Sometime ago, I had written a post exploring the role of alternative herbal medications in the treatment of chronic kidney disease. That post had evoked strong reactions, both for and against, from the readers! Which set me thinking...is there a role of alternative therapies in the treatment of high blood pressure? If yes, is it based on hearsay, or solid medical evidence?
Luckily, to make my job easier, the American Heart Association came out with an official statement addressing this issue early this year. This was published in the journal Hypertension. I will try to summarize this statement's conclusion's addressing the efficacy of approaches like acupuncture, yoga, meditation, etc in treating high blood pressure. Please note that these conclusions apply only to treatment of high blood pressure, and not to other health/psychological benefits that may be derived from doing these activities.
Most types of exercise: aerobic, weight training, and isometric hand-grip exercises helped patients lower blood pressure, with people doing isometric hand-grip exercises showing the most blood pressure reduction (about 10 percent). This was greater than the benefit obtained from a mild aerobic exercise like walking. However, the researchers speculated that this could be related to the lack of intensity or shorter duration of walking done by the subjects. Some older studies have indicated that intense walking over 35 minutes done regularly confers the same cardiovascular benefits.
2) Behavioral therapies
The above is an umbrella term that includes biofeedback and different kinds of meditation and relaxation techniques. The statement concluded that transcendental meditation and biofeedback behavioral therapies do help somewhat with lowering blood pressure.
Transcendental meditation, or TM, was developed in India in the 1950s by Maharishi Mahesh Yogi. It has had it fair share of celebrities, from the Beatles to Madonna, swear by it. The technique involves using mantra (sounds or chants) to focus meditate, while one sits for about 15 minutes with the eyes closed. It gained some notoriety/free publicity in 1977 when a US Court ruled against a TM program being taught in New Jersey schools as being "overtly religious in nature". The program ended up getting scrapped, but the case also helped TM get even more attention in the US. This was followed paradoxically by a comeback of sorts by TM. Later, in a sort of quasi-recognition by the establishment, the Maharishi University in Fairfield, Iowa, received $20 million in NIH (National Institute of Health) funding to study the effects of TM on human health!
Biofeedback, often referred to as "Yoga of the West", is a technique that involves being aware of your internal physiology (using our own senses, or artificial sensors like an ECG machine), and then controlling or adjusting one's behavior to get a favorable outcome. It is used, among other things, for the treatment of urinary incontinence, chronic pain, and stress reduction.
3) Breathing devices
Certain commercial devices available in the market today help people gather data about there breathing rate and depth, relay the information back to them, and play soothing music via headphones to help them relax. One such device quoted by the researchers was Resperate. I tend to think of such devices as basically a type of "assisted-biofeedback" therapy. Such devices could have a role to play in treating hypertension.
|Image courtesy of Marin/ FreeDigitalPhotos.net|
WHAT DOESN'T WORK
Surprisingly, practicing yoga and other meditation/relaxation techniques (other than TM) did not translate in to better blood pressure control (however, it is also acknowledged that it is hard to measure the "dose" or intensity of yoga, for any health study).
The ancient Chinese technique did not lower blood pressure demonstrably for subjects.
There are three important facts about these conclusions that I cannot overstate:
- All the above techniques produced small modest reductions in blood pressure; sometimes as little as 2 mm (compared to 10-15 mm for most medications).
- The conclusions apply only to effects of these approaches on blood pressure, and nothing else. If you are doing yoga because it helps you relax, you should still go ahead and do it!
- As much as I want, these alternative therapies do not replace traditional approaches for blood pressure control (low salt diet, medications). The best way to look at them is as strategies to complement what your doctor has already been prescribing you for your high blood pressure. This could really help if you have mild hypertension, where the alternative therapies could potentially help you get off your blood pressure medications, but I highly doubt anyone with severe hypertension is getting off their Norvasc just because they started doing TM.
My take home message: if you happen to love any of the above alternative approaches, or are doing it as part of your healthy lifestyle, you can continue to do so. You might see a modest reduction in your blood pressure (more with some modalities than the others), but you know what, it is probably not going to hurt either!
Veeraish Chauhan, MD, FACP, FASN
Sarasota/ Bradenton, FL