Slow breathing training, especially with an inspiratory load, is very effective in reducing resting systolic and pulse pressures and could be a valuable adjunct in the management of ISH.

Isolated systolic hypertension (ISH) is the most common form of hypertension in older people. It is characterized by increased resting systolic blood pressure (sBP) and increased sBP in response to exercise. It has previously been shown that slow breathing training reduces resting sBP, and the objective of the present study was to determine whether it also reduced the blood pressure response to static handgrip exercise. ISH patients aged between 60 and 74 years were randomly divided into a control group (10 subjects, 4 of which were male) that breathed normally and a trained group (10 subjects, 4 of which were male) that trained daily for 8 weeks by slow breathing against an inspiratory resistance of 18 cmHO. Before and immediately after training, subjects underwent a 2-min handgrip test (30% max) followed by 2 min of post-exercise circulatory occlusion (PECO) to assess metaboreflex activity. Training reduced sBP by 10.6 mm Hg (95% confidence interval (CI), -16 to -5 mm Hg, P=0.004), but changes were not observed in the control group. The peak exercise sBP was reduced by 23 mm Hg (95% CI, -16 to -31 mm Hg, P<0.001), while the increase in the sBP above resting was reduced by 12.6 mm Hg (95% CI, -6.9 to -18.2 mm Hg, P=0.002). The sBP during PECO was reduced by 8.9 mm Hg (95% CI, -4 to -14 mm Hg, P=0.008), which is indicative of reduced metaboreflex activity; no such change was observed in the control group. The results demonstrate that conventional treatment of older patients with ISH may be improved in two ways by slow breathing training: resting sBP may be reduced by 10 mm Hg, more than can be achieved by conventional pharmacological therapies, while the response to static exercise may be reduced by approximately twice this value.

Objectives Slow loaded breathing training has been shown to reduce resting blood pressure (BP) in isolated systolic hypertension (ISH), but it is not known whether this also reduces their exaggerated BP responses to exercise. Methods The study was a randomized controlled trial with block allocation stratified by sex. Twenty ISH patients (68 ± 5 yrs, 11 males) were randomized with one group undertaking 8‐weeks training with slow loaded breathing (SLB: 25% maximum inspiratory pressure, 6 breaths per minute, 60 breaths every day) or deep breathing control (CON), with 8 weeks follow‐up. Outcome measures were home BP and heart rate (HR) with laboratory measures of BP and HR responses to static handgrip and dynamic arm cranking exercise. Data were compared with a two‐week run‐in baseline. Results Home systolic BP fell by 22 mmHg (20–23; mean, 95% CI), diastolic BP by 9 mmHg (7–11), and HR by 12 bpm (9–15; all p < .001) as a result of SLB training. Systolic BP at the end of 2‐min isometric handgrip was 189 ± 10 mmHg (mean, SD) before training and 157 ± 6 mmHg following SLB training. After 4‐min arm exercise, systolic BP, measured at the ankle, was reduced from 243 ± 8 mmHg during the run‐in period to 170 ± 15 mmHg after SLB training with no change for CON. The reduction in exercise BP, in both types of exercise, was partly due to a reduction in resting BP and to a smaller increase above resting. Systolic and pulse pressures remained below run‐in values 8 weeks after the end of SLB training, and BP response to handgrip exercise remained below run‐in values at 4 weeks after SLB training. Conclusions SLB not only reduces resting BP in ISH but also the responses to both static and dynamic exercise, potentially reducing the negative aspect of exercise for cardiovascular health.

Despite being well controlled and normotensive control subjects at rest, ISH patients had high SBP responses to both dynamic and static exercises, which may constitute a risk for cardiovascular incidents.