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Chen Z, Li Q, Xu T, Zhou X, Shu Y, Guo T, Liang F. An updated network meta-analysis of non-pharmacological interventions for primary hypertension in adults: insights from recent studies. Syst Rev 2024; 13:318. [PMID: 39736688 DOI: 10.1186/s13643-024-02744-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 12/19/2024] [Indexed: 01/01/2025] Open
Abstract
BACKGROUND Primary hypertension significantly impacts global cardiovascular health, contributing to increased mortality rates and posing a substantial public health challenge. Recognizing the growing evidence supporting non-pharmacological interventions (NPIs) for controlling primary hypertension, our study employs Network Meta-Analysis (NMA) to comprehensively assess their efficacy. METHODS This review updates a prior systematic review by searching for original literature on NPIs for primary hypertension from 2013 to 2024. We conducted a thorough search in eight databases, including PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, CNKI, WanFang Data, and Chongqing VIP, identifying potential randomized controlled trials (RCTs) from January 1, 2013, to August 1, 2024. Primary outcomes included the mean changes in blood pressure before and after treatment. Analysis was performed using GeMTC package (R 4.2.3), and Stata 17.0. The confidence of evidence was examined using Confidence in Network Meta-Analysis (CINeMA). RESULTS Utilizing NMA, we reviewed 9,189 studies, identifying 54 eligible articles with 5,827 participants. Investigating 22 distinct NPIs, the focus was on changes in systolic and diastolic blood pressure pre and post-treatment. Lifestyle intervention + Tai Chi significantly reduced systolic (-21.75 mm Hg; 95% CI -33.25 to -10.02) and diastolic blood pressure (-13.62 mm Hg; 95% CI -23.14 to -3.71) compared to usual care and other NPIs. Consistency and regression analyses did not reveal significant differences. CONCLUSION This review provides a comprehensive evaluation of NPIs for primary hypertension, emphasizing lifestyle + Tai Chi as a preferred NPI. Breathing exercises show potential in lowering systolic blood pressure, and acupuncture + tui na demonstrates effectiveness in reducing diastolic blood pressure, outperforming other interventions. The study reinforces the role of NPIs in managing primary hypertension, providing a foundation for future hypertension research.
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Affiliation(s)
- Ziwen Chen
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Qifu Li
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Tao Xu
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Xueli Zhou
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Yunjie Shu
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Taipin Guo
- School of Second Clinical Medicine, The Second Affiliated Hospital, Yunnan University of Chinese Medicine, Kunming, 650500, China.
| | - Fanrong Liang
- Department of Acupuncture and Moxibustion, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China.
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Boyes NG, Klassen SA, Baker SE, Nicholson WT, Joyner MJ, Shoemaker JK, Limberg JK. Interaction of simultaneous hypoxia and baroreflex loading on control of sympathetic action potential subpopulations. J Neurophysiol 2024; 132:1087-1097. [PMID: 39140588 PMCID: PMC11427050 DOI: 10.1152/jn.00277.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 08/05/2024] [Accepted: 08/09/2024] [Indexed: 08/15/2024] Open
Abstract
Efferent muscle sympathetic nerve activity (MSNA) is under tonic baroreflex control. The arterial baroreflex exerts the strongest influence over medium-sized sympathetic action potential (AP) subpopulations in efferent MSNA recordings. Prior work from multiunit MSNA recordings has shown baroreflex loading selectively abolishes the sympathetic response to hypoxia. The purpose of the study was to examine baroreflex control over different-sized AP clusters and characterize the neural recruitment strategies of sympathetic AP subpopulations with baroreflex and combined baroreflex/chemoreflex (i.e., hypoxia) activation. We loaded the arterial baroreceptors [intravenous phenylephrine (PE)] alone and in combination with systemic hypoxia ([Formula: see text] 80%) in nine healthy young men. We extracted sympathetic APs using the wavelet-based methodology and quantified baroreflex gain for individual AP clusters. AP baroreflex threshold gain was measured as the slope of the linear relationship between AP probability versus diastolic blood pressure for 10 normalized clusters. Baroreflex loading with phenylephrine decreased MSNA and AP firing compared with baseline (all P < 0.05). However, the phenylephrine-mediated decrease in AP firing was lost with concurrent hypoxia (P = 0.384). Compared with baseline, baroreflex loading reduced medium-sized AP cluster baroreflex threshold slope (condition P = 0.005) and discharge probability (condition P < 0.0001); these reductions from baseline were maintained during simultaneous hypoxia (both P < 0.05). Present findings indicate a key modulatory role of the baroreceptors on medium-sized APs in blood pressure regulation that withstands competing signals from peripheral chemoreflex activation.NEW & NOTEWORTHY This study provides a novel understanding on baroreflex control of efferent sympathetic nervous system activity during competing stressors: baroreflex loading and peripheral chemoreflex activation. We show chemoreflex activation buffers baroreflex-mediated reductions in sympathetic nervous system activity. More importantly, baroreflex loading reduced baroreflex threshold gain of sympathetic action potential clusters and this reduction withstood chemoreflex activation. These data suggest the arterial baroreflex holds a primary regulatory role over medium-sized sympathetic neurons despite competing chemoreflex signals.
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Affiliation(s)
- Natasha G Boyes
- Department of Nutrition & Exercise Physiology, University of Missouri, Columbia, Missouri, United States
| | - Stephen A Klassen
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
- School of Kinesiology, Brock University, St. Catharines, Ontario,Canada
| | - Sarah E Baker
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Wayne T Nicholson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael J Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - J Kevin Shoemaker
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada
| | - Jacqueline K Limberg
- Department of Nutrition & Exercise Physiology, University of Missouri, Columbia, Missouri, United States
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
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Eser P, Calamai P, Kalberer A, Stuetz L, Huber S, Kaesermann D, Guler S, Wilhelm M. Improved exercise ventilatory efficiency with nasal compared to oral breathing in cardiac patients. Front Physiol 2024; 15:1380562. [PMID: 39165283 PMCID: PMC11334221 DOI: 10.3389/fphys.2024.1380562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 07/02/2024] [Indexed: 08/22/2024] Open
Abstract
Objectives: To assess whether nasal breathing improves exercise ventilatory efficiency in patients with heart failure (HF) or chronic coronary syndromes (CCS). Background: Exercise inefficient ventilation predicts disease progression and mortality in patients with cardiovascular diseases. In healthy people, improved ventilatory efficiency with nasal compared to oral breathing was found. Methods: Four study groups were recruited: Patients with HF, patients with CCS, old (age≥45 years) and young (age 20-40 years) healthy control subjects. After a 3-min warm-up, measurements of 5 min with once nasal and once oral breathing were performed in randomized order at 50% peak power on cycle ergometer. Ventilation and gas exchange parameters measured with spiroergometry were analysed by Wilcoxon paired-sample tests and linear mixed models adjusted for sex, height, weight and test order. Results: Groups comprised 15 HF, CCS, and young control and 12 old control. Ventilation/carbon dioxide production (V ˙ E/V ˙ CO2), ventilation (V ˙ E), breathing frequency (fR), and end-tidal oxygen partial pressure (PETO2) were significantly lower and tidal volume and end-tidal carbon dioxide partial pressure (PETCO2) significantly higher during nasal compared to oral breathing in all groups, with large effect sizes for most parameters. For patients with HF, medianV ˙ E/V ˙ CO2 was 35% lower, fR 26% lower, and PETCO2 10% higher with nasal compared to oral breathing, respectively. Exercise oscillatory ventilation (EOV) was present in 6 patients and markedly reduced with nasal breathing. Conclusion: Nasal breathing during submaximal exercise significantly improved ventilatory efficiency and abnormal breathing patterns (rapid shallow breathing and EOV) in 80% of our patients with HF and CCS.
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Affiliation(s)
- Prisca Eser
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pietro Calamai
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anja Kalberer
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laura Stuetz
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sarina Huber
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominic Kaesermann
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sabina Guler
- Department for Pulmonary Medicine, Allergology and Clinical Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Centre for Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Watso JC, Cuba JN, Boutwell SL, Moss JE, Bowerfind AK, Fernandez IM, Cassette JM, May AM, Kirk KF. Acute nasal breathing lowers diastolic blood pressure and increases parasympathetic contributions to heart rate variability in young adults. Am J Physiol Regul Integr Comp Physiol 2023; 325:R797-R808. [PMID: 37867476 PMCID: PMC11178300 DOI: 10.1152/ajpregu.00148.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/24/2023]
Abstract
There is growing interest in how breathing pace, pattern, and training (e.g., device-guided or -resisted breathing) affect cardiovascular health. It is unknown whether the route of breathing (nasal vs. oral) affects prognostic cardiovascular variables. Because nasal breathing can improve other physiological variables (e.g., airway dilation), we hypothesized that nasal compared with oral breathing would acutely lower blood pressure (BP) and improve heart rate variability (HRV) metrics. We tested 20 adults in this study [13 females/7 males; age: 18(1) years, median (IQR); body mass index: 23 ± 2 kg·m-2, means ± SD]. We compared variables between nasal- and oral-only breathing (random order, five min each) using paired, two-tailed t tests or Wilcoxon signed-rank paired tests with significance set to P < 0.05. We report the median (interquartile range) for diastolic BP and means ± SD for all other variables. We found that nasal breathing was associated with a lower mean BP (nasal: 84 ± 7 vs. oral: 86 ± 5 mmHg, P = 0.006, Cohen's d = 0.70) and diastolic BP [nasal: 68(8) vs. oral: 72(5) mmHg, P < 0.001, Rank-biserial correlation = 0.89] but not systolic BP (nasal: 116 ± 11 vs. oral: 117 ± 9 mmHg, P = 0.48, Cohen's d = 0.16) or heart rate (HR; nasal: 74 ± 10 vs. oral: 75 ± 8 beats·min-1, P = 0.90, Cohen's d = 0.03). We also found that nasal breathing was associated with a higher high-frequency (HF) contribution to HRV (nasal: 59 ± 19 vs. oral: 52 ± 21%, P = 0.04, Cohen's d = 0.50) and a lower low frequency-to-HF ratio at rest (nasal: 0.9 ± 0.8 vs. oral: 1.2 ± 0.9, P = 0.04, Cohen's d = 0.49). These data suggest that nasal compared with oral breathing acutely 1) lowers mean and diastolic BP, 2) does not affect systolic BP or heart rate, and 3) increases parasympathetic contributions to HRV.NEW & NOTEWORTHY There is growing interest in how breathing pace, pattern, and training (e.g., device-guided or -resisted breathing) affect prognostic cardiovascular variables. However, the potential effects of the breathing route on prognostic cardiovascular variables are unclear. These data suggest that nasal compared with oral breathing 1) lowers mean and diastolic blood pressure (BP), 2) does not affect systolic BP or heart rate (HR), and 3) increases parasympathetic contributions to heart rate variability (HRV). These data suggest that acute nasal breathing improves several prognostic cardiovascular variables.
