jksh Journal of the Korean Society of Hypertension J Korean Soc Hypertens 2233-8136 2233-8454 The Korean Society of Hypertension 10.5646/jksh.2013.19.2.55 jksh-19-55 Original Article The Changes of Noninvasive Hemodynamic Parameters after Device-Guided Slow Breathing Exercise in Hypertensive Patients KimJang-YoungMD YooByung-SuMD LeeSeung-HwanMD YoonJunghanMD ChoeKyung-HoonMD Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea Tel: 033) 741-0909, Fax: 033) 741-1219 E-mail: kimjy@yonsei.ac.kr 06 2013 10 06 2013 19 2 55 62 24052013 21062013 26092013 Copyright © 2013 The Korean Society of Hypertension 2013 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background:

The device-guided breathing (DGB) exercise is a non-pharmacological treatment of high blood pressure (BP). Changes in hemodynamic variables after DGB remain to be defined. This study evaluated the hemodynamic effects of DGB in hypertensive patients.

 Methods:

Fifty-nine hypertensive individuals (male, 56%; age, 44 ± 10 years) with systolic BP (SBP) in the range of 140 to169 mm Hg and diastolic BP (DBP) < 105 mm Hg were divided into two group: control group (n = 17) vs. DGB group (n = 42) who slowed respiratory rate by using 15 minutes daily DBG (RESPeRATE) over 8 weeks. Heart rate, BP and hemodynamic parameters including cardiac index (CI), thoracic fluid content (TFC), systemic vascular resistance index (SVRI) and total arterial compliance index (TACI) were measured using the ICG Monitor (CardioDynamics) at baseline and study end.

 Results:

Baseline characteristics were not different between the two groups. Office BP (SBP/DBP) was reduced from baseline to end value by 13.2 ± 11.1/6.9 ± 7.5 mm Hg in DGB group and 2.2 ± 6.9 /0.5 ± 6.6 mm Hg in control group (p = 0.001, p = 0.004, respectively). Heart rate, CI, stroke index, and TFC were not changed in both groups. However, the SVRI was lower and the TACI was higher in DGB group than control group (SVRI: 2,728 ± 599 vs. 3,141 ± 714 dyne sec m2/cm5, p = 0.002; TACI: 0.845 ± 0.194 vs. 0.761 ± 0.184 mm Hg/mL/m2, p = 0.041).

 Conclusions:

Daily device-guided breathing exercise for 8 weeks lowers the BP mediated by reducing the systemic vascular resistance and increasing the total arterial compliance without changes in heart rate and CI.

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The changes of the key hemodynamic variables between baseline and study end. Values are presented as mean ± standard errors. (A) Systemic vascular resistance index. (B) Total arterial compliance index. (C) Cardiac index. (D) Total fluid contents. NS, non-significant.

Components of RESPeRATE (InterCure). (A) Computerized control unit. (B) Respiratory muscle activity monitor (sensor belt). (C) Headphone.

Baseline characteristics of study subjects

Characteristic Control(n = 17) Breathing exercise (n = 42) p-value
Demographic variables
Female/male 9 / 8 24 /18 0.768
Age (yr) 44.5 ± 12.4 44.4 ± 9.4 0.976
Diabetes (%) 0 (0) 2 (4.8) 0.503
Smoking (%) 6 (35.3) 11 (26.2) 0.450
Hyperlipidemia (%) 4 (23.5) 8 (19.0) 0.699
Systolic BP (mm Hg) 148.1 ± 7.6 152.8 ± 9.1 0.167
Diastolic BP (mm Hg) 94.2 ± 6.9 95.8 ± 6.9 0.428
Heart rate (beats/min) 72.5 ± 11.7 70.0 ± 7.1 0.850
Hemodynamic variables
Cardiac index (L/min/m2) 2.68 ± 0.49 2.69 ± 0.47 0.925
Stroke index (mL/m2) 36.9 ± 5.7 39.9 ± 7.5 0.139
SVRI (dyne sec m2/cm5) 3072 ± 772 3092 ± 599 0.912
Velocity index 45.9 ± 19.7 46.9 ± 13.4 0.829
Total fluid content (/kOhm) 29.5 ± 3.8 29.3 ± 3.8 0.880
TACI (mm Hg/mL/m2) 0.703 ± 0.169 0.718 ± 0.182 0.765

Values are presented as mean ± standard deviation or number (%). Hyperlipidemia defined as a total cholesterol > 220 mg/dL. SVRI, systemic vascular resistance index; TACI, total arterial compliance index.

Hemodynamic variables between baseline and study end

Variable Baseline End Changes
Control (n = 17)
Systolic BP (mm Hg) 148.1 ± 7.6 146.0 ± 8.5 2.2 ± 6.9
Diastolic BP (mm Hg) 94.2 ± 6.9 93.7 ± 6.6 0.5 ± 6.7
Heart rate (rate/min) 72.5 ± 11.7 72.7 ± 9.5 -0.2 ± 6.0
Cardiac index (L/min/m2) 2.68 ± 0.49 2.62 ± 0.42 -
SVRI (dyne sec m2/cm5) 3072 ± 772 3141 ± 714 -
Velocity index 45.9 ± 19.7 44.8 ± 14.5 -
Total fluid content (/kOhm) 29.5 ± 3.8 30.7 ± 4.8 -
TACI (mm Hg/mL/m2) 0.703 ± 0.169 0.761 ± 0.184 -
Slow breathing exercise (n = 42)
Systolic BP 152.8 ± 9.1 139.6 ± 10.7* 13.2 ± 11.1†
Diastolic BP 95.8 ± 6.9 89.0 ± 6.9* 6.9 ± 7.5†
Heart rate (rate/min) 70.0 ± 7.1 71.2 ± 9.5 -0.2 ± 11.3
Cardiac index (L/min/m2) 2.69 ± 0.47 2.80 ± 0.56 -
SVRI (dyne sec m2/cm5) 3092 ± 599 2728 ± 599† -
Velocity index 46.9 ± 13.4 51.8 ± 13.4 -
Total fluid content (/kOhm) 29.3 ± 3.8 30.1 ± 3.7 -
TACI (mm Hg/mL/m2) 0.718 ± 0.182 0.845 ± 0.194* -

Values are presented as mean ± standard deviation.

BP, blood pressure; SVRI, systemic vascular resistance index; TACI, total arterial compliance index.

p < 0.05.

p < 0.01.