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Slight decreases in BP seen with alternative therapies
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Certain alternative therapies, including aerobic exercise, resistance or strength training, and isometric hand grip exercises, may be of some benefit for patients with hypertension who do not respond well to standard medical treatment, according to a scientific statement from the American Heart Association.
“There aren’t many large well-designed studies lasting longer than a few weeks looking at alternative therapies, yet patients have a lot of questions about their value,” Robert D. Brook, MD, chair of the panel charged with drafting the scientific statement, said in a press release. “A common request from patients is, ‘I don’t like to take medications; what can I do to lower my blood pressure?’ We wanted to provide some direction.”
Brook and colleagues evaluated data published from 2006 to 2011 on three categories of alternative treatments: behavioral therapies, noninvasive procedures or devices, and exercise-based regimens. Interventions included several types of exercise, yoga, various styles of meditation, biofeedback methods, acupuncture, device-guided breathing, relaxation and stress reduction techniques.
According to the panel’s analysis, behavioral therapies such as biofeedback and transcendental meditation may result in small BP reductions and therefore may be considered in clinical practice. The researchers noted, however, that other types of meditation, which have not been thoroughly studied, yoga or other relaxation techniques are not significantly beneficial in decreasing BP.
The noninvasive procedures examined included acupuncture and device-guided slow breathing. Due to a lack of robust evidence on the BP-lowering effects of acupuncture and the complexities involved in employing the therapy, the researchers do not recommend its use for treatment of hypertension. However, when conducted in 15-minute sessions three to four times per week, device-guided slow breathing was effective in reducing BP, leading the panel to deem it reasonable to perform in clinical practice.
In terms of exercise interventions, panel members found that all types of exercise studied — aerobic, resistance or weight training, and isometric exercises — decreased BP. In particular, 4 weeks of isometric hand grip exercises yielded a 10% reduction in systolic and diastolic BP. Nevertheless, the panel recommended that people with severely uncontrolled hypertension (≥180 mm Hg/110 mm Hg) avoid isometric exercise. Study results also indicated that walking programs resulted in modest decreases in BP.
“Most alternative approaches reduce systolic blood pressure by only 2 mm Hg to 10 mm Hg, whereas standard doses of a blood pressure-lowering drug reduce systolic blood pressure by about 10 mm Hg to 15 mm Hg,” said Brook, who is also an associate professor of medicine at the University of Michigan in Ann Arbor. “So, alternative approaches can be added to a treatment regimen after patients discuss their goals with their doctors.”
For more information:
Brook RD. Hypertension. 2013;doi:10.1161/HYP.0b013e318293645f.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Franz H. Messerli, MD
The conclusion of the AHA statement is that ‘it is reasonable for all individuals with blood pressure levels >120/80 mmHg to consider trials of alternative approaches as adjuvant methods to help lower blood pressure when clinically appropriate.’ To my way of thinking, these recommendations are not very helpful to the practicing physician who is to make the determination of what is ‘clinically appropriate.’
The AHA statement thoroughly and comprehensively summarizes the BP-lowering efficacy of several alternative approaches. By and large, the antihypertensive efficacy of these approaches is disappointing in that they are time consuming and consistently inferior to drug therapy. Moreover, apart from endurance exercise, little if any outcome evidence is available that over the long term these interventions reduce morbidity and mortality. There is little doubt for instance, that a low-salt diet lowers BP. However, there is a lot of doubt that a low-salt diet lowers risk for MI, stroke and death. It seems therefore the reasonable to use these approaches together, with but not instead of drug therapy. I am not convinced that a patient with stage I hypertension should be exposed to an alternative approach for as long as a year before determining whether to continue this path. SHEP has taught us that 1 month of chlorthalidone-based therapy extends life expectancy free of CVD by 1 day. Clearly, the term ‘alternative’ approaches should be abandoned and should be replaced by ‘complimentary’ or ‘adjuvant’ approaches — at least until we have better evidence that indeed these approaches not only lower BP by a few millimeters of mercury, but reduce MI, stroke and death.
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