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High blood pressure reduction in diabetics with interactive device-guided paced breathing: final results of a randomized controlled study

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... 6 One of the most popular commercially available devices for breathing retraining is RESPE Rate, which prioritizes the regulation of expiration. 7 It is possible that any type of regulated slow breathing rate will be enough to lower diastolic blood pressure. Unnecessarily high sympathetic nervous outflow from the central nervous system is considered to be a key factor in the pathophysiology of acute and chronic hypertension, since it stimulates an increase in cardiac output and peripheral resistance. ...
... However, as seen by the wide variation in the ratio of inspiratory to expiratory periods during breathing training with RESPE Rate, this device directed breathing rate but did not necessarily control the depth of inspiration. 7 After eight weeks of home-based loaded inspiratory training with a threshold breathing apparatus, Chulee et al., 9 discovered that both systolic and diastolic blood pressures were reduced. The author predicted that breathing exercise reduced resting systolic and diastolic blood pressure as well as heart rate, with one potential mechanism of action being that the training increased cardiac vagal tone and lowered sympathetic activity to the cardiac and peripheral arterioles. ...
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Background: Slow breathing, especially with prolonged exhalation, appears to reduce sympathetic nerve traffic and thus causes arteriolar dilatation. Loaded inspiratory exercise has been demonstrated in studies to lower blood pressure. However, the optimal intensity and duration of loaded training to control hypertension is not known. The objective of the present study was to compare the effect of 10 cm loaded inspiratory training with that of 20 cm loaded training in controlling hypertension after third and sixth week.
... Our findings differ from previous work involving breathing training in that there was a consistent reduction of 5 to 8 beats/min in resting heart rate as a result of both loaded and unloaded breathing whereas previous studies of breathing training report no change in heart rate , Grossman et al 2001, Rosenthal et al 2001, Viskoper et al 2003. These previous studies used devices which guided the breathing rate but did not necessarily control the depth of inspiration, as is evident from the high variation in the ratio of inspiratory to expiratory times during breathing training with RESPeRate (Schein et al 2007). With the pressure threshold device we have used, it is necessary to maintain a certain inspiratory pressure to obtain any air flow. ...
... Our findings differ from previous work involving breathing training in that there was a consistent reduction of 5 to 8 beats/min in resting heart rate as a result of both loaded and unloaded breathing whereas previous studies of breathing training report no change in heart rate (Schein et al 2001, Grossman et al 2001, Rosenthal et al 2001, Viskoper et al 2003). These previous studies used devices which guided the breathing rate but did not necessarily control the depth of inspiration, as is evident from the high variation in the ratio of inspiratory to expiratory times during breathing training with RESPeRate (Schein et al 2007). With the pressure threshold device we have used, it is necessary to maintain a certain inspiratory pressure to obtain any air flow. ...
Article
Can adding an inspiratory load enhance the antihypertensive effects of slow breathing training performed at home? Randomised trial with concealed allocation. Thirty patients with essential hypertension Stage I or II. Experimental groups performed slow deep breathing at home, either unloaded or breathing against a load of 20 cmH(2)O using a threshold-loaded breathing device. Participants trained for 30 min, twice daily for 8 weeks. A control group continued with normal activities. Resting blood pressure and heart rate were measured at home and in the laboratory before and after the training period. Compared to the control group, systolic and diastolic blood pressure decreased significantly with unloaded breathing by means of 13.5 mmHg (95% CI 11.3 to 15.7) and 7.0 mmHg (95% CI 5.5 to 8.5), [corrected] respectively (laboratory measures). With loaded breathing, the reductions were greater at 18.8 mmHg (95% CI 16.1 to 21.5) and 8.6 mmHg (95% CI 6.8 to 10.4), respectively. The improvement in systolic blood pressure was 5.3 mmHg (95% CI 1.0 to 9.6) greater than with loaded compared to unloaded [corrected] breathing. Heart rate declined by 8 beats/min (95% CI 6.5 to 10.3) with unloaded breathing, and 9 beats/min (95% CI 5.6 to 12.2) with loaded breathing. Very similar measures of blood pressure and heart rate were obtained by the patients at home. Home-based training with a simple device is well tolerated by patients and produces clinically valuable reductions in blood pressure. Adding an inspiratory load of 20 cmH(2)O enhanced the decrease in systolic blood pressure. NCT007919689.
Article
Objectives: Interest is increasing in nonpharmacological interventions to treat blood pressure in hypertensive and prehypertensive patients at low cardiac risk. This meta-analysis of randomized controlled trials assesses the impact of device-guided and non-device-guided (pranayama) slow breathing on blood pressure reduction in these patient populations. Methods: We searched PubMed, EMBASE, CINAHL, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Web of Science, BIOSIS (Biological Abstracts) Citation Index and Alt HealthWatch for studies meeting these inclusion criteria: randomized controlled trial or first phase of a randomized cross-over study; subjects with hypertension, prehypertension or on antihypertensive medication; intervention consisting of slow breathing at ≤10 breaths/minute for ≥5 min on ≥3 days/week; total intervention duration of ≥4 weeks; follow-up for ≥4 weeks; and a control group. Data were extracted by two authors independently, the Cochrane Risk of Bias Tool assessed bias risk, and data were pooled using the DerSimonian and Laird random effects model. Main outcomes included changes in systolic (SBP) and/or diastolic blood pressure (DBP), heart rate (HR), and/or decreased antihypertensive medication. Results: Of 103 citations eligible for full-text review, 17 studies were included in the meta-analysis. Overall, slow breathing decreased SBP by -5.62 mmHg [-7.86, -3.38] and DBP by -2.97 mmHg [-4.28, -1.66]. Heterogeneity was high for all analyses. Conclusions: Slow breathing showed a modest reduction in blood pressure. It may be a reasonable first treatment for low-risk hypertensive and prehypertensive patients who are reluctant to start medication.
Article
This work presents a system for a simultaneous non-invasive estimate of the blood glucose level (BGL) and the systolic (SBP) and diastolic (DBP) blood pressure, using a photoplethysmograph (PPG) and machine learning techniques. The method is independent of the person whose values are being measured and does not need calibration over time or subjects. The architecture of the system consists of a photoplethysmograph sensor, an activity detection module, a signal processing module that extracts features from the PPG waveform, and a machine learning algorithm that estimates the SBP, DBP and BGL values. The idea that underlies the system is that there is functional relationship between the shape of the PPG waveform and the blood pressure and glucose levels. As described in this paper we tested this method on 410 individuals without performing any personalized calibration. The results were computed after cross validation. The machine learning techniques tested were: ridge linear regression, a multilayer perceptron neural network, support vector machines and random forests. The best results were obtained with the random forest technique. In the case of blood pressure, the resulting coefficients of determination for reference vs. prediction were R(SBP)(2)=0.91, R(DBP)(2)=0.89, and R(BGL)(2)=0.90. For the glucose estimation, distribution of the points on a Clarke error grid placed 87.7% of points in zone A, 10.3% in zone B, and 1.9% in zone D. Blood pressure values complied with the grade B protocol of the British Hypertension society. An effective system for estimate of blood glucose and blood pressure from a photoplethysmograph is presented. The main advantage of the system is that for clinical use it complies with the grade B protocol of the British Hypertension society for the blood pressure and only in 1.9% of the cases did not detect hypoglycemia or hyperglycemia.
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