Elsevier

Medical Hypotheses

Volume 142, September 2020, 109780
Medical Hypotheses

Mindfulness with paced breathing reduces blood pressure

https://doi.org/10.1016/j.mehy.2020.109780Get rights and content

Abstract

Elevated blood pressure (BP) is a major avoidable cause of premature morbidity and mortality in the United States (US) and worldwide, due primarily to increased risks of stroke as well as myocardial infarction. While there are therapeutic lifestyle changes and adjunctive pharmacologic medications of proven benefit, recent interest has increasingly focused on Complementary and Alternative Medicine, in particular, Mind-Body Interventions. With respect to BP, it is tempting to speculate that mindfulness with paced breathing will have beneficial effects in the short run that may translate into lowered risks of stroke in the long run. Paced breathing is deep diaphragmatic breathing with typical rates equal to or less than 5–7 breaths per minute compared with the usual rate of 12–14. One plausible mechanism of benefit is that paced breathing stimulates the parasympathetic nervous system which alters neuronal function in specific areas of the brain and reduces stress chemicals. The hypothesis that mindfulness with paced slow breathing reduces BP could be directly tested in randomized trials designed a priori to do so. Subsequently, a finding that mindfulness with paced breathing reduces BP would also lead to direct tests in randomized trials of reductions of carotid atherosclerosis and, if so, a larger scale trial to test whether there is a direct impact of mindfulness with paced breathing on reducing the risks of stroke and MI. If rigorous testing of this medical hypothesis led to positive results this would have large and important clinical and policy implications in the US and worldwide.

Section snippets

Introduction/Background

Cardiovascular disease (CVD), principally myocardial infarction (MI) and stroke, is the leading cause of premature deaths in the United States (US) and is rapidly becoming so worldwide [1].

CVD accounts for over 800,000 deaths in the US each year, and more than 17 million worldwide. In the US, CVD accounts for over 40% of total mortality with MI accounting for 25% and stroke 16.5% of all deaths. Further, worldwide, stroke accounts for 11.0% of total deaths. In addition, in the US stroke alone

The Hypothesis/theory

Mindfulness with paced breathing decreases BP. Mindfulness is defined as a mental state achieved by focusing awareness on the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations [14]. At present, however, there are various types of mindfulness practiced, many without standardization of protocols and some, but not all, include paced breathing. While definitions vary, paced breathing has been defined as deep diaphragmatic breathing with a rate

Evaluation of the hypothesis

With respect to lowering BP and prevention of hypertension, numerous TLCs have been evaluated in randomized trials. Specifically, Phase I of the Trials of Hypertension Prevention (TOHP I) was designed to test the short-term feasibility and efficacy of seven nonpharmacological interventions in persons with high normal BP. These included the lifestyle interventions of weight loss, sodium reduction, and stress management, and the nutritional supplement interventions of calcium, magnesium, and

Empirical data

Complementary and Alternative Medicine (CAM) is a common phrase applied to health care practices that traditionally have not been part of conventional western medicine.

In a case series, which is useful to formulate but not test hypotheses [28], [29] individuals who practiced slow and regular breathing had lower BPs [30]. Two observational case-control studies, which can test moderate to large effects, [28], [29] contribute empirical data to the formulation of this medical hypothesis. In one,

Consequences of the hypothesis and discussion

The hypothesis that mindfulness with paced breathing will reduce BP is promising but unproven. Plausible mechanisms for benefit include sustained effects on the parasympathetic nervous system. If so, CAM and MBI will represent a safe, effective, and easily affordable means to reduce BP in the short run. Subsequently, a finding that mindfulness with paced breathing reduces BP would also lead to direct tests in randomized trials of reductions of carotid atherosclerosis and, if so, a larger scale

Conflicting interests

Ms. Brenner, Dr. LeBlang , Dr. Lizotte-Waniewski, Dr. Espinosa and Dr. Newberg report no disclosures. Ms. Schmidt discloses that she receives royalities for authorship of The Practice: Simple tools for managing stress, finding inner peace, and uncovering happiness. Professor DeMets reports that that he serves as an independent scientist in an advisory role to the National Institutes of Health, the US Food and Drug Administration and the pharmaceutical and medical device industry on the design,

Acknowledgment

We are indebted to Heather Johnson, MD, FACC and Anton Borja, DO for advice and help.

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