Alternative methods OK to try for lowering blood pressure, consensus statement says

Behavioral therapy, biofeedback and exercise regimens may be useful adjuvants for lowering blood pressure, but they have varying degrees of evidence support, according to a consensus statement from the American Heart Association.

The consensus statement, as well as a suggested management algorithm and recommendations for individual approaches in clinical practice, was published online April 22 at Hypertension.

Among behavioral therapies, Transcendental Meditation (TM), other meditation techniques, yoga, and other relaxation therapies generally had modest, mixed, or no consistent evidence demonstrating their efficacy. TM may be considered in clinical practice to lower blood pressure (BP), according to the statement. "Because of many negative studies or mixed results and a paucity of available trials, all other meditation techniques (including MBSR [Mindfulness-Based Stress Reduction]) received a Class III, no benefit, Level of Evidence Crecommendation," the experts concluded.

Biofeedback approaches also generally had modest, mixed, or no consistent evidence demonstrating their efficacy. The statement said that for these techniques, "a paucity of data precludes making recommendations for implementing a specific methodology to treat high BP in clinical practice. On the other hand, no significant health risks were reported among the trials." Of the noninvasive procedures and devices evaluated, device-guided breathing had greater evidence support than acupuncture.

Exercise-based regimens, including aerobics (found by the analysis to be useful or effective, with sufficient evidence support), should be performed by most individuals to reduce BP if clinically appropriate and not contraindicated, the statement said: "We recommend following existing Joint National Committee guidelines to perform aerobic physical activity at least 30 minutes per day most days of the week."

Dynamic resistance training can lower arterial BP by a modest degree, although the evidence base lacks trials of individuals with hypertension, the group found. "However, there is no evidence of harm … Hence, there is no rationale to contraindicate resistance training for most individuals with mild stage I hypertension."

A clear yet relatively small cardiovascular benefit of isometric handgrip resistance training has emerged, including modest improvements in BP, with a regimen of several intermittent bouts of handgrip contractions at 30% maximal strength lasting two minutes each for a total of 12 to 15 minutes per session, at least three times per week over 8 to 12 weeks, the experts noted.

The statement concluded that it would be reasonable to recommend "these alternative approaches as long as they are used under appropriate circumstances and guidance by a health care provider. It is also important to re-emphasize that many of the reviewed alternative therapies (eg, resistance and aerobic exercise, yoga, meditation, acupuncture) may provide a range of health or psychological benefits beyond BP lowering or cardiovascular risk reduction."