HealthDay News — The American Heart Association supports using non-dietary, non-drug, alternative approaches as adjuvant modalities in hypertension treatment, according to a scientific statement.

Robert D. Brook, MD, from the University of Michigan in Ann Arbor, and colleagues performed a literature review and issued recommendations for implementing several alternative BP-lowering techniques in clinical practice based on the available level of evidence. The findings were published online in Hypertension.

Exercised-based aerobic BP-lowering methods were awarded a Class 1 Level A recommendation, indicating this method is useful and effective, and meets the highest standard for evidence-based therapy based on supporting data from multiple randomized clinical trials or meta-analyses.

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Aerobic exercise includes activities such as speed walking, jogging, running, dancing, cycling, swimming, and using elliptical machines.

“[T]he overall available evidence and the results from the most recent meta-analyses support that moderate-intensity dynamic aerobic regimens are capable of significantly lowering BP among most individuals within a few months,” the researchers wrote.

To achieve BP-lowering benefits, advise patients to follow existing Joint National Committee exercise guidelines, which recommend moderate- or high-intensity exercise for at least 30 minutes on most days to achieve a total of at least 150 minutes of exercise per week.

Other exercise-based modalities including dynamic resistance (Class IIA, Level B), such as weight lifting and circuit training, and isometric handgrip exercises (Class IIB, Level C), such as squeezing stress balls or athletic grippers and holding heavy weights, were also endorsed as “likely effective treatments.” Existing evidence indicates that the benefits of these methods outweigh risks, but efficacy for BP-lowering is less well-established.

“Should additional studies in larger and broader populations corroborate [the] effectiveness thus far demonstrated, it is conceivable that [these] technique[s] may merit even stronger recommendations in the future,” the researchers wrote.

There was generally modest, mixed or no consistent evidence demonstrating the efficacy of behavioral therapies, including transcendental meditation, other meditation techniques, yoga, other relaxation therapies, and biofeedback approaches.The AHA, therefore, does not recommend using these techniques in clinical practice to reduce BP at this time.

“The mechanism whereby meditation techniques lower BP when it occurs remains unclear. It has been suggested that the mechanisms may lead to reductions in stress and physiological arousal, thereby producing favorable effects on the autonomic nervous system balance,” the researchers wrote. “Further studies are needed to clarify the importance of this and other possible biological pathways.”

Among the non-invasive procedures and devices assessed, there was greater evidence to support device-guided breathing (Class IIA, Level B) than acupuncture (Class III, Level B).

At this time, there is just one FDA-approved slow-breathing device, Resperate, which consists of a belt that is placed around the patient’s thorax to monitor his or her breathing rate. The device then feeds real-time data into a small battery-operated controller box, which generates musical tones into headphones to correspond with inspiration and expiration.

Overall evidence from 13 clinical trials and meta-analyses suggest that device-guided slow breathing can significantly lower BP. However, the AHA cautions that device-guided breathing has not been directly compared with other forms of self-taught regulated breathing, which may be able to produce similar results without the pricey device — Resperate currently costs upwards of $200 U.S. dollars.

Acupuncture is not recommended in clinical practice to reduce BP at this time. The researchers cited limited quality studies, the rare potential for minor adverse events such as pain and bleeding at the needle site, and the associated risk that patients who pursue acupuncture may defer active medical treatment as rationale for this classification.

The full algorithm for alternative hypertension treatments, as well as complete definitions of the classification system used to rank treatments is available in the AHA’s policy statement.


  1. Brook RD et al. AHA Scientific Statement.”Beyond Medications and Diet: Alternative Approaches to Lowering Blood Pressure.” Hypertension. 2013; doi: 10.1161/HYP.0b013e318293645f.