K.S. de Freitas Gonçalves1, A.C. Queiroz Godoy Daniel1, J.L. Tatagiba Lamas2, H. Ceretta Oliveira2, L. Cloutier3, R.C. De Campos Pereira Silveira1, E. Velludo Veiga1
1University of São Paulo, College of Nursing, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, Brazil, 2University of Campinas, School of Nursing, Campinas, Brazil, 3Université du Québec à Trois-Rivières, Department of Nursing Université du Québec à Trois-Rivières, Quebec, Canada
Background: Hypertension is a multifactorial chronic disease and the main risk factor for the development of cardiovascular diseases and chronic kidney disease. Pharmacological treatments alone have not overcome the high prevalence of hypertension. Non-pharmacological treatments are also effective in reducing blood pressure levels in patients with hypertension. Such treatments include body weight control, the establishment of healthy eating habits, alcohol consumption control, smoking cessation, stress control, aerobic and isometric physical exercises and slow breathing. The latter can be device-guided slow breathing (DGSB) or non-device-guided slow breathing (NDGSB). These breathing exercises consist of slow and deep breathing, 6 to 10 breaths per minute. Although the effects of other types of exercise in people with hypertension is well established, the effects of slow breathing are less clear.
Purpose: To analyze the impact of prolonged use of device or non-device guided slow breathing compared to usual care, on the BP values of hypertensive patients.
Methods: Systematic review and meta-analysis of randomized clinical trials, based in the recommendations of the Cochrane Handbook of Systematic Reviews and PRISMA. Two reviewers independently analyzed all titles and abstracts retrieved with the search and extracted the data. In the presence of disagreement between the reviewers, a third reviewer was convened.
Population: Hypertensive patients, with or without comorbidities, over 18 years old, of both sexes, with or without hypertensive medication.
Interventions: The selected studies showed comparisons between groups that performed device-guided and/or non-device-guided slow breathing with control conditions.
Outcomes: The primary outcome was the value of systolic blood pressure (SBP) and diastolic blood pressure (DBP) after the interventions. The secondary outcome was a reduction in the quantity / dosage of drugs administered to hypertension control.
Population: Hypertensive patients, with or without comorbidities, over 18 years old, of both sexes, with or without hypertensive medication.
Interventions: The selected studies showed comparisons between groups that performed device-guided and/or non-device-guided slow breathing with control conditions.
Outcomes: The primary outcome was the value of systolic blood pressure (SBP) and diastolic blood pressure (DBP) after the interventions. The secondary outcome was a reduction in the quantity / dosage of drugs administered to hypertension control.
Results: Twenty-two studies involving 17,214 participants were included in the quantitative analysis.The studies involved hypertensive adults, of both gender, under pharmacological treatment or not, but no study has reported on the secondary outcome, which would be reducing the dose of antihypertensive medication after the interventions. Considerable heterogeneity was revealed between studies. Using a random-effects model, it was found that DGSB did not significantly reduce SBP and DBP compared to usual care, both in terms of BP values and in relation to their variability (SBP, MD -2.13 mmHg, [95% CI -12.71 to 8.44], 288 individuals,I2 = 93%, high heterogenity; DBP, MD -0.90, 95% CI -3.97 to 2.11, 288 individuals,I2 = 63%, substantial heterogenity; SBP variability MD -2.42, 95% CI -7.24 to 2.40, 443 individuals,I2 = 85%,high heterogenity; DBP variability MD -1.67, 95% CI -4.57 to 1.24, 443 individuals,I2 = 80%, high heterogenity).Regarding NDGSB, only three studies addressed the technique. However, subgroup analysis were not possible because of the inherent differences in the study follow-up period varying from 30 seconds to 8 weeks.
Conclusions: Based on these results it appears that device-guided slow breathing did not reduce blood pressure in hypertensive patients although the wide confidence intervals around some results do not exclude the possibility of clinically relevant effects.
Implications: The evidence about DGSB does not clearly support a beneficial effect in reducing BP value and evidence about NDGSB are still scarce in the literature.
Funding acknowledgements:
The work was unfunded.
Keywords:
Hypertension
Breathing Exercises
Device-guided breathing
Hypertension
Breathing Exercises
Device-guided breathing
Topics:
Cardiorespiratory
Older people
Cardiorespiratory
Older people
Did this work require ethics approval? No
Reason: Ethical approval did not required because this work is a systematic review.
All authors, affiliations and abstracts have been published as submitted.