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Affiliation(s)
- Joseph C Watso
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Jens N Cuba
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Savannah L Boutwell
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Justine E Moss
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Allison K Bowerfind
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Isabela M Fernandez
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Jessica M Cassette
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Allyson M May
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
| | - Katherine F Kirk
- Cardiovascular and Applied Physiology Laboratory, Department of Health, Nutrition, & Food Sciences, Florida State University, Tallahassee, Florida, United States
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Herawati I, Mat Ludin AF, M M, Ishak I, Farah NMF. Breathing exercise for hypertensive patients: A scoping review. Front Physiol 2023; 14:1048338. [PMID: 36760529 PMCID: PMC9905130 DOI: 10.3389/fphys.2023.1048338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/11/2023] [Indexed: 01/26/2023] Open
Abstract
Background: Non-pharmacological management of hypertension includes weight loss, alcohol and sodium restriction, regular exercise, and relaxation. In people with overweight hypertension, systolic blood pressure (SBP) and diastolic blood pressure (DBP) can be decreased via exercise and weight loss together. Breathing exercises are one method of relaxing. Objectives: The aim of this scoping review is to map the information that is currently available about the advantages of breathing exercises in decreasing blood pressure in hypertension patients. Methods: This scoping review adheres to Arksey and O'Malley's framework, which entails identifying review questions, seeking pertinent evidence, choosing pertinent studies, mapping data, and discussing, concluding, and reporting the findings. The PRISMA flowchart is used to show how the evidence search process works. Results: As a result, 339 articles in total were retrieved from the three databases. 20 papers total were included in this review after screening. In 14 of the 20 investigations, participants with stage 1 and stage 2 essential hypertension, two with pre-hypertension, and four with Isolated Systolic Hypertension (ISH) were studied. The respondents' ages ranged from 18 to 75. The systolic blood pressure declined by 4-54.22 mmHg, while the diastolic blood pressure dropped by 3-17 mmHg. Conclusion: Slow breathing can be used as an alternate, non-pharmacological therapy for hypertension individuals to reduce blood pressure. Systematic Review Registration: (https://osf.io/ta9u6/).
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Affiliation(s)
- Isnaini Herawati
- Biomedical Science Programme & Center for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
- Faculty of Health Sciences, Universitas Muhammadiyah Surakarta, J. A.Yani Tromol Pos 1 Pabelan Kartasura, Surakarta, Indonesia
| | - Arimi Fitri Mat Ludin
- Biomedical Science Programme & Center for Healthy Ageing and Wellness (HCARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Mutalazimah M
- Faculty of Health Sciences, Universitas Muhammadiyah Surakarta, J. A.Yani Tromol Pos 1 Pabelan Kartasura, Surakarta, Indonesia
| | - Ismarulyusda Ishak
- Biomedical Science Programme & Center for Toxicology and Health Risk (CORE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Nor M. F. Farah
- Occupational Therapy Programme & Center for Community Health Studies (REACH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
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Pingali H, Hunter SD. Exploring mechanisms of blood pressure regulation in response to device-guided and non-device-guided slow breathing: A mini review. Auton Neurosci 2023; 244:103050. [PMID: 36410208 DOI: 10.1016/j.autneu.2022.103050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hypertension is a widespread disease that, if persistent, increases the risks of coronary heart disease mortality and morbidity. Slow breathing is a recommended blood pressure-lowering strategy though the mechanisms mediating its effects are unknown. OBJECTIVE This review aims to evaluate autonomic and vascular function as potential mediators driving BP adaptive responses with slow breathing. METHODS We searched EBSCO host, Web of Science, Cochrane Central Register of Controlled Trials, and PubMed using key words for optimized search results. RESULTS Nineteen studies were included in this review (11 device-guided; 8 non-device-guided breathing). Though some studies showed increased vagally mediated components of heart rate variability during slow breathing, results from acute and long-term studies were incongruent. Increases in baroreflex sensitivity (BRS) following a single device-guided slow breathing bout were noted in normotensive and hypertensive adults. Long-term (4 weeks to 3 months) effects of slow breathing on BRS were absent. Device-guided breathing resulted in immediate reductions in muscle sympathetic nerve activity (MSNA) in normo- and hyper-tensive adults though results from long-term studies yielded inconsistent findings. Non-device-guided slow breathing posed acute and chronic effects on vascular function with reductions in arterial stiffness in adults with type I diabetes and increases in microvascular endothelial function in adults with irritable bowel syndrome. Non-device guided breathing also reduced pro-inflammatory cytokines in healthy and hypertensive adults in acute and chronic studies. No adverse effects or non-adherence to treatment were noted in these trials. CONCLUSION Device-guided slow breathing is a feasible and effective modality in improving BRS, HRV, and arterial stiffness though its long-term effects are obscure. Though less evidence exists supporting the efficacy of non-device-guided slow breathing, acute and chronic studies demonstrate improvements in vascular function and inflammatory cytokines. More studies are needed to further explore the long-term effects of slow breathing in general and non-device-guided breathing in particular.
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Affiliation(s)
- Harika Pingali
- Texas State University Department of Health & Human Performance, San Marcos, TX, USA
| | - Stacy D Hunter
- Texas State University Department of Health & Human Performance, San Marcos, TX, USA.
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7
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Hunter SD, Bernardi L, McAllister MJ, John D, Rahimi M, Lopez MR. Device-guided slow breathing alters postprandial oxidative stress in young adult males: A randomized sham-controlled crossover trial. Nutr Metab Cardiovasc Dis 2023; 33:203-209. [PMID: 36344308 PMCID: PMC9812884 DOI: 10.1016/j.numecd.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND AIMS Slow, deep breathing (SDB) lowers blood pressure (BP) though the underlying mechanisms are unknown. Redox improvements could facilitate hemodynamic adjustments with SDB though this has not been investigated. The purpose of this randomized, sham-controlled trial was to examine the acute effects of SDB on oxidative stress and endothelial function during a physiological perturbation (high-fat meal) known to induce oxidative stress. METHODS AND RESULTS Seventeen males (ages 18-35 years) were enrolled, and anthropometric measurements and 7-day physical activity monitoring were completed. Testing sessions consisted of 24-h diet recalls (ASA24), blood sample collection for superoxide dismutase (SOD) and thiobarbituric acid reactive substances (TBARS) analysis, and flow-mediated dilation (FMD). High-fat meals were ingested and 2-min breathing exercises (SDB or sham control breathing) were completed every 15 min during the 4-h postprandial phase. Blood sample collection and FMD were repeated 1-, 2-, and 4-h post meal consumption. Mean body mass index and step counts were 25.6 ± 4.3 kg/m2 and 8165 ± 4405 steps per day, respectively. Systolic and diastolic BP and nutrient intake 24 h prior were similar between conditions. No time or time by condition interaction effects were observed for FMD. The total area under the curve (AUC) for SOD was significantly lower during SDB compared to the sham breathing condition (p < 0.01). No differences were observed in TBARS AUC (p = 0.538). CONCLUSIONS Findings from the current investigation suggest that SDB alters postprandial redox in the absence of changes in endothelial function in young, healthy males. CLINICAL TRIAL REGISTRATION NUMBER NCT04864184. CLINICAL TRIALS IDENTIFIER NCT04864184.
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Affiliation(s)
- Stacy D Hunter
- Texas State University Department of Health & Human Performance, San Marcos, TX, USA.
| | - Luciano Bernardi
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, Finland; Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Matthew J McAllister
- Texas State University Department of Health & Human Performance, San Marcos, TX, USA
| | - Dinesh John
- Northeastern University Department of Health Sciences, Boston, MA, USA
| | - Mitra Rahimi
- Texas State University Department of Health & Human Performance, San Marcos, TX, USA
| | - Micqauella R Lopez
- Texas State University Department of Health & Human Performance, San Marcos, TX, USA
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Ovadia-Blechman Z, Tarrasch R, Velicki M, Chalutz Ben-Gal H. Reducing Test Anxiety by Device-Guided Breathing: A Pilot Study. Front Psychol 2022; 13:678098. [PMID: 35677145 PMCID: PMC9167931 DOI: 10.3389/fpsyg.2022.678098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/02/2022] [Indexed: 11/16/2022] Open
Abstract
Test anxiety remains a challenge for students and has considerable physiological and psychological impacts. The routine practice of slow, Device-Guided Breathing (DGB) is a major component of behavioral treatments for anxiety conditions. This paper addresses the effectiveness of using DGB as a self-treatment clinical tool for test anxiety reduction. This pilot study sample included 21 healthy men and women, all college students, between the ages of 20 and 30. Participants were randomly assigned to two groups: DGB practice (n = 10) and wait-list control (n = 11). At the beginning and the end of 3-weeks DGB training, participants underwent a stress test, followed by measures of blood pressure and reported anxiety. Anxiety reduction in the DGB group as compared to controls was not statistically significant, but showed a large effect size. Accordingly, the clinical outcomes suggested that daily practice of DGB may lead to reduced anxiety. We assume that such reduction may lead to improved test performance. Our results suggest an alternative treatment for test anxiety that may also be relevant for general anxiety, which is likely to increase due to the ongoing COVID-19 pandemic.
