Alternative Ways to Lower Your Blood Pressures, What Works?


If you're been diagnosed with hyperten­sion—high blood pressure—your health­care provider may have recommended lifestyle changes as a first line of defense: Lose any extra pounds, reduce your sodium and alcohol consumption, quit smoking, try a healthier diet and get moving with aerobic exercise. These changes can help bring down blood pressure numbers and reduce the risk of hypertension-related complications, such as heart attack and stroke. The same changes can help if you have prehypertension—blood pressure that's only slightly elevated—and want to lower your levels before the condition turns into full-blown hypertension.


If lifestyle changes aren't effective in lowering your blood pressure, you may need to do more. Many people with hyper­tension—a reading of 140/90 millimeters of mercury (mm Hg) and higher—require drugs to help rein in their numbers.


Some people turn to additional non-dietary and nondrug approaches to help lower their-blood pressure, such-as medita­tion, acupuncture and different forms of exercise. To aid patients and doctors in making safe and effective choices, the American Heart Association (AHA) has issued a scientific statement that provides an evidence-based look at certain alterna­tive approaches. Because the effects of many of these approaches are relatively modest, the AHA stresses that none should replace your standard treatment plan, especially any drugs already pre­scribed by your provider.


An expert panel evaluated the scientific evidence from more than 1,000 meta-analyses and reviews on alternative approaches published from 2006 to 2011. The AHA published its recommendations in the June issue of Hypertension.


The panel didn’t address dietary mea­sures, previously covered in a 2006 position statement, which outlined dietary steps for controlling high blood pressure, including reduced salt intake (1,500 mg daily), increased potassium consumption (4,700 mg daily from food) and moderate alcohol intake (one drink a day for women, two for men).


Who should consider alternatives?


The AHA says that some alternative ther­apies can be considered by people who:


• Aren't able to lower their blood pressure with dietary changes


• Are prehypertensive (blood pressure levels between 120/80 mm Hg and 139/89 mm Hg)


• Have stage I hypertension (blood pressure levels of 140/90 mm Hg to 159/99 mm Hg), are in otherwise good health and are considered at low risk but want to avoid or delay taking drugs


• Have high blood pressure but wish to try a therapy either as an adjunct to drugs or to avoid taking additional drugs


• Have controlled high blood pressure but who want to reduce drugs or lessen the number of drugs taken


• Have treatment-resistant hypertension (high blood pressure that can't be suc­cessfully lowered with drugs)


• Can't tolerate or don't respond well to blood pressure drugs


In general, the panel found that a three-month trial of an alternative therapy, with up to a 12-month trial-in Iow-risk.indi­viduals, was sufficient to allow any benefits to take effect. The therapies rarely caused side effects or had health risks. If blood pressure remained high, increased or resulted in disease, the panel recommended starting a drug regimen.


Here's a look at alternative therapies that showed the most positive effects on blood pressure.


Exercise-based regimens


• Aerobic exercise


The fact that aerobic activities such as walking, jogging, running and cycling received the highest marks for impact on high blood pressure of all the therapies studied doesn't come as a surprise. For more than 40 years, experts have recom­mended these aerobic activities to help con­trol blood pressure numbers. Joint National Committee guidelines recommend at least 30 minutes of moderate activity on most days of the week. If your blood pressure is uncontrolled or you have other health con­ditions, speak with your healthcare pro­vider before starting an exercise program.


• Dynamic resistance exercise


Resistance activities such as weight lift­ing and circuit training are known to help strengthen muscles, but what about the most important muscle, your heart? Research into resistance exercise's effect on the heart has been uneven; however, many studies have shown at least modest positive benefits. The AHA panel concluded that dynamic resistance exercise can modestly lower blood pressure. The Centers for Dis­ease Control and Prevention recommends performing a muscle-strengthening activ­ity such as lifting weights or doing heavy gardening (digging, shoveling) at least twice a week, with eight to 12 repetitions each session.


• Isometric (resistance) exercise


Could you literally squeeze your way to better blood pressure? One study found that four weeks of performing isometric handgrip exercises could reduce blood pres­sure by as much as 10. mm Hg. Handgrip exercises can be done by squeezing an inexpensive spring-loaded device, available at most sporting goods stores, that helps promote hand and lower-arm strength.


The AHA panel recommended several intermittent bouts of handgrip contrac­tions that last two minutes each for a total of 12 to 15 minutes a session, performed at least three times a week. An important caveat: Only a few small studies have been published on the handgrip–blood pressure connection, so more research is needed.


Behavioral therapies


• Biofeedback


Biofeedback techniques include cognitive behavioral therapy, relaxation therapy, guided imagery and psychological educa­tion. The techniques are based onrecog­nizing cues from your body and, with the help of a biofeedback specialist and special equipment, using these cues to learn how to control normally involuntary processes, such as blood pressure. Biofeedback's effect on blood pressure has been highly variable, with the AHA panel finding that among the studies they looked at, reductions in


• Transcendental meditation


Transcendental meditation (TM) uses specific mantras, or chants, to move past distracting thoughts and toward a state of increased awareness. Some studies have shown TM to have modest effects on blood pressure. The AHA says patients can try TM to help lower blood pressure but couldn't recommend other forms of medi­tation like mindful meditation because of insufficient evidence.


• Other behavioral therapies


Because of a lack of strong evidence, the panel couldn't recommend behavioral ther­apies such as yoga and other relaxation and stress-reducing techniques.


• Acupuncture


Although some studies have shown acu­puncture to have positive effects on blood pressure, the quality of many acupuncture–blood pressure studies is limited and results have been mixed. Therefore, the AHA panel didn't recommend trying acupunc­ture to lower blood pressure.


Devices and other procedures


• Device-guided slow breathing


Taking deep breaths at the rate of six per 30 seconds may reduce systolic blood pres­sure by up to 3.9 mm Hg within minutes, according to a study published in the jour­nal Hypertension Research. Additional research has suggested that use of deep-breathing techniques over the course of weeks and months may produce long-term blood pressure reduction.


The Food and Drug Administration has approved one device, Resperate, for use in reducing stress and as a complement to high blood pressure treatment. The breath­ing system uses a sensor belt wrapped around your chest to monitor your breath­ing rate. The system prompts you to match jou.. 4tgçt9musicaltones (which are synced to inhaling and exhaling) through headphones. The AHA panel said that Resperate may be worth a try, but more research is needed to find out whether similar outcomes can be duplicated without using the over-the-counter device—which is pricey (about $300-$400).


• Acupuncture


Although some studies have shown acupuncture to have positive effects on blood pressure, the quality of many acupuncture blood pressure studies is limited and results have been mixed. Therefore, the AHA panel didn’t recommend trying acupuncture to lower blood pressure.


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Clearly, the AHA scientific statement shows that exercise is the most important element you should include in your treatment plan when trying to lower blood pressure. Other therapies require more research to flesh out their correlation to reducing high blood pressure. More studies need to be done on the long-term effectiveness of alternative approaches as well as the effectiveness of combining several methods. Even so, these alternative approaches, teamed with suitable lifestyle changes and drugs it needed, are all viable options for people looking for ways to optimize their blood pressure.