this american heart association scientific statement aims to summarize the blood pressureâlowering efficacy of several alternative approaches and to provide a class of recommendation for their implementation in clinical practice based on the available level of evidence from the published literature. the lack of inclusion of home or ambulatory bp monitoring (abpm) outcomes in many studies is also a significant shortcoming. a systematic literature search limited to human studies and the english language was next performed in pubmed for publications between january 1, 2006, and october 31, 2011, for each of the above methodologies in relation to bp. the healthcare research and quality report published an evidence-based document on meditation practices for health in 2007.31 the university of alberta evidence-based practice center was commissioned to prepare the report. the meta-analysis published in 2007 comparing tm with attention control included 6 randomized, controlled trials of at least 8 weeksâ duration that were thought to be well designed with a total of 449 individuals. the trial in nonmedicated individuals with hypertension involved randomization to 8 weeks of meditation or no intervention.42 reductions in resting clinic systolic bp (median, â15 mm hg) and in ambulatory systolic and diastolic bps were reported in the meditation group. on the other hand, a systematic review done in 2010 that included strict study inclusion assessment found no evidence for the effectiveness of biofeedback in regard to hypertension control compared with placebo, no intervention, pharmacotherapy, and/or behavioral therapy.47 as with most interventions, there has been a wide range of reported individual patient- and trial-specific bp responses. it originated in ancient india as primarily a word to describe a contemplative state with the aim of cessation of mental activity and attainment of a state of superior consciousness. finally, bp was rarely the primary outcome of interest, with abpm used in only a few studies. in 1988, the hypertension intervention pooling project integrated data from 12 randomized, controlled trials and concluded that relaxation provided a small treatment effect for diastolic but not systolic bp among individuals with hypertension not taking medication.63 after this report, a review performed in 1991 concluded that the effects of relaxation seemed to depend on the study design.64 individuals with higher initial bp levels appeared to benefit more. relaxation therapies were also associated with a small risk for worsening or uncontrolled hypertension resulting from delaying medical treatment in the trials.67 in light of these limitations, it was suggested that further higher-quality studies are required to conclude that relaxation techniques effectively and safely lower bp. nevertheless, the authors of both meta-analyses summarized that their overall findings were inconclusive in terms of the benefit of acupuncture for bp lowering among individuals with hypertension. such training is extensive, time-consuming, and expensive, and a substantial modification in medical education and training would be required to make acupuncture accessible and available for the management of hypertension in many regions of the world. studies that measured home bp in those who use the device showed that home bp levels began to decrease after â1 to 2 weeks of daily use.102 typical of all treatments, a larger bp-lowering effect was seen among those with higher initial bp values.
for the purposes of this review, exercise is characterized as predominantly dynamic aerobic, dynamic resistance, and isometric resistance. overall, there was no observed effect of several exercise-related variables, including training frequency, intensity, and mode, as well as time per session, on the magnitude of bp response; however, the individual studies were not specifically designed in most instances to assess the effect of these factors. however, mean day and nighttime ambulatory bp levels were not significantly altered after training, regardless of exercise intensity.121 in contrast, in a study designed to assess the effect of exercise intensity in men with elevated ambulatory bp (mean, 145/85mm hg), there was a graded additive bp-lowering effect on postexercise bp of more intense exercise. another randomized, controlled study designed to assess the effect of exercise on a standard 6-minute walk test in end-stage renal disease compared the effects of 6 months of supervised intradialytic exercise training with home-based exercise training or usual care in individuals undergoing hemodialysis.129 there were no statistically significant differences between intradialytic and home-based exercise or usual care for either the 6-mile walk or bp parameters. finally, a recent article published in 2012 has provided some of the first evidence that aerobic exercise training can effectively lower bp even among individuals with resistant hypertension, defined as a bp â¥140/90 mm hg on 3 medications or a bp controlled by â¥4 medications.135 fifty individuals were randomized in a parallel-design study to participate (or not participate) in an 8- to 12-week treadmill exercise program 3 times per week. there were no significant differences in the effects of the interventions stratified by baseline bp level. the evidence base is notable for a lack of trials in individuals with hypertension. although this change in bp was impressive, it is important to note that this analysis included only 3 studies and a small number of total participants. current recommendations state that isometric exercise should be avoided among individuals with bp levels >180/110 mm hg until their hypertension is better controlled.112 isometric exercise causes an acute stimulation of the metaboreflex in a physiological attempt to restore muscle blood flow. this recommendation to incorporate resistance exercise training for most individuals expands on existing bp guidelines that only explicitly promote aerobic activity.4 however, the simple advice to individuals to adopt an exercise regimen is often met with modest and variable success.18 a different or additional alternative modality may be used if bp proves unresponsive, if further treatment is needed to achieve goals, or if there is a lack of adherence to exercise. our recommended approach mirrors previous expert opinions for implementing dietary modifications among individuals with hypertension10â12 and accords with the management principles for when and how to use nonpharmacological therapies in general as promulgated by nation-level guidelines.4â6 in summary, it is the consensus of the writing group that it is reasonable for all individuals with bp levels >120/80 mm hg to consider a trial of alternative approaches as adjuvant methods to help lower bp. however, it must be acknowledged that event-based trials are unlikely to be conducted because of the prohibitive sample size required to demonstrate a benefit with small reductions in bp in relatively healthy individuals with mild hypertension. it is also important to re-emphasize that many of the reviewed alternative therapies (eg, resistance and aerobic exercise, yoga, meditation, acupuncture) may provide a range of health or psychological benefits beyond bp lowering or cardiovascular risk reduction. there is insufficient or inconclusive evidence at the present time to recommend the use of the other techniques reviewed in this scientific statement for the purposes of treating overt hypertension or prehypertension. a link to the âcopyright permissions request formâ appears on the right side of the page.
more and more, patients show up to appointments with hypertension expert john bisognano, m.d., ph.d. carrying bags full of “natural” products that they hope will help lower their blood pressure. patients with hypertension tend to have lower levels of the enzyme, and a meta-analysis – an overarching analysis of past studies – found that treatment with coenzyme q10 supplements significantly reduced blood pressure. woolf noted that “coenzyme q10 has a pretty profound effect on blood pressure, but whenever research is based on a collection of other data you have to have some skepticism.” woolf said he still thinks the compound is promising.
they say health care providers and patients need to be aware that the safety of these products is not always rigorously established and that formulations can vary. the resperate system uses a breath sensor and gives patients feedback through headphones to help them slow their breathing, which research suggests benefits blood pressure. the zona plus is a device that patients grip in either hand and perform multiple sets of squeezing at different levels in response to electronic cues.
the best evidence exists for dark chocolate, coenzyme q10, qigong, slow breathing techniques, and meditation. two rcts support bp reduction by treating vitamin l-arginine may help blood vessels dilate, lowering blood pressure. arginine increases blood flow and may interact with medications for high 9. ginger. ginger is incredibly versatile and a staple in alternative medicine. people have used it for centuries to improve many aspects of, .
proven approaches promoted by the guidelines include weight loss, reduced sodium intake, adoption of a dietary approaches to lower hypertension– the potential herbal remedies woolf identified include mistletoe extract, used in traditional chinese medicine to treat hypertension. mistletoe supplements or products that increase nitric oxide or widen blood vessels (vasodilators), such as cocoa, coenzyme q10, l-arginine and garlic, . supplements and herbsminerals such as magnesium.products like dark cocoa, coenzyme q10, and garlic. they boost nitric oxide, which helps your blood pressure.
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