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4.4 83.3
2.8 0.939
BMI (kg m
2
) 27.9
1.3 29.4
1.2 0.402
Heart rate (b.p.m.) 68.1
2.3 66.3
2.8 0.622
Breathing rate (b.p.m.) 14.10.8 13.61.0 0.698
Tidal volume (ml) 46234 41944 0.444
Minute ventilation (l min
1
) 6.20.4 5.20.4 0.085
End tidal CO
2
(mmHg) 39.3
1.0 37.5
0.7 0.148
Systolic BP (mmHg) 141.8
2.4 140.1
2.1 0.597
Diastolic BP (mmHg) 88.2
1.6 85.2
1.8 0.221
Abbreviations: BP, blood pressure; BMI, body mass index; b.p.m.,
breaths per min.
Blood pressure effects of guided slow breathing
DE Anderson et al
2
Journal of Human Hypertension
They were instructed to silently repeat the word
one during each exhalation interval. Daily perfor-
mance at home was documented in a diary. All
participants were called at home weekly to record
adherence data.
Participants were instructed to practice their
breathing exercise daily throughout the 4-week
intervention phase. Both groups reported excellent
adherence to the task instructions. Data recorded in
the device showed that DGB was practiced for
27.90.3 of the 28 days, during which mean
breathing rate was o10 per min for 11.5
1.0 of
the 15 min. The DGB group synchronized their
breathing with the tones 81.915.3% of the time.
The CTL group reported practicing on 27.90.3 of
the 28 days for an average of 17.52
1.9 137.7
2.3 137.3
1.9 137.8
2.2
24-h diastolic BP (mmHg) 84.6
1.1 83.8
1.5 80.4
1.7 81.8
1.7
Night time breathing rate ( per min) 15.70.4 15.70.4 15.70.6 16.00.6
Night time tidal volume (ml) 36127 36649 33030 32627
Night time min ventilation (l min
1
) 5.7
0.5 5.8
0.9 5.1
0.4 5.3
0.6
Blood pressure effects of guided slow breathing
DE Anderson et al
5
Journal of Human Hypertension
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. The findings are also consistent with
the effects in a previous study that daytime BP in the
natural environment is decreased by regular practice
of DGB.
2
In this study, this finding was confined to
female subjects, but as discussed below, is consistent
with the results of other research, which suggests that
the associations of breathing pattern with BP may be
more marked in women than in men. That the effects
of DGB on daytime BP in women were related to
decreases in autonomic arousal is also consistent
with the results of a previous study with women
showing that acute increases in BP in the workplace
were accompanied by increases in perceived stress
and urinary catecholamines.
15
The findings in this study do not, however, support
the view that regular practice of DGB has effects on
mediators of long-term BP level. According to
Guytons formulation of hypertension pathogenesis,
neither changes in cardiac output or peripheral
resistance that accompany changes in sympathetic
nervous system activity can result in long-term
changes in BP because of the infinite ability of the
kidneys to adjust blood volume up or down to
maintain BP around its set point.
16
The development
of chronic hypertension necessarily involves changes
in the set point around which BP fluctuates, the locus
of which has variously been ascribed to the kidneys
11
or central nervous system.
17
Previous research found that sustained salt-sensi-
tive hypertension could be generated in laboratory
animals by intermittent suppression of breathing
that increased pCO
2
and generated a cascade of
responses involving transient changes in acidbase
balance and renal regulation of sodium.
18
From
those findings, it was speculated that regular
practice of DGB might alter renal regulation of
sodium and long-term BP through a respiratory
mechanism that includes sustained decreases in
pCO
2
.
19
In this study, resting PetCO
2
was measured
before and after the DGB and CTL interventions as
an index of possible changes in pCO
2
. In fact, a
significant decrease in resting PetCO
2
was observed
from the first screening session to the post-interven-
tion session in the DGB group. Positive associations
between resting PetCO
2
and resting BP have been
observed in previous studies with women. Higher
resting PetCO
2
has been associated with higher
resting systolic BP in women over 50 years of
age,
20
and especially if they scored low on trait
anger.
