Effectiveness of Slow Breathing on Blood Pressure and Quality of Life in Patients with Hypertension: A Randomized Trial

  • B Srinivasan Rajah Muthiah Medical College and Hospital, Annamalai University, Chidambaram, Tamil Nadu, India
  • D Rajkumar Rajah Muthiah Medical College, Annamalai University, Chidambaram, Tamil Nadu, India
Keywords: Breathing training, High blood pressure, Hypertension, Non-pharmacological measures, Quality of life, Slow breathing


Background: Hypertension constitutes a significant cardiovascular burden globally. Non-pharmacological interventions are highly sought either as an adjunct or primary means of managing hypertension. Slow breathing (SB) is one of such approach which gains attention in recent times due to its multiple physiological benefits in lowering blood pressure (BP). However, there is a gap in literature testing the ability of SB training on quality of life (QOL) of hypertensive (HT) patients.
Aim of the Study: This study aims to find out the effectiveness of SB on reduction of BP and improvement in the health-related QOL in HT patients.
Materials and Methods: It was a randomized, open, and parallel-group trial design carried out at the Outpatient Department of Medicine in Rajah Muthiah Medical College and Hospital, Annamalai University, Chidambaram, Tamil Nadu, India. The study consists of 60 HT patients assigned equally to either study or control group. The study group was trained with SB training for 4 weeks, whereas no specific treatment was given for controls.
Results: The mean drop in systolic BP (SBP) for the study group was 14.24 ± 3.30 mmHg, whereas the mean drop was only 5.28 ± 2.26 mmHg for controls. The mean drop in diastolic BP (DBP) was 6.20 ± 2.69 mmHg for the study group, whereas it was only 3.12 ± 2.05 mmHg for controls. There was significantly higher drop in systolic as well as DBP in the study group. Likewise, the World Health Organization QOL-BREF (WHOQOL-BREF) was improved to 10.79 ± 5.47 in the 0–100 scale for the study group, whereas the mean improvement in the WHOQOL-BREF for control was 5.95 ± 0.01 in the 0–100 point scale.
Conclusions: It was concluded that 4 weeks of SB training were effective in reducing BP and improving QOL in patients with HT.

Author Biographies

B Srinivasan, Rajah Muthiah Medical College and Hospital, Annamalai University, Chidambaram, Tamil Nadu, India

Lecturer, Division of Physical Medicine and Rehabilitation, 

D Rajkumar, Rajah Muthiah Medical College, Annamalai University, Chidambaram, Tamil Nadu, India

Principal and Dean, Professor, Department of Physiology, 


1. Mackay I, Mensah G. Atlas of Heart Disease and Stroke. Geneva: World
Health Organization; 2004.
2. Global Burden of Disease Study 2015. Health Data. Available from: http://
www.ghdx.healthdata.org/gbd-data-tool. [Last accessed on 2019 Feb 02].
3. Gupta R. Convergence in urban-rural prevalence of hypertension in India.
J Hum Hypertens 2016;30:79-82.
4. Gupta R, Kaul V, Agrawal A, Guptha S, Gupta VP. Cardiovascular risk
according to educational status in India. Prev Med 2010;51:408-11.
5. Whelton PK, Carey RM, Aronow WS, Casey DE Jr., Collins KJ,
ASPC/NMA/PCNA guideline for the prevention, detection, evaluation and
management of high blood pressure in adults: Executive summary. J Am
Coll Cardiol 2018; 71:2199-269.
6. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, et al.
ACC/AHA guideline on the primary prevention of cardiovascular disease:
A report of the American College of ardiology/American Heart Association
task force on clinical practice guidelines. J Am Coll Cardiol 2019;140:e563-95.
7. Parati GP, Izzo JL, Gavish B. Respiration and blood pressure. In: Izzo JL,
Sica DA, Black HR, editors. Hypertension Primer. Dallas: American Heart
Association; 2008. p. 136-8.
8. Pitzalis MV, Mastropasqua F, Massari F, Passantino A, Colombo R,
Mannarini A, et al. Effect of respiratory rate on the relationships between
RR interval and systolic blood pressure fluctuations: A frequency-dependent
phenomenon. Cardiovasc Res 1998;38:332-9.
9. Bernardi L, Gabutti A, Porta C, Spicuzza L. Slow breathing reduces
chemoreflex response to hypoxia and hypercapnia, and increases baroreflex
sensitivity. J Hypertens 2001;19:2221-9.
10. Bernardi L, Porta C, Spicuzza L, Bellwon J, Spadacini G, Frey AW, et al.
Slow breathing increases arterial baroreflex sensitivity in patients with
chronic heart failure. Circulation 2002;105:143-5.
11. Joseph CN, Porta C, Casucci G, Casiraghi N, Maffeis M, Rossi M, et al.
Slow breathing improves arterial baroreflex sensitivity and decreases blood
pressure in essential hypertension. Hypertension 2005;46:714-8.
12. Goso Y, Asanoi H, Ishise H, Kameyama T, Hirai T, Nozawa T, et al.
Respiratory modulation of muscle sympathetic nerve activity in patients
with chronic heart failure. Circulation 2001;104:418-23.
13. Spicuzza L, Gabutti A, Porta C, Montano N, Bernardi L. Yoga and
chemoreflex response to hypoxia and hypercapnia. Lancet 2000;356:1495-6.
14. Anderson DE, McNeely JD, Windham BG. Device-guided slow-breathing
effects on end-tidal CO(2) and heart-rate variability. Psychol Health Med
15. Joshua DS, Gary CB, Melissa MB. The quality of life of patients with
hypertension. J Clin Hypertens 2002;4:181-8.
16. Anderson DE, McNeely JD, Windham BG. Regular slow-breathing exercise
effects on blood pressure and breathing patterns at rest. J Hum Hypertens
17. Schein MH, Gavish B, Herz M, Rosner-Kahana D, Naveh P, Knishkowy B,
et al. Treating hypertension with a device that slows and regularises
breathing: A randomised, double-blind controlled study. J Hum Hypertens
18. Elliot WJ, Izzo JL Jr., White WB, Rosing DR, Snyder CS, Alter A, et al.
Graded blood pressure reduction in hypertensive out patients associated
with use of a device to assist with slow breathing. J Clin Hypertens
19. Swarnalatha N. Effect of slow breathing training for a month on blood
pressure and heart rate variability in healthy subjects. Natl J Physiol Pharm
Pharmacol 2014;4:245-8.
20. Bollen JC, Dean SG, Siegert RJ, Howe TE, Goodwin VA. A systematic
review of measures of self-reported adherence to unsupervised home-based
rehabilitation exercise programmes, and their psychometric properties.
BMJ Open 2014;4:e005044.
21. World Health Organization. The World Health Organization Quality of
Life (WHOQOL) BREF. Geneva, Switzerland: World Health Organization;
22. Losa-Iglesias ME, Becerro-de-Bengoa-Vallejo R, Becerro-de-Bengoa-Losa
KR. Reliability and concurrent validity of a peripheral pulse oximeter and
health-app system for the quantification of heart rate in healthy adults.
Health Informatics J 2016;22:151-9.
23. Kameyama M, Uehara K, Takatori M, Tada K. Clinical usefulness of
EMMA for monitoring end-tidal carbon dioxide. Masui 2013;62:477-80.