Treating hypertension in type II diabetic patients with device-guided breathing: a randomized controlled trial

Abstract

The objective of the study was to evaluate the efficacy of device-guided breathing to lower blood pressure (BP) in hypertensive type II diabetic patients. A randomized controlled trial was carried out in four urban family practice clinics in Israel. Non-insulin-dependent diabetic, hypertensive patients with uncontrolled BP, receiving antihypertensive therapy or those non-medicated were enrolled. Baseline characteristics of the 66 patients who completed the study (33 intervention and 33 control) were: 62% men, age 62±8 years (mean±s.d.); body mass index 29±5 kg/m 2 ; systolic BP 148±11 mm Hg and diastolic BP 81 ± 9 mm Hg. The intervention group used a device (RESPeRATE), which interactively guides the user towards slow and regular breathing by synchronizing respiration voluntarily to musical tones for 15 min daily for an 8-week period. The control group continued with their regular treatment. BP was measured in the clinic at baseline, after 4 weeks and at 8 weeks.Medication was unchanged for 4 weeks prior to and during the study period. The main outcome measure was the office BP change from baseline to the end of the 8-week period. BP was reduced in the treatment group (mean ± s.e.) systolic À10.0 ± 1.8 mm Hg and diastolic À3.6 ± 1.3 mm Hg (Po0.0001 and Po0.01), but not in the controls þ 1.6±2.1 and À1.0±1.4 mm Hg P40.4 and P40.4, respectively. Test for between group difference Po0.0001 and P ¼ 0.08. The subjects were highly compliant with the treatment, performing 75% of the requested exercise sessions. Greater BP reduction was observed with increased compliance with device usage (P ¼ 0.01 and P ¼ 0.001). It is concluded that self-treatment with device-guided breathing at home for 8 weeks by non-insulin-dependent diabetic patients was associated with a substantial reduction in office systolic BP.

Regular slow-breathing exercise effects on blood pressure and breathing patterns at rest

“…The findings on resting BP are consistent with those in previous studies of longer duration, [1][2][3][4][5][6][7][8] and support the view that the antihypertensive effects of DGB on BP operate over a pathway in which a prolonged expiratory phase of the respiratory cycle exert reflex effects that decrease peripheral vasoconstriction and increase peripheral blood flow. 9 As the magnitude of BP effects of regular DGB has been shown previously to depend on pre-intervention BP, 4 the magnitude of the effects reported here may also reflect the borderline hypertensive condition of the sample.…”

“…[1][2][3][4][5][6][7][8] However, only three of the studies reported to date involved randomized clinical trials. Two of those did not measure BP in the natural environment, 3,8 and the third was unable to confirm greater effects than in a control group. 7 Whether the effects of DGB observed in the clinic setting extend to the natural environment is an important issue that needs to be investigated in a randomized clinical trial with 24-h BP monitoring preceding and following the DGB intervention.…”

Sympathetic nerve activity is decreased during device-guided slow breathing

“…Second, in spite of the action of diuretics in MSNA be controversial 24 increasing 25 or not affecting the sympathetic nervous system, 26 this class of drugs was not used as monotherapy in our patients. Finally, Schein et al 19 did not observe any influence of the hypertensive medications, including diuretics in BP reduction with the same device. Moreover, it is known that this device may have therapeutic potential as low-risk adjunctive therapy for hypertension.…”

“…Recently, Schein et al 19 found office SBP reduction after 8 weeks of the device use at home in type 2 diabetic patients, compared with controls. The investigators believe that the inhibition of the sympathetic outflow during exhalation and arteriolar vasodilation are responses of the pulmonary stretch receptors activated by the prolonged exhalation, although, they do not believe that this is the mechanism responsible for reducing BP in diabetic patients, because of their autonomic dysfunction.…”

Respiratory Physiotherapy in a Web Browser, Feasibility Study

“…Such a behavior can already be observed in humans, for example, when a person exhales through pursed lips as a sign of relief. Some devices do not require a user to exhale against pressure, such as Resperate device (Intercure Ltd) [23][24][25][26][27] and so it has fewer benefits for COPD patients. We conclude that conducting pursed lip breathing exercises by using an acoustic microphone in front of user's mouth is feasible and should be further researched.…”