Effects of mental relaxation and slow breathing in essential hypertension

doi:10.1016/j.ctim.2005.11.007

Complementary Therapies in Medicine

Volume 14, Issue 2, June 2006, Pages 120-126

https://doi.org/10.1016/j.ctim.2005.11.007 Get rights and content

Summary

Objectives

To compare mental relaxation and slow breathing as adjunctive treatment in patients of essential hypertension by observing their effects on blood pressure and other autonomic parameters like heart rate, respiratory rate, peripheral skin temperature, electromyographic activity of the frontalis muscle and skin conductance.

Methods

One hundred patients of essential hypertension either receiving antihypertensive drugs or unmedicated were selected randomly. Various parameters were recorded during the resting state and then during mental relaxation and slow breathing for 10 min each, separated by a quiet period of 15 min. All parameters were recorded again after mental relaxation and slow breathing. Changes in various parameters observed after mental relaxation and slow breathing were analyzed and compared.

Results

Both mental relaxation and slow breathing resulted in a fall in systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate and electromyographic activity with increase in peripheral skin temperature and skin conductance. Slow breathing caused a significantly higher fall in heart rate (p < 0.05), respiratory rate (p < 0.001), systolic blood pressure (p < 0.05) and diastolic blood pressure (p < 0.01). Increase in peripheral skin temperature (p < 0.05) and reduction in electromyographic activity (p < 0.05) occurred more with mental relaxation. No significant differences were seen between increases in skin conductance (p > 0.2) observed with both the modalities.

Conclusions

Even a single session of mental relaxation or slow breathing can result in a temporary fall in blood pressure. Both the modalities increase the parasympathetic tone but have effects of different intensity on different autonomic parameters.

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.

Section snippets

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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In this follow up study, we investigate a subset of 1,308 dogs whose owners (n = 1,048) described as having at least one form of fearful/anxious behavior. Using a self-reported questionnaire, owners were also asked to indicate the resolutions employed, including training methods and equipment, behavior modification programs, behavior modification and training techniques, medications, and forms of alternative medicine. Owners sought professional help for 50% of the fearful or anxious dogs. Nearly a quarter of the dogs were brought to a veterinarian for help; 15% of which were diagnosed with a medical condition contributing to the dog's misbehavior. Overall, reward-based training, mental stimulation, and habituation were associated with increased odds of improvement. For the specific fear/anxiety-based problems, various consultants and techniques or treatments were found beneficial. Inanimate fears benefited from the use of benzodiazepines, herbal remedies, and dietary changes. Animate fears had increased odds of improvement if the dog was brought to a behavior consultant, use of a relaxation protocol, and systematic desensitization. Situational fears benefitted from mental stimulation, a relaxation protocol, and short, frequent training sessions. Generalized anxiety had increased odds of improvement with nutraceutical therapy and enrollment in dog sporting activities. Negative odds of improvement were found if the dog had pre-existing aggression in conditions involving inanimate fears, situational anxiety, and post-traumatic stress disorder. Neutering (male or female) reduced odds of improvement for animate fears, as did consultation with a veterinarian or non-veterinary behaviorist and the use of benzodiazepines. Changes in management had a negative effect on treatment of situational fear/anxiety. Consulting a trainer and hormone therapy reduced odds of improvement with generalized anxiety disorder. Paradoxically, odds of improvement for post-traumatic stress disorder were reduced when increasing a dog's exercise level was employed in treatment.
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Citation Excerpt :
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The present study aimed to determine the effects of mindful breath awareness & muscle relaxation (MBMR) and transcranial electrical stimulation (tCES) techniques on improving the systolic and diastolic blood pressure status in patients with type 2 diabetes.
The research method was randomized controlled trial (RCT) using split-plot ANOVA (SPANOVA). Thirty patients were selected through purposive sampling from Bonab County Diabetes Association (Iran) and were randomly divided into three 10-member groups, namely MBMR, tCES, and MBMR+tCES groups. Participants received their group interventions in 10 individual sessions. All patients were evaluated for systolic and diastolic blood pressure at two stages, before and immediately after each session. SPANOVA and Bonferroni pairwise comparison tests were used for data analysis.
The results indicated that the MBMR and tCES techniques, alone and in combination, had significant and equal effects on reducing diastolic blood pressure, but the MBMR treatment was more effective in the systolic blood pressure than the tCES.
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Rising heart rate (HR) and elevated blood pressure (BP) cause a greater frequency of cardiovascular events. Many patients cannot maintain target HR and BP using pharmacological therapies. To evaluate the effectiveness of voluntary slow breathing exercises in reducing resting HR and BP, we searched Embase (1974 to April 2016), PubMed (1966 to April 2016), the Cochrane Central Register of Controlled Trials (issue 4, April 2016), and PEDro (www.pedro.org.au; 1999 to April 2016). The primary outcome was the mean change in HR at rest. Secondary outcomes included changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) as well as compliance with the breathing training. Finally, we included 6 studies consisting of 269 subjects. Practice of the breathing exercises resulted in statistically significant HR reduction (mean difference: −1.72 beats/min, 95% CI −2.70 to −0.75). Reductions were seen in SBP (mean difference: −6.36 mm Hg, 95% CI −10.32 to −2.39) and DBP (mean difference: −6.39 mm Hg, 95% CI −7.30 to −5.49) compared with the controls. Trial durations ranged from 2 weeks to 6 months. In conclusion, the existing evidence from randomized controlled trails demonstrates that short-term voluntary slow breathing exercises can reduce resting HR, SBP, and DBP for patients with cardiovascular diseases.

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^☆: Grant support by: Himalayan Institute Hospital Trust, Dehradun, India.

View full text

Effects of mental relaxation and slow breathing in essential hypertension☆

Summary

Objectives

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Conclusions

Acknowledgements

Prev Med

Am J Hypertens

Am J Hypertens

J Behav Ther Exp Psychiatry

Treating hypertension with a device that slows and regularises breathing: a randomised, double-blind controlled study

J Hum Hypertens

Breathing-control lowers blood pressure

J Hum Hypertens

Non-pharmacologic measures for lowering blood pressure

Cardiovasc Drugs Ther

Relaxation therapy in the treatment of hypertension. A review

Arch Gen Psychiatry

Mechanisms of the hypotensive effect of psychorelaxation therapy in hypertension

Kardiologiia

Results of the use of relaxation therapy in hypertension

Kardiologiia

Seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of high blood pressure

Hypertension