21
It has been hypothesized that high resting
PetCO
2
might have a permissive role in the devel-
opment of sodium-sensitive form of hypertension.
22
Although 24-h BP did not decrease in this study, it
would be premature to conclude that regular DGB
could not decrease 24-h BP under other conditions.
For example, the present intervention was 4 weeks
in duration, and at least two of the previous studies
of DGB continued to show a progression of
decreases in BP after the first 4 weeks.
3,5
The
adherence in this study was excellent, but 15min
per day is only a small fraction of the waking hours
during which deeper, slower breathing might exert
its effects. It is conceivable that an intervention that
encouraged deeper breathing over a greater percen-
tage of the day could affect the set point for BP.
In summary, the finding of no changes in 24-h BP
in response to repeated practice of DGB in the
context of significant changes in resting BP is poten-
tially important because of its implications for the
pathways mediating short- and long-term BP regu-
lation. It remains to further research to clarify the
Table 3 Means and s.e. of systolic and diastolic blood pressure (BP) (mmHg) for each of three 8-h intervals of the 24-h day preceding
(pre) and following (post) the device-guided breathing (DGB) and control (CTL) interventions for men and women
Group DGB CTL
Time Night
(00000800h)
Day
(08001600h)
Evening
(16002400h)
Night
(00000800h)
Day
(08001600h)
Evening
(16002400 h)
Systolic BP
Women
Pre 130.21.7 146.81.2 138.10.8 127.91.1 139.40.7 137.40.6
Post 131.6
1.0 141.4
0.6** 137.9
1.0 128.3
1.2 137.3
0.7 137.7
0.7
Men
Pre 123.7
0.8 137.8
0.8 137.7
1.7 128.7
0.9 142.3
0.9 138.3
1.0
Post 128.50.7 138.01.2 142.40.6 128.41.5 141.20.9 142.70.6
Diastolic BP
Women
Pre 79.9
1.7 89.8
0.5* 83.2
0.8 72.6
1.3 80.4
0.6 77.6
0.7
Post 79.2
0.8 87.2
0.6 82.3
1.0 71.8
0.9 81.6
0.8 81.7
0.7
Men
Pre 72.40.5 84.71.0 82.61.5 74.01.3 86.10.9 82.01.6
Post 76.4
0.4 84.8
0.9 83.9
0.8 77.1
1.5 84.1
1.2 85.7
0.7
**Po0.001; *Po0.05.
Blood pressure effects of guided slow breathing
DE Anderson et al
6
Journal of Human Hypertension
extent to which retraining in breathing patterns is
capable of producing salutary effects on mechan-
isms involved in long-term BP regulation.
Conflict of interest
The authors declare no conflict of interest.
Acknowledgements
This research was solely supported by the Intramural
Research Program of the NIH, National Institute
on Aging. The authors are indebted to Dr Deborah
Grady for calling our attention to the guided brea-
thing device, and to Drs Benjamin Gavish, S Mortesa
Farasat and Margaret A Chesney for review of the
paper.
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What is known about this topic
K Several previous studies have reported that regular practice
of device-guided slow breathing exercises decrease resting
blood pressure (BP) in hypertensive patients.
K Device-guided slow breathing is known to be accompanied
by decreases in peripheral vasoconstriction, but whether
they produce decreases in 24-h BP remains to be
determined.
What this study adds
K This study shows that daily practice of device-guided slow
breathing exercises decreases resting, but not 24-h BP in
patients with mild hypertension.
K The decreases in resting BP are accompanied by decreases
in breathing rate and increases in tidal volume at rest.
K These results raise the issue of whether the salutary effects
of slow breathing exercises address the root causes of
hypertension, or merely decrease the autonomic influence
on BP.
Blood pressure effects of guided slow breathing
DE Anderson et al
7
Journal of Human Hypertension