Treating hypertension in type II diabetic patients with device-guided breathing: a randomized controlled trial - Schein et al. (2009)

Key Points

  • Slow breathing significantly reduces blood pressure in hypertensive type II diabetics

  • More time spent slow breathing leads to greater improvements in blood pressure

  • Slow breathing can be used as a compliment to standard care to improve blood pressure

The Breathing Diabetic Summary

In our review of Howorka et al. (2013), we discovered that diabetics are more likely to develop hypertension than non-diabetics.  The current study reveals that hypertension occurs twice as much in diabetics than non-diabetics.  Fortunately, along with normal care, slow breathing appears to reduce high blood pressure in diabetics.

This study recruited 65 type II diabetics with hypertension.  The subjects were divided into an intervention group and a control group.  The intervention group used the RESPeRATE® device, which gradually guided them toward slower breathing.  They were instructed to use the device once daily for 15 minutes, with the goal of achieving 45 minutes of slow breathing (<10 breaths/min) a week.  Importantly, they were told to continue their normal pharmacological care and not to change their diet or exercise routines.

The patients that performed slow breathing significantly reduced their systolic blood pressure, diastolic blood pressure, and pulse pressure. These changes were not evident in the control group.  Their analysis showed that the improvements in blood pressure began ~1 month after beginning the daily slow breathing practice.

Because the RESPeRATE® device records and saves all of the information from each breathing session, the authors were able to examine the results based on how long each participant used the device.  As we might expect, the more time spent breathing slowly, the greater the reduction in blood pressure.

Overall, this paper showed that slow breathing reduced blood pressure in type II diabetic patients with hypertension.  The more time patients spent breathing slowly, the greater the reduction in blood pressure.  Notably, these improvements did not require any additional modifications to diet, exercise, or medicine.

Let’s start using Principle 1 today as a complement our current treatment plan to lower blood pressure and treat or prevent hypertension.

(SIDE NOTE: Two of the authors of this paper are employed by the company that produces the RESPeRATE® device.Thus, the results could be biased. Luckily, there are many other papers showing the efficacy of breathing slowly to lower blood pressure, and we don’t need to buy anything to start breathing slowly today!)

Abstract from Paper

The objective of the study was to evaluate the efficacy of device-guided breathing to lower blood pressure (BP) in hypertensive type II diabetic patients. A randomized controlled trial was carried out in four urban family practice clinics in Israel. Non-insulin dependent diabetic, hypertensive patients with uncontrolled BP, receiving antihypertensive therapy or those non-medicated were enrolled. Baseline characteristics of the 66 patients who completed the study (33 intervention and 33 control) were: 62% men, age 62±8 years (mean±s.d.); body mass index 29±5kg/m2; systolic BP 148±11mmHg and diastolic BP 81±9mmHg. The intervention group used a device (RESPeRATE), which interactively guides the user towards slow and regular breathing by synchronizing respiration voluntarily to musical tones for 15min daily for an 8-week period. The control group continued with their regular treatment. BP was measured in the clinic at baseline, after 4 weeks and at 8 weeks. Medication was unchanged for 4 weeks prior to and during the study period. The main outcome measure was the office BP change from baseline to the end of the 8-week period. BP was reduced in the treatment group (mean±s.e.) systolic -10.0±1.8mmHg and diastolic -3.6±1.3mmHg (P<0.0001 and P<0.01), but not in the controls +1.6±2.1 and +1.0±1.4mmHg P>0.4 and P>0.4, respectively. Test for between group difference P<0.0001 and P=0.08. The subjects were highly compliant with the treatment, performing 75% of the requested exercise sessions. Greater BP reduction was observed with increased compliance with device usage (P=0.01 and P=0.001). It is concluded that self-treatment with device-guided breathing at home for 8 weeks by non-insulin-dependent diabetic patients was associated with a substantial reduction in office systolic BP.

Journal Reference:

MH Schein, B Gavish, T Baevsky, M Kaufman, S Levine, A Nessing, and A Alter, (2009) Treating hypertension in type II diabetic patients with device-guided breathing: a randomized controlled trial, Journal of Human Hypertension, 23, 325–331.