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Affiliation(s)
- Zehava Ovadia-Blechman
- School of Medical Engineering, Afeka—Tel Aviv Academic College of Engineering, Tel Aviv, Israel
- *Correspondence: Zehava Ovadia-Blechman,
| | - Ricardo Tarrasch
- School of Education, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Maria Velicki
- School of Medical Engineering, Afeka—Tel Aviv Academic College of Engineering, Tel Aviv, Israel
| | - Hila Chalutz Ben-Gal
- School of Industrial Engineering and Management, Afeka—Tel Aviv Academic College of Engineering, Tel Aviv, Israel
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Freitas Gonçalves KS, Queiroz Godoy Daniel AC, Tatagiba Lamas JL, Oliveira HC, Cloutier L, De Campos Pereira Silveira RC, Veiga EV. Device and nondevice‐guided slow breathing to reduce blood pressure in hypertensive patients: A systematic review and meta‐analysis. Health Sci Rep 2022; 5:e636. [PMID: 35601033 PMCID: PMC9110782 DOI: 10.1002/hsr2.636] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 11/09/2022] Open
Abstract
Backgroud and Aims Hypertension (HTN) is a multifactorial chronic disease. Considering the high prevalence rates of this disease, treatment of HTN is necessary, not only to reduce blood pressure (BP) levels but also to prevent the development of cardiovascular, cerebrovascular, and kidney diseases. This treatment can be through medication, which will be determined according to the BP values, obtained either in medical consultations or at home; presence of cardiovascular risk factors, and the presence of target organ damage identified during anamnesis. The aim of this systematic review and meta‐analysis is to summarize the effects of device‐guided slow breathing (DGSB) and nondevice‐guided slow breathing (NDGSB) on BP levels of patients with HTN. Methods This study is a systematic review and meta‐analysis of randomized clinical trials, pertaining to hypertensive patients, with or without comorbidity, over 18 years old, of both sexes, and with or without hypertensive medication. The selected studies showed comparisons between groups that performed DGSB and/or NDGSB with control conditions. The primary outcome was the value of systolic blood pressure (SBP) and diastolic blood pressure (DBP) after the interventions. Results Twenty‐two studies involving 17,214 participants were included in the quantitative analysis. Considerable heterogeneity was revealed between studies. Using random effect model, it was found that DGSB did not significantly reduce SBP and DBP compared to usual care, both in terms BP values and in relation to their variations (SBP, mean difference [MD]: −2.13 mmHg, (95% confidence interval [CI]: −12.71 to 8.44), 288 individuals; I2 = 93%, high heterogenity: DBP, MD: −0.90, 95% CI: −3.97 to 2.11, 288 individuals; I2 = 63%, substantial heterogenity. SBP variations MD: −2.42, 95% CI: −7.24 to 2.40, 443 individuals; I2 = 85% high heterogenity/DBP variations MD: −1.67, 95% CI: −4.57 to 1.24, 443 individuals; I2 = 80%, high heterogenity). Conclusion Based on these results it appears that DGSB did not reduce BP in hypertensive patients and NDGSB is a new path for the future.
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Affiliation(s)
- Kamila S. Freitas Gonçalves
- WHO Collaborating Centre for Nursing Research Development, College of Nursing University of São Paulo Ribeirão Preto Brazil
| | - Ana C. Queiroz Godoy Daniel
- WHO Collaborating Centre for Nursing Research Development, College of Nursing University of São Paulo Ribeirão Preto Brazil
| | | | | | - Lyne Cloutier
- Department of Nursing Université du Québec à Trois‐Rivières Québec Canada
| | | | - Eugenia V. Veiga
- WHO Collaborating Centre for Nursing Research Development, College of Nursing University of São Paulo Ribeirão Preto Brazil
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Payseur DK, Belhumeur JR, Curtin LA, Moody AM, Collier SR. The effect of acute alcohol ingestion on systemic hemodynamics and sleep architecture in young, healthy men. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:509-516. [PMID: 32369424 DOI: 10.1080/07448481.2020.1756826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 02/12/2020] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Abstract
Objective Heightened nocturnal blood pressure (BP) may be attributed to the disruption of sleep, a condition worsened by alcohol ingestion. This study investigated the effects of acute alcohol ingestion on hemodynamics and sleep architecture in a young, healthy cohort of male. METHODS: Subjects (n = 17) underwent acute alcohol ingestion reaching a breath alcohol content of 0.08. Each subject endured a battery of hemodynamic tests and had their sleep architecture and nocturnal blood pressure monitored pre- and post-ingestion. Results: Systolic blood pressure (SBP) increased both 30 minutes and 12 hours after alcohol. Ambulatory nocturnal SBP significantly increased after alcohol compared to baseline measures. Minutes of total, rapid eye movement, and light sleep all increased after alcohol ingestion, while a decrease was observed for sleep latency. Conclusions: An acute bout of heavy alcohol consumption may attenuate nocturnal BP dipping that, in turn, may hasten the progression of hypertension-related cardiovascular disease.
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Affiliation(s)
- Daniel K Payseur
- Vascular Biology & Autonomic Studies Lab, Appalachian State University, Boone, North Carolina, USA
| | | | - Lisa A Curtin
- Department of Psychology, Appalachian State University, Boone, North Carolina, USA
| | - Anne M Moody
- Vascular Biology & Autonomic Studies Lab, Appalachian State University, Boone, North Carolina, USA
| | - Scott R Collier
- Vascular Biology & Autonomic Studies Lab, Appalachian State University, Boone, North Carolina, USA
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11
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Floras JS. From Brain to Blood Vessel: Insights From Muscle Sympathetic Nerve Recordings: Arthur C. Corcoran Memorial Lecture 2020. Hypertension 2021; 77:1456-1468. [PMID: 33775112 DOI: 10.1161/hypertensionaha.121.16490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Multiunit recordings of postganglionic sympathetic outflow to muscle yield otherwise imperceptible insights into sympathetic neural modulation of human vascular resistance and blood pressure. This Corcoran Lecture will illustrate the utility of microneurography to investigate neurogenic cardiovascular regulation; review data concerning muscle sympathetic nerve activity of women and men with normal and high blood pressure; explore 2 concepts, central upregulation of muscle sympathetic outflow and cortical autonomic neuroplasticity; present sleep apnea as an imperfect model of neurogenic hypertension; and expose the paradox of sympathetic excitation without hypertension. In awake healthy normotensive individuals, resting muscle sympathetic nerve activity increases with age, sleep fragmentation, and obstructive apnea. Its magnitude is not signaled by heart rate. Age-related changes are nonlinear and differ by sex. In men, sympathetic nerve activity increases with age but without relation to their blood pressure, whereas in women, both rise concordantly after age 40. Mean values for muscle sympathetic nerve activity burst incidence are consistently higher in cohorts with hypertension than in matched normotensives, yet women's sympathetic nerve traffic can increase 3-fold between ages 30 and 70 without causing hypertension. Thus, increased sympathetic nerve activity may be necessary but is insufficient for primary hypertension. Moreover, its inhibition does not consistently decrease blood pressure. Despite a half-century of microneurographic research, large gaps remain in our understanding of the content of the sympathetic broadcast from brain to blood vessel and its specific individual consequences for circulatory regulation and cardiovascular, renal, and metabolic risk.
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Affiliation(s)
- John S Floras
- Sinai Health and University Health Network Division of Cardiology, Toronto General Hospital Research Institute, and the Department of Medicine, University of Toronto
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12
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da Silva CD, de Abreu RM, Rehder-Santos P, De Noronha M, Catai AM. Can respiratory muscle training change the blood pressure levels in hypertension? A systematic review with meta-analysis. Scand J Med Sci Sports 2021; 31:1384-1394. [PMID: 33630377 DOI: 10.1111/sms.13943] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 08/24/2020] [Accepted: 02/22/2021] [Indexed: 02/07/2023]
Abstract
The aim was to systematically review randomized controlled trials investigating the effects of respiratory training on blood pressure control in hypertensive individuals. Systematic review with meta-analysis was coducted following the guidelines from PRISMA statement. Searches for randomized controlled trials were performed in four electronic databases (PubMed, Cochrane Library, SCOPUS, and PEDro). Studies were included if they were randomized controlled trials that examined the impact of respiratory training on blood pressure of individuals with systemic arterial hypertension and the patients had no other associated disease. Eight studies were included for final analysis (total of 270 participants; 18-85 years) and presented an average score of 6.25 in the PEDro scale, being considered of high methodological quality. The meta-analysis showed a reduction in systolic and diastolic blood pressure for respiratory training when the load was applied [-15.72 (-18.63; -12.81) and -7.08 (-9.03; -5.13) mmHg, respectively]. There was also a reduction in systolic, but not in diastolic blood pressure when the training was performed without load [-5.08 (-7.49; -2.66) and -1.04 (-2.55; +0.46) mmHg, respectively]. The respiratory training has a positive effect in BP in hypertensive patients, however, only when performed with load seems to be able to promote some beneficial effect on diastolic blood pressure reduction.
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Affiliation(s)
- Claudio D da Silva
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Raphael M de Abreu
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Patrícia Rehder-Santos
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of Sao Carlos, Sao Carlos, Brazil
| | | | - Aparecida M Catai
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of Sao Carlos, Sao Carlos, Brazil
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13
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Larson M, Chantigian DP, Asirvatham-Jeyaraj N, Van de Winckel A, Keller-Ross ML. Slow-Paced Breathing and Autonomic Function in People Post-stroke. Front Physiol 2020; 11:573325. [PMID: 33192570 PMCID: PMC7662434 DOI: 10.3389/fphys.2020.573325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/28/2020] [Indexed: 11/14/2022] Open
Abstract
Purpose: To determine if acute slow breathing at 6 breaths/min would improve baroreflex sensitivity (BRS) and heart rate variability (HRV), and lower blood pressure (BP) in adults after stroke. Methods: Twelve individuals completed two randomized study visits where they performed a 15-min bout of breathing exercises at 6 breaths/min (slow) and at 12 breaths/min (control). Continuous BP and heart rate (HR) were measured throughout, and BRS, BRS response to elevations in blood pressure (BRSup), BRS response to depressions in blood pressure (BRSdown), and HRV were calculated and analyzed before (pre), during, and after (post) breathing exercises. Results: BRS increased from pre to post slow breathing by 10% (p = 0.012), whereas BRSup increased from pre to during slow breathing by 30% (p = 0.04). BRSdown increased from pre to post breathing for both breathing conditions (p < 0.05). HR (control: Δ - 4 ± 4; slow: Δ - 3 ± 4 beats/min, time, p < 0.01) and systolic BP (control: Δ - 0.5 ± 5; slow: Δ - 6.3 ± 8 mmHg, time, p < 0.01) decreased after both breathing conditions. Total power, low frequency power, and standard deviation of normal inter-beat intervals (SDNN) increased during the 6-breaths/min condition (condition × time, p < 0.001), whereas high frequency increased during both breathing conditions (time effect, p = 0.009). Conclusions: This study demonstrated that in people post-stroke, slow breathing may increase BRS, particularly BRSup, more than a typical breathing space; however, paced breathing at either a slow or typical breathing rate appears to be beneficial for acutely decreasing systolic BP and HR and increasing HRV.
