Role of Paced Breathing for Treatment of Hypertension

Hypertension remains to be a major contributor to global morbidity and mortality. Despite a plethora of pharmacological options available, an abundance of patients have uncontrolled blood pressure thus creating the need for additional strategies, including non-pharmacologic approaches. In this review, we discuss the antihypertensive effect of slow and deep respiration by increasing baroreflex sensitivity.

Asking patients to carry out paced breathing sessions unaccompanied by a personal coach or unaided by a device may be unfeasible. Among proposed breathing techniques, RESPeRATE is a US Food and Drug Administration-certified device that assists slow breathing. In this review, we consider the mechanisms through which guided breathing mechanisms may impact on blood pressure control and alternative techniques. Guided breathing techniques along with lifestyle therapies may be helpful as a first step for patients with mild hypertension and prehypertension who do not suffer from cardiovascular disease, renal disease, or diabetes. Drug therapy must be considered after a couple of months if non-pharmacological therapy was unsuccessful. Device-guided paced breathing (DGB) may be recommended for those who cannot obtain full control of their hypertension with medical therapy alone or cannot tolerate potential side effects of pharmacologic treatment. Also, patients with well-controlled hypertension who may wish to try to reduce medication burden may be candidates for DGB. Patients with white coat or labile hypertension who are interested in biofeedback techniques could also be considered.