Sunday, February 08, 2009
High blood pressure is frequently difficult to treat in a short time by acupuncture or herbs. Patients become discouraged and turn to western medicine. Some forms of Qigong can help lower blood pressure. However, most of these forms must be taught to the patient and are not simple to learn.
Most of these Qigong methods have a common factor. The rate of respiration is slowed down. This may be the chief parameter which accounts for their lowering of blood pressure.
Recent research shows that 3 or 4 15-minute sessions of slow breathing (less than or equal to 10 breaths per minute) can lower both systolic and diastolic blood pressure, usually within 8 weeks (1) – (19). In one clinical trial, some diabetics were not able to sufficiently lower their respiration rate. However, with a longer training period a lower rate of respiration might be achieved.
The breathing exercise should be performed using normal, Buddhist or diaphragmatic breathing, like opera singers. The Daoists thought that normal breathing was one of the secrets of longevity. If you look at a baby in its crib you will only notice its stomach move up and down as it breathes. By contrast, when most seniors breathe their upper chest heaves up and down and there is no visible movement of their abdomen, a consequence of shallow breathing. A Chinese doctor looks at the abdomen of a critically ill patient. If it moves up and down as the patient breathes, the patient has a better chance of surviving than a patient with no visible abdominal movement on breathing. Thus, you may have to instruct patients so that normal or diaphragmatic breathing is done automatically.
Normal or diaphragmatic breathing can be practiced lying down or sitting in a chair. The practice methods are similar. The method of practice while sitting in a chair will be described. Inhale and exhale gently, smoothly and continuously through your nose. Sit comfortably, with your knees bent and your shoulders, head and neck relaxed. Place one hand on your upper chest and the other just below your rib cage. This will allow you to feel your diaphragm move as you breathe. As you inhale, the hand on your chest must move as little as possible, while the hand on your abdomen must move outwards. When you exhale, the hand on your abdomen moves inward, which you can help by slightly and gently pulling your abdominal muscle inward. Once again, the hand on your chest moves as little as possible. At first, you’ll probably get tired while doing this exercise because an increased effort will be needed to use the diaphragm correctly. Keep at it, because with continued practice, diaphragmatic breathing will become easy and automatic. Practice this exercise 5-10 minutes a few times a day.
Slow breathing has the physiological effect of relaxing the muscles surrounding the small blood vessels, which allows the blood to flow more easily. Alpha blockers block receptors in arteries and smooth muscle. This action relaxes the blood vessels and leads to an increase in blood flow and a lower pressure for the control of hypertension. The action in the urinary tract enhances urinary flow for an enlarged prostate. Slow breathing seems to have the same effect as alpha blockers. Thus, it may also reduce the symptoms of an enlarged prostate. This conjecture has not been subjected to clinical trials, but has worked on two subjects.
There is another simple breathing technique purported to help eliminate and prevent heart attacks due to abnormal electrical events to the heart, and to generally enhance performance of the central nervous system (CNS) and to help eliminate the effects of traumatic shock and stress to the CNS. Most patients would prefer to try this approach rather than the risks of ablation or a cardiac pacemaker.
The method requires 1 breath per minute (BPM) respiratory exercise with slow inspiration for 20 seconds, breath retention for 20 seconds, and slow expiration for 20 seconds, for 31 consecutive minutes. Do not attempt to use the required time intervals to start. Use a time interval - say, 5 seconds, or even less, so that no straining is involved. Try to practice every day.
This technique produced favourable shifts in all hemodynamic variables measured for 4 subjects during the 1 BPM exercise and in the post-exercise resting period (20). The authors conclude that the long-term effects of this technique appear to reset a cardio-respiratory brain-stem pacemaker. This effect may be the basis for the purported health claim of this yogic breathing exercise. Large scale clinical trials seem warranted.
1. Device-Guided Breathing to Lower Blood Pressure: Case Report and Clinical Overview. W Elliott, J Izzo. Medscape General Medicine, 2006; 8(3).
2. Graded Blood Pressure Reduction in Hypertensive Outpatients Associated with Use of a Device to Assist with Slow Breathing. W Elliott, J Izzo, Jr., WB White, D Rosing, CS Snyder, A Alter, B Gavish, HR Black, J Clin Hypertens, 2004 6(10): 553-559.
3. Nonpharmacologic Treatment of Hypertension by Respiratory Exercise in the Home Setting. E Meles, C Giannattasio, M Failla, G Gentile, A Capra, G Mancia, American Journal of Hypertension 2004, 17:370–374.