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Affiliation(s)
- Mia Larson
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Daniel P. Chantigian
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Ninitha Asirvatham-Jeyaraj
- Indian Institute of Science, Bangalore, India
- Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Ann Van de Winckel
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
- Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Manda L. Keller-Ross
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
- Division of Physical Therapy, Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States
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14
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Fonkoue IT, Hu Y, Jones T, Vemulapalli M, Sprick JD, Rothbaum B, Park J. Eight weeks of device-guided slow breathing decreases sympathetic nervous reactivity to stress in posttraumatic stress disorder. Am J Physiol Regul Integr Comp Physiol 2020; 319:R466-R475. [PMID: 32847397 DOI: 10.1152/ajpregu.00079.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Posttraumatic stress disorder (PTSD) is characterized by increased risk for developing hypertension and cardiovascular disease. We recently showed that device-guided slow breathing (DGB) acutely lowers blood pressure (BP) and muscle sympathetic activity (MSNA) and improves baroreflex sensitivity (BRS) in PTSD. The aim of this study was to assess the long-term benefits of DGB on autonomic function at rest and during stress. We hypothesized that long-term DGB improves arterial BRS and lowers BP and MSNA in PTSD. Twenty-five veterans with PTSD were studied and randomized to either 8 wk of daily DGB (n = 12) or 8 wk of sham device (Sham; n = 13). BP, heart rate (HR), and MSNA were measured at rest and during mental math. Arterial BRS was assessed using the modified Oxford technique. Resting MSNA, BP, and heart rate (HR) remained comparable before and after 8 wk in both groups (DGB and Sham). Likewise, the change in sympathetic and cardiovagal BRS was not different between the groups. Interestingly, DGB significantly decreased MSNA reactivity to mental math when expressed as burst frequency (P = 0.012) or burst incidence (P = 0.008) compared with Sham, suggesting a sustained effect of DGB on sympathetic reactivity to stress in PTSD. Contrary to our hypothesis, long-term DGB did not lower systolic BP, diastolic BP, or HR responses to stress compared with Sham. Likewise, pulse pressure reactivity after 8 wk (P = 0.121) was also comparable. In summary, these data suggest that long-term use of DGB may lead to a sustained dampening of sympathetic reactivity to mental stress in PTSD.
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Affiliation(s)
- Ida T Fonkoue
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Yingtian Hu
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Toure Jones
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Monica Vemulapalli
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Justin D Sprick
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Barbara Rothbaum
- Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia
| | - Jeanie Park
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
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15
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Gabriely R, Tarrasch R, Velicki M, Ovadia-Blechman Z. The influence of mindfulness meditation on inattention and physiological markers of stress on students with learning disabilities and/or attention deficit hyperactivity disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 100:103630. [PMID: 32163834 DOI: 10.1016/j.ridd.2020.103630] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/16/2020] [Accepted: 03/02/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Over recent decades, the number of students diagnosed with learning disabilities and/or attention deficit hyperactivity disorders has substantially increased. These students face various challenges and experience stress when receiving higher education. AIMS The purpose of this study was to compare two non-pharmacological interventions: mindfulness and device-guided slow breathing, with a control group. METHODS Seventy-three students (age = 25.76, std. dev = 3.10) with attention problems and/or learning disabilities were randomly assigned to three groups: mindfulness meditation, device guided breathing practice and waiting-list control. Before and after the intervention physiological and psychological measures were collected. RESULTS Our results show that only mindfulness practice improved awareness of the present moment and decreased hyperactivity and inattention. Furthermore, both mindfulness and practice with device-guided breathing were associated with stress reduction, as shown by an increase in the galvanic skin response only in the control group. CONCLUSIONS Implementation of the study results may lead to an advance in treating attention deficit disorders and learning disabilities, especially among higher education students.
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Affiliation(s)
| | - Ricardo Tarrasch
- School of Education, Tel Aviv University, Israel; Sagol School of Neuroscience, Tel Aviv University, Israel.
| | - Maria Velicki
- School of Medical Engineering, Afeka - Tel Aviv Academic College of Engineering, Israel
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16
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Pagaduan J, Wu SSX, Kameneva T, Lambert E. Acute effects of resonance frequency breathing on cardiovascular regulation. Physiol Rep 2019; 7:e14295. [PMID: 31782265 PMCID: PMC6882954 DOI: 10.14814/phy2.14295] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Acute slow breathing may have beneficial effects on cardiovascular regulation by affecting hemodynamics and the autonomic nervous system. Whether breathing at the resonance frequency (RF), a breathing rate that maximizes heart rate oscillations, induces differential effects to that of slow breathing is unknown. We compared the acute effects of breathing at either RF and RF + 1 breaths per minute on muscle sympathetic nervous activity (MSNA) and baroreflex function. Ten healthy men underwent MSNA, blood pressure (BP), and heart rate (HR) recordings while breathing for 10 min at their spontaneous breathing (SB) rate followed by 10 min at both RF and RF + 1 randomly assigned and separated by a 10-min recovery. Breathing at either RF or RF + 1 induced similar changes in HR and HR variability, with increased low frequency and decreased high frequency oscillations (p < .001 for both). Both respiration rates decreased MSNA (-5.6 and -7.3 bursts per min for RF and RF + 1 p < .05), with the sympathetic bursts occurring more often during mid-inspiration to early expiration (+57% and + 80%) and longer periods of silence between bursts were seen (p < .05 for RF + 1). Systolic BP was decreased only during RF (-4.6 mmHg, p < .05) but the decrease did not differ to that seen during RF + 1 (-3.1 mmHg). The sympathetic baroreflex function remained unchanged at either breathing rates. The slope of the cardiac baroreflex function was unaltered but the cardiac baroreflex efficiency was improved during both RF and RF + 1. Acute breathing at either RF or RF + 1 has similar hemodynamic and sympatho-inhibitory effects in healthy men.
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Affiliation(s)
- Jeffrey Pagaduan
- School of Health SciencesCollege of Health and MedicineUniversity of TasmaniaTasmaniaAustralia
| | - Sam SX Wu
- School of Health SciencesCollege of Health and MedicineUniversity of TasmaniaTasmaniaAustralia
- School of Health SciencesDepartment of Health and Medical SciencesSwinburne University of TechnologyHawthornVictoriaAustralia
| | - Tatiana Kameneva
- Faculty of Science, Engineering and TechnologySwinburne University of TechnologyHawthornVictoriaAustralia
- Iverson Health Innovation Research InstituteSchool of Health Sciences Faculty of Health, Arts and DesignSwinburne University of TechnologyHawthornVictoriaAustralia
- Department of Biomedical EngineeringUniversity of MelbourneParkvilleAustralia
| | - Elisabeth Lambert
- School of Health SciencesDepartment of Health and Medical SciencesSwinburne University of TechnologyHawthornVictoriaAustralia
- Iverson Health Innovation Research InstituteSchool of Health Sciences Faculty of Health, Arts and DesignSwinburne University of TechnologyHawthornVictoriaAustralia
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17
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Adler TE, Coovadia Y, Cirone D, Khemakhem ML, Usselman CW. Device-guided slow breathing reduces blood pressure and sympathetic activity in young normotensive individuals of both sexes. J Appl Physiol (1985) 2019; 127:1042-1049. [DOI: 10.1152/japplphysiol.00442.2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Slow breathing (SLOWB) is recommended for use as an adjuvant treatment for hypertension. However, the extent to which blood pressure (BP) responses to SLOWB differ between men and women are not well-established. Therefore, we tested the hypothesis that an acute bout of SLOWB would induce larger decreases in BP in males than in females, given that males typically have higher resting BP. We also examined autonomic contributors to reduced BP during SLOWB; that is, muscle sympathetic nerve activity and spontaneous cardiovagal (sequence method) and vascular sympathetic baroreflex sensitivity. We tested normotensive females ( n = 10, age: 22 ± 2 y, body mass index: 22 ± 2 kg/m2) and males ( n = 12, age: 23 ± 3 y, body mass index: 26 ± 4 kg/m2). Subjects were tested at baseline and during the last 5 min of a 15-min RESPeRATE-guided SLOWB session. Overall, SLOWB reduced systolic BP by 3.2 ± 0.8 mmHg (main effect, P < 0.01). Females had lower systolic BP (main effect, P = 0.02); we observed no interaction between sex and SLOWB. SLOWB also reduced muscle sympathetic nerve activity burst incidence by −5.0 ± 1.4 bursts/100 heartbeats (main effect, P < 0.01). Although females tended to have lower burst incidence (main effect, P = 0.1), there was no interaction between sex and SLOWB. Cardiovagal baroreflex sensitivity improved during SLOWB (21.0 vs. 36.0 ms/mmHg, P = 0.03) with no effect of sex. Despite lower overall BP in females, our data support a lack of basement effect on SLOWB-induced reductions in BP, as SLOWB was equally effective in reducing BP in males and females. Our findings support the efficacy of the RESPeRATE device for reducing BP in both sexes, even in young, normotensive individuals. NEW & NOTEWORTHY We provide support for the effectiveness of device-guided slow breathing for blood pressure reduction in young normotensive women and men. Despite having lower baseline blood pressure and sympathetic nerve activity, women experienced equivalent reductions in both measures in response to RESPeRATE-guided slow breathing as men. Thus, slow breathing appears to be effective in young healthy normotensive individuals of both sexes and may be an ideal preventative therapy against future hypertension.
