Therefore, even a single session of mental relaxation or slow breathing is effective in reducing blood pressure at least temporarily. Slow breathing is more effective than mental relaxation in lowering systolic blood pressure, diastolic blood pressure, heart rate and respiratory rate while mental relaxation is more effective in reducing electromyographic activity and increasing peripheral skin temperature. It is therefore suggested that these techniques should be used on long-term basis as
Acknowledgements
We are grateful to the Presidential body of the Himalayan Institute Hospital Trust, Dehradun, India, for funding this project. We are thankful to Dr. K.S. Negi, Associate Professor (Biostatistics), Himalayan Institute of Medical Sciences, Dehradun, India, for his help in statistical analysis.
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Grant support by: Himalayan Institute Hospital Trust, Dehradun, India.