4. Respiration and Blood Pressure. G Parati, JL Izzo Jr, B Gavish, in Hypertension Primer, Third Edition. JL Izzo and HR Black, Eds. Baltimore, Lippincott, Williams, and Wilkins, 2003; Ch. A40, p117-120.
5. Non-Pharmacological Treatment of Resistant Hypertensives by Device-Guided Slow Breathing Exercises. R Viskoper , I Shapira, R Priluck, R Mindlin, L Chornia, A Laszt, D Dicker, B Gavish, A Alter, American Journal of Hypertension 2003; Vol 16:484-487.
6. Device-Guided Breathing Exercises Reduce Blood Pressure - Ambulatory and Home Measurements. T Rosenthal, A Alter, E Peleg, B Gavish, American Journal of Hypertension 2001; 14:74-76.
7. Breathing-control lowers blood pressure.E Grossman, A Grossman , MH Schein, R Zimlichman, B Gavish. Journal of Human Hypertension 2001; 15:263-269.
8. Treating hypertension with a device that slows and regularizes breathing: A randomised, double-blind controlled study. M Schein, B Gavish, M Herz , D Rosner-Kahana, P Naveh, B Knishkowy, E Zlotnikov, N Ben-Zvi, RN Melmed , Journal of Human Hypertension 2001; 15:271-278.
9. The Changes of Noninvasive Hemodynamic Parameters after Device-Guided Slow Breathing Exercise in Hypertensive Patients. J Y Kim, M S Han, H H Yoo, H M Choe, B S Yoo, S H Lee, J Yoon, and K H Choe. Journal of Clinical Hypertension,2006, Vol 8, Issue 5, Suppl A.
10. Does Baseline Systolic Blood Pressure Affect Antihypertensive Efficacy with Device-Guided Breathing Exercise?Kim JY, Han MS, Yoo HH, Choe HM, Yoo BS, Lee SH, Yoon J, and Choe KH. Journal of Clinical Hypertension,2006, Volume 8, Issue 5, Suppl A.
11. Non-pharmacological treatment of hypertension in diabetics by device-guided paced breathing: A randomized controlled study. M H Schein, A Alter and B Gavish. Journal of Clinical Hypertension, 2006, Vol 8, Issue 5, Supl A,. P- 79.
12. Blood pressure change following 8-week, 15-minute daily treatment with paced breathing guided by a device: A korean multi-center study. J H Bae, J H Kim, K H Choe, S P Hong, K S Kim, C H Kim and W H Kim. Journal of Clinical Hypertension,2006, Vol 8, Issue 5, Suppl A,. P-86
13. Treating hypertension in diabetics with device-guided breathing: A randomized controlled study. MH Schein, A Alter and B Gavish. EGPRN 2005.
14. Treating high blood pressure by device-guided paced breathing in the home setting: Evidence-based approach. M Schein, E Grossman, T Rosenthal, C Giannattasio, W Elliott, R Viskoper, A Alter, B Gavish British Hypertension Society Annual Meeting, Cambridge, UK. Sept 2005
15. Reduction of home blood pressures and white coat effect after 8 weeks of device-guided paced breathing. W Elliott, B Gavish, A Alter, J L. Izzo, and H R. Black, American Journal of Hypertension, 2005, 18(5): 211A
16. Blood pressure reduction with device-guided breathing: Pooled data from 7 controlled studies. Elliott, HR Black, A Alter, B Gavish. Journal of Hypertension,
2004; 22(2): S116
17. Acute effects of device guided-breathing on cardiovascular parameters and baroreflex sensitivity in normal subjects. G Parati, F Glavina, G Ongaro, A Maronati, B Gavish, P Castiglioni, M Di Rienzo, G Mancia. American Journal of Hypertension
18. The pressure dependence of arterial compliance: A model interpretation. B Gavish, American Journal of Hypertension, 2001; 14:121A. 2004; 17(5):54A
19. Are breathing exercises an active component in reducing high blood pressure? A retrospective view. B Gavish. Journal of Hypertension 2001, Supplement 2, S79-S80.
Repeated blood pressure measurements may probe directly an arterial property. Gavish B., American Journal of Hypertension 2000; 13:190A.
20.. Hemodynamic Observations on a Yogic Breathing Technique Claimed to Help Eliminate and Prevent Heart Attacks: A Pilot Study. David S. Shannahoff, Khalsa, B., Bo Sramek, Matthew B. Kennel, Stuart