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Affiliation(s)
- Tessa E. Adler
- Cardiovascular Health and Autonomic Regulation Laboratory, Department of Kinesiology and Physical Education, McGill University, Quebec, Canada
| | - Yasmine Coovadia
- Cardiovascular Health and Autonomic Regulation Laboratory, Department of Kinesiology and Physical Education, McGill University, Quebec, Canada
| | - Domenica Cirone
- Cardiovascular Health and Autonomic Regulation Laboratory, Department of Kinesiology and Physical Education, McGill University, Quebec, Canada
| | - Maha L. Khemakhem
- Cardiovascular Health and Autonomic Regulation Laboratory, Department of Kinesiology and Physical Education, McGill University, Quebec, Canada
| | - Charlotte W. Usselman
- Cardiovascular Health and Autonomic Regulation Laboratory, Department of Kinesiology and Physical Education, McGill University, Quebec, Canada
- McGill Research Centre for Physical Activity and Health, McGill University, Quebec, Canada
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18
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Xu SK, Chen Y, Liu CY, Spekowius G, van Ee R, de Jong M, Shen M, Li Y, Wang JG. A randomized cross-over study on the blood pressure lowering effect of the combined passive head-up and -down movement with Device-Guided slow breathing. Blood Press 2019; 28:291-299. [PMID: 31068018 DOI: 10.1080/08037051.2019.1613884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: Baroreflex emerges as a therapeutic target of hypertension. We investigated blood pressure (BP) lowering effect of the combined passive head-up and -down movement with device-guided slow breathing in untreated mild hypertension or high-normal BP. Methods: In a randomized, cross-over trial, untreated subjects with an ambulatory systolic/diastolic BP of 125-140/80-90 mmHg and a clinic BP of 130-150/80-90 mmHg were randomized to intervention treatment with head movement and slow breathing or sham control, and then crossed over. Both treatments consisted of 1-week preparation, 2-week treatment, and 1-week recovery. During the 2-week treatment, subjects were treated for a session of 20 min/day. BP, pulse rate and respiration were measured before and after each treatment session. Ambulatory BP monitoring was performed at baseline and the end of the 2-week treatments' period, and home BP monitoring in the morning and evening for the whole 8-week follow-up period. Results: 14 subjects completed the study. The intervention treatment, compared to control, reduced respiration rate by -2.1 breaths/min (95% CI -2.9 to -1.2, p = .0001), but not clinic BP and pulse rate (p ≥ .67). The intervention treatment, compared to control, significantly reduced nighttime systolic/diastolic blood pressure by -5.63/-3.82 mm Hg (p ≤ .01) but not 24-h or daytime ambulatory blood pressure (p ≥ .69). Home BP decreased with the intervention treatment, but the between-treatment difference was not statistically significant (p ≥ .27). Conclusions: The combined head movement with slow breathing did not influence 24-h BP, but reduced nighttime BP in untreated mild hypertension or high-normal BP.
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Affiliation(s)
- Shao-Kun Xu
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Yi Chen
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Chang-Yuan Liu
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China
| | | | | | | | - Meng Shen
- Health Systems, Philips Research China , Shanghai , China
| | - Yan Li
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China
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19
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Cierpka-Kmieć K, Hering D. Tachycardia: The hidden cardiovascular risk factor in uncomplicated arterial hypertension. Cardiol J 2019; 27:857-867. [PMID: 30799548 DOI: 10.5603/cj.a2019.0021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 02/04/2019] [Indexed: 12/30/2022] Open
Abstract
Early detection and management of elevated blood pressure is crucial in reducing the burden of cardiovascular disease (CVD). The importance of an absolute risk assessment and patient risk stratification has been highlighted in the European hypertension guidelines since 2003. Amongst numerous risk factors influencing patient prognosis, elevated heart rate (HR) has been indicated as important predictor of future risk of hypertension, coronary heart disease, sudden cardiac death, heart failure, CVD, stroke, total cancer and mortality. Given that resting HR can be easily determined in clinical practice and modified by lifestyle changes as well as beta-blocker therapy, it seems reasonable that lowering resting HR should be a potential target to reduce disease burden and premature mortality. However, there is a lack of outcome studies of HR lowering in tachycardia-related hypertension. This review outlines the underlying mechanisms of early course hypertension pathophysiology with the critical role of the sympathetic nervous system activation, the prognostic significance of fast HR and the mechanistic rationale for the use of non-pharmacological approaches and/or highly long-acting cardioselective beta-blockers with some consideration given to betaxolol properties.
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Affiliation(s)
| | - Dagmara Hering
- Medical University of Gdansk, Poland, Debinki 7, 80-952 Gdansk, Poland.
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20
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Lachowska K, Bellwon J, Moryś J, Gruchała M, Hering D. Slow breathing improves cardiovascular reactivity to mental stress and health-related quality of life in heart failure patients with reduced ejection fraction. Cardiol J 2019; 27:772-779. [PMID: 30697682 DOI: 10.5603/cj.a2019.0002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 12/31/2018] [Accepted: 01/03/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Previous studies have demonstrated therapeutic benefits of slow breathing (SLOWB) in chronic heart failure (HF) but its impact on cardiovascular reactivity in response to laboratory stressors remains unknown. METHODS Using device-guided breathing this study explored the acute and long-term effects of SLOWB on hemodynamic responses to handgrip, mental and cold pressor tests, and health-related quality of life (QoL) in stable HF patients with reduced ejection fraction (HFrEF) who had received all available optimal drug and device therapies. Blood pressure (BP) and heart rate (HR) were measured in 21 patients with HFrEF (23.9 ± 5.9%) at rest, during laboratory stressors, before and after acute SLOWB, and 12 weeks after SLOWB home training (30 min daily). Health-related QoL (MacNew questionaries) was assessed before and 12 weeks after SLOWB home training. RESULTS Resting BP significantly increased in response to three laboratory stressors. Pressor and cardiac changes during mental stress were greater than responses to the handgrip test (p < 0.05). Mental stress also produced a greater HR change than cold pressor test (p < 0.05). Both acute and long-term SLOWB significantly reduced BP and HR responses to mental stress (p < 0.05), but not to isometric and cold pressor tests. SLOWB improved scores of all domains of QoL (p < 0.05) at 12 weeks follow-up. CONCLUSIONS These findings demonstrate that SLOWB reduces acute and chronic effects of cardiovascular reactivity to mental stress and improves various aspects of health-related QoL in patients with severe HFrEF. Whether stress reduction and psychological changes achieved with SLOWB may translate to improved outcomes in HFrEF warrants further exploration.
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Affiliation(s)
- Kamila Lachowska
- Medical University of Gdansk, Poland, Debinki 7, 80-952 Gdansk, Poland
| | - Jerzy Bellwon
- Medical University of Gdansk, Poland, Debinki 7, 80-952 Gdansk, Poland
| | - Joanna Moryś
- Medical University of Gdansk, Poland, Debinki 7, 80-952 Gdansk, Poland
| | - Marcin Gruchała
- Medical University of Gdansk, Poland, Debinki 7, 80-952 Gdansk, Poland
| | - Dagmara Hering
- Medical University of Gdansk, Poland, Debinki 7, 80-952 Gdansk, Poland.
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21
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Grassi G, Pisano A, Bolignano D, Seravalle G, D’Arrigo G, Quarti-Trevano F, Mallamaci F, Zoccali C, Mancia G. Sympathetic Nerve Traffic Activation in Essential Hypertension and Its Correlates. Hypertension 2018; 72:483-491. [DOI: 10.1161/hypertensionaha.118.11038] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 03/05/2018] [Accepted: 05/22/2018] [Indexed: 12/19/2022]
Abstract
Muscle sympathetic nerve activity (MSNA) has shown that sympathetic activation may occur in essential hypertension (EHT). However, the small sample size of the studies, the heterogeneity of the patients examined, and the presence of confounders represented major weaknesses not allowing to draw definite conclusions. Among the 432 studies identified providing information in EHT on MSNA, 63 were eligible (1216 patients) and meta-analyzed grouping them on the basis of clinically relevant questions: (1) Is MSNA increased in hypertension of mild/moderate-to-severe degree? (2) Does sympathetic activation occur in borderline, white-coat, and masked EHT? (3) Is MSNA related to clinic and ambulatory blood pressure and target organ damage? (4) Are heart rate and venous plasma norepinephrine valuable surrogate markers of MSNA in clinical practice? The results show that MSNA was significantly greater (1.5×;
P
<0.001) in mild-to-moderate and severe EHT as compared with normotensive controls and that this was the case also in borderline, white-coat, and masked hypertension as well. Interestingly, MSNA was significantly greater in both untreated and treated hypertension (
P
<0.001 for both), related to clinic and ambulatory blood pressure (
r
=0.67 and
r
=0.83;
P
<0.001 for both), inversely related to heart rate (
r
=−0.38;
P
<0.001) and directly to venous plasma norepinephrine (
r
=0.28;
P
<0.001) and left ventricular mass index (
r
=0.27;
P
<0.001). Thus, EHT is a condition characterized by a sustained sympathetic overdrive, whose magnitude is proportional to its clinical severity. This is more clearly manifest when MSNA rather than indirect markers of adrenergic drive, such as heart rate and plasma norepinephrine, are used.
