Does anyone in your family take “blood pressure pills”? Hypertension, or high blood pressure, is a health problem that affects a third of the adult population in Spain, according to data published by the Spanish Journal of Cardiology. However, the figures are better than in other countries, such as Argentina, where it reaches 48% of the population.
Hypertension is a significant risk factor for cardiovascular diseases, such as myocardial infarction, stroke and heart failure. Additionally, it can damage vital organs such as the kidneys and eyes, leading to kidney failure and vision problems. In the long term, if left untreated, it accelerates the aging of the arteries, which increases the risk of developing atherosclerosis. The WHO estimates that 46% of adults with hypertension are unaware of it and may not have obvious symptoms, hence its nickname “silent killer.”
The use of drugs to treat hypertension practically tripled in Spain between 1996 and 2006. In recent years it has remained constant, but there is a slight upward trend. Although overtaken by analgesics and anxiolytics, they remain among the most prescribed medications.
But are there non-pharmacological aids to improve the situation of people suffering from hypertension? Recent research indicates yes, and this one in particular is within everyone’s reach: breathing control.
The use of drugs to treat hypertension practically tripled in Spain between 1996 and 2006. Although overtaken by analgesics and anxiolytics, they remain among the most prescribed drugs.
Breathing and blood pressure
Blood pressure in our body is controlled primarily by the autonomic nervous system, that is, it is automatic (we do not have to think about regulating blood pressure, just as we do not voluntarily regulate our heart rate or our breathing). The endocrine system also intervenes, with hormones like angiotensin II and aldosterone, which adjust blood volume. Many medications act on these hormones. Finally, the kidneys control fluid and electrolyte balance, which affects blood pressure.
If we look at the autonomic nervous system, there are two branches: the sympathetic system and the parasympathetic system. The sympathetic system is the accelerator: it increases blood pressure by releasing norepinephrine, which constricts blood vessels and increases heart rate. Something very useful when we are in danger. On the other hand, the parasympathetic system, through the vagus nerve, the brake pedal, reduces blood pressure, slows the heart rate and dilates blood vessels.
This regulation is rapid and responds to momentary changes in physical activity or stress, almost immediately adjusting blood pressure to maintain homeostasis. The good news is that we can act on the brake pedal, the vagus nerve, by controlling the rhythm of our breathing, and thus helping to reduce blood pressure.
Deep breathing, as effective as pills?
According to what Dr. Miguel Garber, a cardiologist specializing in hypertension, tells this media: “We always knew that blood pressure numbers could be reduced with a few simple lifestyle changes. Today we know that it is possible to improve blood pressure with five minutes of breathing exercises,” he says.
A 2021 study by the University of Colorado in the United States confirmed the same thing that Dr. Garber points out, that practicing just five minutes a day of breathing exercise was enough to sustainably reduce blood pressure. Additionally, it improved some parameters of vascular health as much or more than aerobic exercise or medications.
The researchers called this exercise high-resistance inspiratory muscle strength training (IMST). This exercise was not new. It was developed in the 1980s to help critically ill respiratory patients strengthen the diaphragm and other muscles involved in breathing.
We always knew that blood pressure numbers could be reduced with a few simple lifestyle changes. Today we know that it is possible to improve blood pressure with five minutes of breathing exercises.
Miguel Garber
— cardiologist specializing in hypertension
The IMST exercise involves vigorously inhaling using a hand-held device that provides air resistance. It’s a bit like sucking forcefully through the tube of a running vacuum cleaner, which also sucks. The study participants, people with hypertension, did this exercise for six weeks, compared to a control group.
In testing, the IMST group experienced an average reduction in systolic blood pressure (the highest number) of nine points, greater than that typically achieved by walking 30 minutes a day five days a week. This reduction is also equivalent to the effects of certain hypotensive medications. Even six weeks after stopping IMST, they maintained most of this improvement.
The treatment group also saw a 45% improvement in vascular endothelial function, or the ability of arteries to dilate upon stimulation, as well as a significant increase in levels of nitric oxide, a key molecule in dilation of arteries and prevention of plaque buildup. This means that the risk of other key factors of cardiovascular disease is reduced.
IMST exercises are performed by breathing through a small plastic device, similar to an inhaler. But it’s not necessary to have it to get benefits from other breathing exercises. There is a similar technique of inhaling normally and exhaling through a straw, which is used in some centers to treat anxiety and asthma.
Exercises to reduce tension
Other breathing exercises require only breathing. Among them are the pranayama practices of yoga, diaphragmatic breathing (inflating the abdomen, not the chest, to accommodate more volume of air when inhaling), inhaling through the nose, alternately covering one holes, or the breathing of the physiological sigh. (two quick, strong inspirations followed by a long, controlled exhalation).
“Patients with essential hypertension tend to hyperventilate at rest,” says Dr. Garber. “Slow, deep breathing improves baroreflex sensitivity [la relación entre la frecuencia cardíaca y la presión arterial] and reduces blood pressure in patients with hypertension.
Although these are common meditation or stress control techniques, they all have something in common: they act on the parasympathetic nervous system, which in turn is responsible for lowering blood pressure. Many studies have been published that have analyzed the effects of these techniques on hypertension and the results, although modest, are positive. A review of 20 studies involving people aged 18 to 75 found that breathing exercises could reduce systolic blood pressure by up to 52 mmHg. “This is done by relaxing the mind, providing a state of relaxation and reducing daily stress,” says Dr. Garber.
The advantage of breathing exercises is that anyone can do them and they have no contraindications. “The use of respiratory rehabilitation, including yoga exercises and breathing techniques, can complement the pharmacological and clinical treatment of essential hypertension,” concludes Dr. Garber.
The use of respiratory rehabilitation, including yoga exercises and breathing techniques, can complement the pharmacological and clinical treatment of essential hypertension.
Miguel Garber
— cardiologist specializing in hypertension
“Breathing relaxes the involuntary nervous system, helping to regulate heart levels and blood pressure, even with the possibility of reducing antihypertensive medications.” However, Dr. Garber cautions that hypertension can have many different causes and that one should never stop taking medications without consulting the healthcare professional who prescribed the treatment.
The AARP, an American non-profit organization dedicated to improving health, offers a series of recommendations for simple breathing exercises to control hypertension:
- The 4-7-8 method: Breathe in through your nose for a count of four, hold your breath for a count of seven, and exhale for a count of eight.
- 4-4-4-4 box breathing: inhale through your nose for a count of four, hold your breath for a count of four, exhale for a count of four, and hold your breath again for a count of four.
- Breathe with pursed lips: Inhale slowly through your nose, exhale through your mouth with pursed lips, as if you are blowing out the candles on a birthday cake, trying to make it last four times as long as the inhale.
- Diaphragmatic breathing: place both hands on your stomach and inhale through your nose, letting your stomach expand. Exhale through your mouth, deflating your abdomen.
- Alternate nasal breathing: Exhale completely and cover the left nostril with your index finger. Inhale completely through your right nostril. Close both nostrils with your fingers, pause for two seconds and release the left nostril. With your thumb in the right nostril, exhale through the left nostril then inhale through the same nostril. Squeeze both nostrils and hold them closed for two seconds. Release the right nostril and exhale through that nostril. Repeat.
* Darío Pescador is editor and director of Quo Magazine and author of the book the best of yourself Published by Oberon.
