AHA: Alternative therapies can treat hypertension

Alternative therapies such as aerobic exercise, resistance or strength training, and isometric hand grip exercises may help lower blood pressure, according to the American Heart Association.

In a new scientific statement published in its journal Hypertension, the association said alternative approaches could help people with blood pressure levels higher than 120/80 mm Hg and those who cannot tolerate or do not respond well to standard medications.

However, alternative therapies should not replace proven methods to lower blood pressure, including physical activity, managing weight, not smoking or drinking excess alcohol, eating a low-sodium and balanced diet, and taking medications when prescribed, the association said.

Hypertension affects more than 26% of the population worldwide and contributes to more than 13% of premature deaths, according to the association.

An expert panel assessed three alternative remedy categories: exercise regimens, behavioral therapies such as meditation, and non-invasive procedures or devices, including acupuncture and device-guided slow breathing. The panel did not review dietary and herbal treatments.

“There aren’t many large, well-designed studies lasting longer than a few weeks looking at alternative therapies, yet patients have a lot of questions about their value,” Robert D. Brook, MD, chairman of the panel and an associate professor of medicine at the University of Michigan in Ann Arbor, said in a news release. “A common request from patients is, ‘I don’t like to take medications; what can I do to lower my blood pressure?’ We wanted to provide some direction.”

The alternative therapies rarely caused serious side effects and posed few health risks, but the analysis revealed some approaches were more beneficial than others and could be part of a comprehensive blood pressure-lowering treatment plan.

Brook and colleagues reviewed data published in 2006-11, including 1,000 studies on behavioral therapies, non-invasive procedures and devices, and three types of exercise (aerobic, resistance or weight training, and isometric exercises, most commonly handgrip devices).

The studies also examined the effects of yoga, different styles of meditation, biofeedback methods, acupuncture, device-guided breathing, relaxation and stress reduction techniques.

The panel found:

• All three types of exercise reduced blood pressure. Walking programs provided modest benefit while, somewhat surprisingly, four weeks of isometric hand grip exercises resulted in some of the most impressive improvements: a 10% drop in systolic and diastolic blood pressure. However, isometric exercise should be avoided among people with severely-uncontrolled hypertension (180/110 mm/Hg or higher), according to the association.

• Behavioral therapies such as biofeedback and transcendental meditation may help lower blood pressure by a small amount. However, there’s not sufficient data to support using other types of meditation.

• Strong clinical evidence also is lacking to recommend yoga and other relaxation techniques for reducing blood pressure.

• There is not enough evidence to recommend acupuncture for lowering blood pressure, particularly given the complexities involved in employing this treatment. However, device-guided slow breathing did prove effective in lowering blood pressure when performed for 15-minute sessions three to four times a week.

“Most alternative approaches reduce systolic blood pressure by only 2 to 10 mm Hg, whereas standard doses of a blood pressure-lowering drug reduce systolic blood pressure by about 10 to 15 mm Hg,” Brook said. “So, alternative approaches can be added to a treatment regimen after patients discuss their goals with their doctors.”

Given the global public health burden of hypertension, more research is needed to look at the long-term cardiovascular health impact of alternative therapies and the effects of combining them together or adding them to other proven lifestyle measures, Brook said.

Read a PDF of the statement: http://hyper.ahajournals.org/content/early/2013/04/22/HYP.0b013e318293645f.abstract.

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