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Affiliation(s)
- Guido Grassi
- From the Department of Medicine and Surgery, Clinica Medica, University of Milano-Bicocca, Italy (G.G., G.S., F.Q.-T.)
| | - Anna Pisano
- Consiglio Nazionale delle Ricerche-Istituto di Fisiologia Clinica, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy (A.P., D.B., G.D., F.M., C.Z.)
| | - Davide Bolignano
- Consiglio Nazionale delle Ricerche-Istituto di Fisiologia Clinica, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy (A.P., D.B., G.D., F.M., C.Z.)
| | - Gino Seravalle
- From the Department of Medicine and Surgery, Clinica Medica, University of Milano-Bicocca, Italy (G.G., G.S., F.Q.-T.)
| | - Graziella D’Arrigo
- Consiglio Nazionale delle Ricerche-Istituto di Fisiologia Clinica, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy (A.P., D.B., G.D., F.M., C.Z.)
| | - Fosca Quarti-Trevano
- From the Department of Medicine and Surgery, Clinica Medica, University of Milano-Bicocca, Italy (G.G., G.S., F.Q.-T.)
| | - Francesca Mallamaci
- Consiglio Nazionale delle Ricerche-Istituto di Fisiologia Clinica, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy (A.P., D.B., G.D., F.M., C.Z.)
| | - Carmine Zoccali
- Consiglio Nazionale delle Ricerche-Istituto di Fisiologia Clinica, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy (A.P., D.B., G.D., F.M., C.Z.)
| | - Giuseppe Mancia
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.M.)
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22
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Long-term effects of device-guided slow breathing in stable heart failure patients with reduced ejection fraction. Clin Res Cardiol 2018; 108:48-60. [PMID: 29943271 PMCID: PMC6333716 DOI: 10.1007/s00392-018-1310-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/19/2018] [Indexed: 12/13/2022]
Abstract
Background Slow breathing (SLOWB) alleviates symptoms of chronic heart failure (HF) but its long-term effects are unknown. We examined the acute and long-term impact of device-guided breathing on hemodynamics and prognostic parameters in HF patients with reduced ejection fraction (HFrEF). Methods and results Twenty-one patients with HFrEF (23.9 ± 5.8%, SD ± mean) on optimal medical therapy underwent blood pressure (BP), heart rate (HR), HR variability, 6-min walk test (6MWT), cardiopulmonary exercise testing (CPET), and echocardiography measurements before and 3 months after SLOWB home training (30 min daily). After 3 months, all patients were assigned to continue SLOWB (Group 1) or no-SLOWB (Group 2). All tests were repeated after 6 months. Acute SLOWB (18 ± 5 vs 8 ± 2 breaths/min, P < 0.001) had no influence on BP and HR but improved saturation (97 ± 2 vs 98 ± 2%, P = 0.01). Long-term SLOWB reduced office systolic BP (P < 0.001) but not central or ambulatory systolic BP. SLOWB reduced SDNN/RMSSD ratio (P < 0.05) after 3 months. One-way repeated measures of ANOVA revealed a significant increase in 6MWT and peak RER (respiratory exchange ratio) from baseline to 6-month follow-up in group 1 (P < 0.05) but not group 2 (P = 0.85 for 6MWT, P = 0.69 for RER). No significant changes in echocardiography were noted at follow-up. No HF worsening, rehospitalisation or death occurred in group 1 out to 6-month follow-up. Two hospitalizations for HF decompensation and two deaths ensued in group 2 between 3- and 6-month follow-up. Conclusions SLOWB training improves cardiorespiratory capacity and appears to slow the progression of HFrEF. Further long-term outcome studies are required to confirm the benefits of paced breathing in HFrEF.
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23
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Fonkoue IT, Marvar PJ, Norrholm SD, Kankam ML, Li Y, DaCosta D, Rothbaum BO, Park J. Acute effects of device-guided slow breathing on sympathetic nerve activity and baroreflex sensitivity in posttraumatic stress disorder. Am J Physiol Heart Circ Physiol 2018; 315:H141-H149. [PMID: 29652544 DOI: 10.1152/ajpheart.00098.2018] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Patients with posttraumatic stress disorder (PTSD) have elevated sympathetic nervous system reactivity and impaired sympathetic and cardiovagal baroreflex sensitivity (BRS). Device-guided slow breathing (DGB) has been shown to lower blood pressure (BP) and sympathetic activity in other patient populations. We hypothesized that DGB acutely lowers BP, heart rate (HR), and improves BRS in PTSD. In 23 prehypertensive veterans with PTSD, we measured continuous BP, ECG, and muscle sympathetic nerve activity (MSNA) at rest and during 15 min of DGB at 5 breaths/min ( n = 13) or identical sham device breathing at normal rates of 14 breaths/min (sham; n = 10). Sympathetic and cardiovagal BRS was quantified using pharmacological manipulation of BP via the modified Oxford technique at baseline and during the last 5 min of DGB or sham. There was a significant reduction in systolic BP (by -9 ± 2 mmHg, P < 0.001), diastolic BP (by -3 ± 1 mmHg, P = 0.019), mean arterial pressure (by -4 ± 1 mmHg, P = 0.002), and MSNA burst frequency (by -7.8 ± 2.1 bursts/min, P = 0.004) with DGB but no significant change in HR ( P > 0.05). Within the sham group, there was no significant change in diastolic BP, mean arterial pressure, HR, or MSNA burst frequency, but there was a small but significant decrease in systolic BP ( P = 0.034) and MSNA burst incidence ( P = 0.033). Sympathetic BRS increased significantly in the DGB group (-1.08 ± 0.25 to -2.29 ± 0.24 bursts·100 heart beats-1·mmHg-1, P = 0.014) but decreased in the sham group (-1.58 ± 0.34 to -0.82 ± 0.28 bursts·100 heart beats-1·mmHg-1, P = 0.025) (time × device, P = 0.001). There was no significant difference in the change in cardiovagal BRS between the groups (time × device, P = 0.496). DGB acutely lowers BP and MSNA and improves sympathetic but not cardiovagal BRS in prehypertensive veterans with PTSD. NEW & NOTEWORTHY Posttraumatic stress disorder is characterized by augmented sympathetic reactivity, impaired baroreflex sensitivity, and an increased risk for developing hypertension and cardiovascular disease. This is the first study to examine the potential beneficial effects of device-guided slow breathing on hemodynamics, sympathetic activity, and arterial baroreflex sensitivity in prehypertensive veterans with posttraumatic stress disorder.
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Affiliation(s)
- Ida T Fonkoue
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia.,Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Paul J Marvar
- Department of Pharmacology and Physiology, Institute for Neuroscience, George Washington University , Washington, District of Columbia
| | - Seth D Norrholm
- Mental Health Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia.,Psychiatry and Behavioral Sciences, Emory University , Atlanta, Georgia
| | - Melanie L Kankam
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia.,Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Yunxiao Li
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University , Atlanta, Georgia
| | - Dana DaCosta
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia.,Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | | | - Jeanie Park
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia.,Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
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24
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Bao XJ, Mao SQ, Gu TL, Zheng SY, Zhao JS, Zhang LN. Hypomethylation of the Interferon γ Gene as a Potential Risk Factor for Essential Hypertension: A Case-Control Study. TOHOKU J EXP MED 2018; 244:283-290. [DOI: 10.1620/tjem.244.283] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Xing-Jie Bao
- Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathological and Physiological Technology, Medical School of Ningbo University
| | - Shu-Qi Mao
- Beilun District Center for Disease Control and Prevention
| | - Tian-Lun Gu
- Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathological and Physiological Technology, Medical School of Ningbo University
| | - Shu-Ying Zheng
- Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathological and Physiological Technology, Medical School of Ningbo University
| | - Jin-Shun Zhao
- Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathological and Physiological Technology, Medical School of Ningbo University
| | - Li-Na Zhang
- Department of Preventive Medicine, Zhejiang Provincial Key Laboratory of Pathological and Physiological Technology, Medical School of Ningbo University
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25
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Lachowska K, Gruchała M, Narkiewicz K, Hering D. Sympathetic Activation in Chronic Heart Failure: Potential Benefits of Interventional Therapies. Curr Hypertens Rep 2017; 18:51. [PMID: 27193773 DOI: 10.1007/s11906-016-0660-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Heart failure (HF) is a major and growing public health problem. This condition is associated with poor prognosis, a high rate of mortality, frequent hospitalization and increasing costs to health care systems. Pharmacological approaches aimed at reducing morbidity and mortality in HF have primarily focused on inhibition of the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system (SNS), both of which have been associated with disease development, progression and adverse cardiovascular (CV) outcomes. The increasing number of hospitalizations for HF decompensation suggests the failure of available treatment options, indicating the necessity for alternative therapeutic approaches. Alongside pharmacological and cardiac resynchronization therapies in selected patients with arrhythmia, recent advancements in the management of HF have been directed at inhibiting relevant neurogenic pathways underlying disease development and progression. Initial evidence regarding the safety and effectiveness of interventional procedures suggests that HF patients may benefit from novel adjunctive therapies. Here we review the critical role of sympathetic activation in HF and the rationale for therapeutic interventions including device-based and interventional approaches aimed at restoring autonomic neural balance in this condition.
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Affiliation(s)
- Kamila Lachowska
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Marcin Gruchała
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Dagmara Hering
- Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Level 3 MRF Building, Rear 50 Murray Street, Perth, WA, 6000, MDBP: M570, Australia.
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26
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de Barros S, da Silva GV, de Gusmão JL, de Araújo TG, de Souza DR, Cardoso CG, Oneda B, Mion D. Effects of long term device-guided slow breathing on sympathetic nervous activity in hypertensive patients: a randomized open-label clinical trial. Blood Press 2017; 26:359-365. [PMID: 28724309 DOI: 10.1080/08037051.2017.1357109] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Device-guided slow breathing (DGB) is indicated as nonpharmacological treatment for hypertension. The sympathetic nerve activity (SNA) reduction may be one of the mechanisms involved in blood pressure (BP) decrease. The aim of this study is to evaluate the long-term use of DGB in BP and SNA. SUBJECTS AND METHODS Hypertensive patients were randomized to listen music (Control Group-CG) or DGB (aim to reduce respiratory rate to less than 10 breaths/minute during 15 minutes/day for 8 weeks). Before and after intervention ambulatory blood pressure monitoring (ABPM), catecholamines and muscle sympathetic nerve activity (MSNA) by microneurography were performed. RESULTS 17 volunteers in the DGB and 15 in the CG completed the study. There was no change in office BP before and after intervention in both groups. There was a reduction in systolic and diastolic BP in the awake period by ABPM only in the CG (131 ± 10/92 ± 9 vs 128 ± 10/88 ± 8mmHg, p < 0.05). In relation to SNA, no difference in catecholamines was observed. In the volunteers who had a microneurography record, there was no change the MSNA (bursts/minute): DGB (17(15-28) vs 19(13-22), p = 0.08) and CG (22(17-23) vs 22(18-24), p = 0.52). CONCLUSION Long-term DGB did not reduce BP, catecholamines levels or MSNA in hypertensive patients. ClinicalTrials.gov identifier: NCT01390727.
