How Effective Are Non-Drug and Non-Diet Therapies In Lowering Blood Pressure?

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Meditation, yoga, aerobic exercise and strength training are popular ways to lower blood pressure, so the latest study compared their effectiveness against common drug and diet treatments.

About 26% of people worldwide have high blood pressure, and hypertension is responsible for half of strokes and heart disease. But recommendations urging patients to change their eating habits — by reducing the amount of salt and fat they consume — and to exercise more aren’t easy to follow. Drug treatments are effective, but some patients do not respond well to standard medications, making alternative treatment options an important part of their care. Yet it’s not clear how effective these strategies are in lowering blood pressure and eventually helping people to avoid stroke or heart disease.

So a panel of researchers convened by the American Heart Association, led by Dr. Robert Book, a professor of medicine at the University of Michigan in Ann Arbor, reviewed data from recent studies to come up with a scientific statement evaluating alternative therapies for people with blood pressure higher than 120/80 mm Hg.

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The panel researchers reviewed 1,000 studies, published between 2006 and 2011, that investigated three alternative remedy categories. The first involved exercise regimens, the second included behavioral therapies like mediation and the final therapy category assessed non-invasive procedures like acupuncture or devices that helped patients slow their breathing. Although none of the therapies caused serious adverse effects, the benefits recorded by these studies were small.

For instance, when the researchers looked at the three types of exercise regimens — aerobic, resistance or weight training and isometric exercises — they found that all three regimens lowered blood pressure. But isometric hand grip exercises were associated with the greatest improvements in blood pressure — a 10% drop in systolic and diastolic blood pressure. The decline was greater than that recorded among those who walked regularly. the reason, say the researchers could have something to do with the fact that those who walked in the study were not exercising at an intense enough levels; some studies showed that walking had more of a beneficial effect on blood pressure if participants used a faster pace or exercised more frequently, such as walking over 35 minutes more than four days a week.

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Behavioral therapies like transcendental mediation, which helps to lower stress, only lowered blood pressure slightly, and there was little evidence that other types of meditation provided benefit either. Although some studies have linked yoga to a lower risk of some specific heart disorders, the researchers concluded that the data wasn’t strong enough to recommend yoga and other relaxation techniques to lower blood pressure.

Finally, device-guided slow breathing showed some promise in lowering blood pressure when patients used it for 15 minute sessions for three to four times in a day. One such device, RESPeRATE, involved a belt around the thorax to monitor breathing. The device fed real-time data on respiration rate into a small battery-operated controller box that played back musical tones into the wearer’s headphones to guide them toward more relaxed and controlled breathing to help to lower blood pressure.

However, studies did not support the benefits of another popular therapy for treating blood pressure — acupuncture — in treating hypertension.

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So are any of the alternative therapies worth trying, especially for people whose blood pressure remains high on pharmaceutical medications or who can’t tolerate the side effects of these drugs? Brock said in a statement that most of the alternative approaches the panel evaluated lowered blood pressure by 2-10 mm Hg, while prescription medications resulted in a 10-15 mm Hg decline in systolic pressure on average. But the panel found that the alternative options can’t hurt, since the evidence did not reveal serious harms, so the strategies should be used in addition to, and not replace well-established approaches to managing blood pressure. These include exercising, eating a low-sodium diet, managing weight and avoiding smoking and excessive drinking. And for those who can tolerate them, taking the appropriate medications.

Considering a combination of strategies to find the right doses and appropriate mix of options for each patient, say the researchers, may be the best way to take advantage of the variety of blood pressure-lowering strategies that are available.

The study is published in the journal Hypertension.

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