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Affiliation(s)
- Silvana de Barros
- a Nephrology Department, Hypertension Unit , General Hospital-University of São Paulo School of Medicine , São Paulo , Brazil
| | - Giovanio Vieira da Silva
- a Nephrology Department, Hypertension Unit , General Hospital-University of São Paulo School of Medicine , São Paulo , Brazil
| | | | - Tatiana Goveia de Araújo
- a Nephrology Department, Hypertension Unit , General Hospital-University of São Paulo School of Medicine , São Paulo , Brazil
| | - Dinoélia Rosa de Souza
- c Exercise Hemodynamic Laboratory, School of Physical Education and Sport , University of São Paulo , São Paulo , Brazil
| | | | - Bruna Oneda
- a Nephrology Department, Hypertension Unit , General Hospital-University of São Paulo School of Medicine , São Paulo , Brazil
| | - Décio Mion
- a Nephrology Department, Hypertension Unit , General Hospital-University of São Paulo School of Medicine , São Paulo , Brazil
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27
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28
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Sympathetic Activity in Patients With Secondary Symptomatic Mitral Regurgitation or End-Stage Systolic Heart Failure. JACC Cardiovasc Interv 2016; 9:2050-2057. [PMID: 27639906 DOI: 10.1016/j.jcin.2016.06.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/20/2016] [Accepted: 06/20/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study shows the impact of secondary mitral regurgitation (sMR) and transcatheter mitral valve repair (TMVR) with the MitraClip system on sympathetic nerve activity (SNA). BACKGROUND An increase in SNA is associated with worse outcomes and limited survival in patients with chronic heart failure (CHF). METHODS Twenty CHF-patients without relevant sMR and 30 CHF patients with symptomatic sMR were enrolled prospectively. All patients underwent standardized laboratory testing and microneurography. Sixteen patients from the sMR group underwent the MitraClip procedure; 10 patients after TMVR and 9 untreated sMR patients completed 6 months of follow-up. RESULTS Comparing groups according to presence of sMR, we found no differences in left ventricular dimensions, and serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and noradrenaline; sMR was associated with increased MSNA (106 ± 60 burst/min vs. 74 ± 48 burst/min, d = 0.58), an impaired sympathetic baroreflex gain (10 ± 7 burst/mm Hg vs. 5 ± 5 burst/mm Hg, d = 0.61), and a higher heart rate (90 ± 27/beats/min vs. 78 ± 12/beats/min, d = 0.58). TMVR led to improved New York Heart Association functional class (d > 0.05), reduced levels of NT-proBNP (5,251 ± 3,760 pg/ml vs. 3,710 ± 2,464 pg/ml; d = 0.58) improvement in 6-minute walk test (204 ± 33 m vs. 288 ± 45 m, d = 0.64), but unchanged levels of noradrenaline. TMVR decreased MSNA burst-frequency (130 ± 78 bursts/min vs. 74 ± 21 bursts/min; d = 0.58) and baroreflex gain (7 ± 4 burst/mm Hg vs. 4 ± 1 burst/mm Hg; d = 0.61). CONCLUSIONS In patients with CHF, concomitant sMR is associated with increased sympathetic nerve activity, which was independent from measured levels of NT-proBNP, noradrenaline, and left ventricular dimensions. Reduction of sMR with the MitraClip procedure reduced SNA and improved baroreflex gain, in line with improvements of functional capacity.
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29
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Qi Z, Ding S. Obesity-associated sympathetic overactivity in children and adolescents: the role of catecholamine resistance in lipid metabolism. J Pediatr Endocrinol Metab 2016; 29:113-25. [PMID: 26488603 DOI: 10.1515/jpem-2015-0182] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 08/27/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Obesity in children and adolescents is characterized by chronic sympathetic overdrive and reduced epinephrine-stimulated lipolysis. This resistance to catecholamines occurs during the dynamic phase of fat accumulation. This review will focus on the relationship between sympathetic-adrenal activity and lipid metabolism, thereby highlighting the role of catecholamine resistance in the development of childhood obesity. RESULTS AND CONCLUSIONS Catecholamine resistance causes lipid accumulation in adipose tissue by reducing lipolysis, increasing lipogenesis and impeding free fatty acid (FFA) transportation. Exercise improves catecholamine resistance, as evidenced by attenuated systemic sympathetic activity, reduced circulating catecholamine levels and enhanced β-adrenergic receptor signaling. Insulin resistance is mostly a casual result rather than a cause of childhood obesity. Therefore, catecholamine resistance in childhood obesity may promote insulin signaling in adipose tissue, thereby increasing lipogenesis. This review outlines a series of evidence for the role of catecholamine resistance as an upstream mechanism leading to childhood obesity.
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30
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Hering D, Kara T, Kucharska W, Somers VK, Narkiewicz K. Longitudinal tracking of muscle sympathetic nerve activity and its relationship with blood pressure in subjects with prehypertension. Blood Press 2015; 25:184-92. [PMID: 26654200 DOI: 10.3109/08037051.2015.1121708] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Prehypertension is associated with increased cardiovascular events. While the "tracking phenomenon" is an important longitudinal characteristic of blood pressure (BP), changes in muscle sympathetic nerve activity (MSNA) over time remain unclear. This study tested the hypothesis that MSNA tracking contributes to BP trends in prehypertension. BP and MSNA were assessed in 13 prehypertensive males at rest, during hand grip and mental stressors at baseline and after 8 years. Baseline office BP averaged 127 ± 2/81 ± 2 mmHg and MSNA 24 ± 4 bursts/min. BP increased by 7 ± 2/5 ± 2 mmHg (P < 0.01) and MSNA by 11 ± 2 bursts/min (P < 0.001) at follow-up. SBP and DBP were interrelated at baseline (r = 0.65, P = 0.02) and at follow-up (r = 0.78, P = 0.002). MSNA tracking (r = 0.82; P < 0.001) was similar to BP. MSNA was strongly related to DBP at baseline (r = 0.73; P < 0.01) and follow-up (r = 0.64; P = 0.01), more so than SBP. BMI increased (P < 0.001) at follow-up but was unrelated to BP or MSNA. Despite comparable pressor and cardiac increases to handgrip and mental stressors, sympathetic responses were blunted, more pronounced to isometric test (P < 0.006) at follow-up. In conclusion, the trend in MSNA corresponds with BP changes over time suggesting that tonic sympathetic activation may contribute to time-related increase in resting BP and the development of sustained hypertension in prehypertension.
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Affiliation(s)
- Dagmara Hering
- a Department of Hypertension and Diabetology , Medical University of Gdansk , Gdansk , Poland ;,b International Clinical Research Center, Department of Cardiovascular Diseases , St. Anne's University Hospital Brno , Brno , Czech Republic
| | - Tomas Kara
- b International Clinical Research Center, Department of Cardiovascular Diseases , St. Anne's University Hospital Brno , Brno , Czech Republic ;,c Divisions of Cardiovascular Disease and Hypertension , Mayo Clinic , Rochester , MN , USA
| | - Wiesława Kucharska
- a Department of Hypertension and Diabetology , Medical University of Gdansk , Gdansk , Poland
| | - Virend K Somers
- c Divisions of Cardiovascular Disease and Hypertension , Mayo Clinic , Rochester , MN , USA
| | - Krzysztof Narkiewicz
- a Department of Hypertension and Diabetology , Medical University of Gdansk , Gdansk , Poland ;,b International Clinical Research Center, Department of Cardiovascular Diseases , St. Anne's University Hospital Brno , Brno , Czech Republic ;,c Divisions of Cardiovascular Disease and Hypertension , Mayo Clinic , Rochester , MN , USA
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31
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Venturelli M, Cè E, Limonta E, Schena F, Caimi B, Carugo S, Veicsteinas A, Esposito F. Effects of endurance, circuit, and relaxing training on cardiovascular risk factors in hypertensive elderly patients. AGE (DORDRECHT, NETHERLANDS) 2015; 37:101. [PMID: 26381921 PMCID: PMC5005840 DOI: 10.1007/s11357-015-9835-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 09/07/2015] [Indexed: 05/10/2023]
Abstract
Recommendations for prevention of cardiovascular diseases (CVDs) risk factors among older adults highlighted the importance of exercise-based interventions, including endurance training (ET). However, the evidence of efficacy of other interventions based on short-bouts of exercise (circuit training, CT), and the practice of breath-control and meditation (relaxing training, RT) is growing. The aim of this study was to elucidate if CT or RT are equally effective in CVD risk factors reduction compared to ET. To this purpose, in 40 elderly participants, with clinically diagnosed grade 1 hypertension, resting blood pressure, blood glucose, and cholesterol levels, peak oxygen uptake ([Formula: see text]), mechanical efficiency and quality of life were evaluated before and after 12 weeks of ET, CT, and RT treatments. Resting blood pressure reduced significantly in all groups by ∼11 %. In ET, blood cholesterol levels (-18 %), [Formula: see text] (+8 %), mechanical efficiency (+9 %), and quality of life scores (+36 %) ameliorated. In CT blood glucose levels (-11 %), [Formula: see text] (+7 %) and quality of life scores (+35 %) were bettered. Conversely, in RT, the lower blood pressure went along only with an improvement in the mental component of quality of life (+42 %). ET and CT were both appropriate interventions to reduce CVDs risk factors, because blood pressure reduction was accompanied by decreases in blood glucose and cholesterol levels, increases in [Formula: see text], mechanical efficiency, and quality of life. Although RT influenced only blood pressure and quality of life, this approach would be an attractive alternative for old individuals unable or reluctant to carry out ET or CT.
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Affiliation(s)
- Massimo Venturelli
- Department of Biomedical Sciences for Health, University of Milan, Via Colombo 71, 20133, Milan, Italy
| | - Emiliano Cè
- Department of Biomedical Sciences for Health, University of Milan, Via Colombo 71, 20133, Milan, Italy
| | - Eloisa Limonta
- Department of Biomedical Sciences for Health, University of Milan, Via Colombo 71, 20133, Milan, Italy
| | - Federico Schena
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Barbara Caimi
- ASP Pio Albergo Trivulzio, Division of Cardiology, University of Milan, Milan, Italy
| | - Stefano Carugo
- ASP Pio Albergo Trivulzio, Division of Cardiology, University of Milan, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Arsenio Veicsteinas
- Department of Biomedical Sciences for Health, University of Milan, Via Colombo 71, 20133, Milan, Italy
- Center of Sport Medicine, Don Gnocchi Foundation, Milan, Italy
| | - Fabio Esposito
- Department of Biomedical Sciences for Health, University of Milan, Via Colombo 71, 20133, Milan, Italy.
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32
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Carter JR, Goldstein DS. Sympathoneural and adrenomedullary responses to mental stress. Compr Physiol 2015; 5:119-46. [PMID: 25589266 DOI: 10.1002/cphy.c140030] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This concept-based review provides historical perspectives and updates about sympathetic noradrenergic and sympathetic adrenergic responses to mental stress. The topic of this review has incited perennial debate, because of disagreements over definitions, controversial inferences, and limited availability of relevant measurement tools. The discussion begins appropriately with Cannon's "homeostasis" and his pioneering work in the area. This is followed by mental stress as a scientific idea and the relatively new notions of allostasis and allostatic load. Experimental models of mental stress in rodents and humans are discussed, with particular attention to ethical constraints in humans. Sections follow on sympathoneural responses to mental stress, reactivity of catecholamine systems, clinical pathophysiologic states, and the cardiovascular reactivity hypothesis. Future advancement of the field will require integrative approaches and coordinated efforts between physiologists and psychologists on this interdisciplinary topic.
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Affiliation(s)
- Jason R Carter
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan Clinical Neurocardiology Section, Clinical Neurosciences Program, Division of Intramural Research, National Institutes of Health, Bethesda, Maryland
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33
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Time sequence of autonomic changes induced by daily slow-breathing sessions. Clin Auton Res 2014; 25:95-104. [DOI: 10.1007/s10286-014-0255-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 08/21/2014] [Indexed: 12/12/2022]
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34
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Harada D, Asanoi H, Takagawa J, Ishise H, Ueno H, Oda Y, Goso Y, Joho S, Inoue H. Slow and deep respiration suppresses steady-state sympathetic nerve activity in patients with chronic heart failure: from modeling to clinical application. Am J Physiol Heart Circ Physiol 2014; 307:H1159-68. [DOI: 10.1152/ajpheart.00109.2014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Influences of slow and deep respiration on steady-state sympathetic nerve activity remain controversial in humans and could vary depending on disease conditions and basal sympathetic nerve activity. To elucidate the respiratory modulation of steady-state sympathetic nerve activity, we modeled the dynamic nature of the relationship between lung inflation and muscle sympathetic nerve activity (MSNA) in 11 heart failure patients with exaggerated sympathetic outflow at rest. An autoregressive exogenous input model was utilized to simulate entire responses of MSNA to variable respiratory patterns. In another 18 patients, we determined the influence of increasing tidal volume and slowing respiratory frequency on MSNA; 10 patients underwent a 15-min device-guided slow respiration and the remaining 8 had no respiratory modification. The model predicted that a 1-liter, step increase of lung volume decreased MSNA dynamically; its nadir (−33 ± 22%) occurred at 2.4 s; and steady-state decrease (−15 ± 5%), at 6 s. Actually, in patients with the device-guided slow and deep respiration, respiratory frequency effectively fell from 16.4 ± 3.9 to 6.7 ± 2.8/min ( P < 0.0001) with a concomitant increase in tidal volume from 499 ± 206 to 1,177 ± 497 ml ( P < 0.001). Consequently, steady-state MSNA was decreased by 31% ( P < 0.005). In patients without respiratory modulation, there were no significant changes in respiratory frequency, tidal volume, and steady-state MSNA. Thus slow and deep respiration suppresses steady-state sympathetic nerve activity in patients with high levels of resting sympathetic tone as in heart failure.
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Affiliation(s)
- Daisuke Harada
- The Cardiology Division, Imizu City Hospital, Imizu City, Toyama, Japan; and
| | - Hidetsugu Asanoi
- The Cardiology Division, Imizu City Hospital, Imizu City, Toyama, Japan; and
| | - Junya Takagawa
- The Cardiology Division, Imizu City Hospital, Imizu City, Toyama, Japan; and
| | - Hisanari Ishise
- The Cardiology Division, Imizu City Hospital, Imizu City, Toyama, Japan; and
| | - Hiroshi Ueno
- The Cardiology Division, Imizu City Hospital, Imizu City, Toyama, Japan; and
| | - Yoshitaka Oda
- The Cardiology Division, Toyama University Hospital, Toyama City, Toyama, Japan
| | - Yukiko Goso
- The Cardiology Division, Toyama University Hospital, Toyama City, Toyama, Japan
| | - Shuji Joho
- The Cardiology Division, Toyama University Hospital, Toyama City, Toyama, Japan
| | - Hiroshi Inoue
- The Cardiology Division, Toyama University Hospital, Toyama City, Toyama, Japan
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35
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Dick TE, Mims JR, Hsieh YH, Morris KF, Wehrwein EA. Increased cardio-respiratory coupling evoked by slow deep breathing can persist in normal humans. Respir Physiol Neurobiol 2014; 204:99-111. [PMID: 25266396 DOI: 10.1016/j.resp.2014.09.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 09/19/2014] [Accepted: 09/22/2014] [Indexed: 12/12/2022]
Abstract
Slow deep breathing (SDB) has a therapeutic effect on autonomic tone. Our previous studies suggested that coupling of the cardiovascular to the respiratory system mediates plasticity expressed in sympathetic nerve activity. We hypothesized that SDB evokes short-term plasticity of cardiorespiratory coupling (CRC). We analyzed respiratory frequency (fR), heart rate and its variability (HR&HRV), the power spectral density (PSD) of blood pressure (BP) and the ventilatory pattern before, during, and after a 20-min epoch of SDB. During SDB, CRC and the relative PSD of BP at fR increased; mean arterial pressure decreased; but HR varied; increasing (n = 3), or decreasing (n = 2) or remaining the same (n = 5). After SDB, short-term plasticity was not apparent for the group but for individuals differences existed between baseline and recovery periods. We conclude that a repeated practice, like pranayama, may strengthen CRC and evoke short-term plasticity effectively in a subset of individuals.
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Affiliation(s)
- Thomas E Dick
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH, United States; Department of Neurosciences, Case Western Reserve University, Cleveland, OH, United States.
| | - Joseph R Mims
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Yee-Hsee Hsieh
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Kendall F Morris
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Erica A Wehrwein
- Department of Physiology, Michigan State University, East Lansing, MI, United States
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36
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de Barros S, da Silva GV, de Gusmão JL, de Araujo TG, Mion D. Reduction of sympathetic nervous activity with device-guided breathing. J Clin Hypertens (Greenwich) 2014; 16:614-5. [PMID: 24953782 DOI: 10.1111/jch.12360] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Silvana de Barros
- Nephrology Department, Hypertension Unit, General Hospital - University of São Paulo School of Medicine, São Paulo, Brazil
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37
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Moraes DJA, Machado BH, Paton JFR. Specific Respiratory Neuron Types Have Increased Excitability That Drive Presympathetic Neurones in Neurogenic Hypertension. Hypertension 2014; 63:1309-18. [DOI: 10.1161/hypertensionaha.113.02283] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Davi J. A. Moraes
- From the School of Physiology and Pharmacology, Bristol Heart Institute, Medical Sciences Building, University of Bristol, Bristol, BS8 1TD, England (D.J.A.M., J.F.R.P.); and Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, 14049–900, SP, Brazil (D.J.A.M., B.H.M.)
| | - Benedito H. Machado
- From the School of Physiology and Pharmacology, Bristol Heart Institute, Medical Sciences Building, University of Bristol, Bristol, BS8 1TD, England (D.J.A.M., J.F.R.P.); and Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, 14049–900, SP, Brazil (D.J.A.M., B.H.M.)
| | - Julian F. R. Paton
- From the School of Physiology and Pharmacology, Bristol Heart Institute, Medical Sciences Building, University of Bristol, Bristol, BS8 1TD, England (D.J.A.M., J.F.R.P.); and Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, 14049–900, SP, Brazil (D.J.A.M., B.H.M.)
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38
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Limberg JK, Morgan BJ, Schrage WG, Dempsey JA. Respiratory influences on muscle sympathetic nerve activity and vascular conductance in the steady state. Am J Physiol Heart Circ Physiol 2013; 304:H1615-23. [PMID: 23585141 DOI: 10.1152/ajpheart.00112.2013] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In patients with hypertension, volitional slowing of the respiratory rate has been purported to reduce arterial pressure via withdrawal of sympathetic tone. We examined the effects of paced breathing at 7, 14, and 21 breaths/min, with reciprocal changes in tidal volume, on muscle sympathetic nerve activity, forearm blood flow, forearm vascular conductance, and blood pressure in 21 men and women, 8 of whom had modest elevations in systemic arterial pressure. These alterations in breathing frequency and volume did not affect steady-state levels of sympathetic activity, blood flow, vascular conductance, or blood pressure (all P > 0.05), even though they had the expected effect on sympathetic activity within breaths (i.e., increased modulation during low-frequency/high-tidal volume breathing) (P < 0.001). These findings were consistent across subjects with widely varied baseline levels of sympathetic activity (4-fold), mean arterial pressure (78-110 mmHg), and vascular conductance (15-fold), and those who became hypocapnic during paced breathing vs. those who maintained normocapnia. These findings challenge the notion that slow, deep breathing lowers arterial pressure by suppressing steady-state sympathetic outflow.
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Affiliation(s)
- Jacqueline K Limberg
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, School of Education, University of Wisconsin, Madison, WI, USA
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