The impact of music guided deep breathing exercise on blood pressure control - A participant blinded randomised controlled study.

INTRODUCTION: As pharmacological treatment of hypertension has become a burden worldwide, the study looked into nonpharmacological ways of reducing blood pressure. The objective was to determine if music guided, slow and deep breathing will reduce the blood pressure among patients with hypertension in eight weeks. METHODS: A participant blinded, multi-centre, randomised controlled trial was conducted in which the participants in the intervention group (IG) practiced deep breathing exercise guided by sound cues and those in the control group (CG) listened to the music. The primary end point was reduction in blood pressure at eight weeks. RESULTS: 87 patients, 46 males and 41 females with mean age of 61.1 years were recruited and 93.1% of them successfully completed the study. There was significant reduction in systolic and diastolic Blood Pressure from baseline by 8 weeks in both groups. The reduction in Mean systolic blood pressure (SBP) in the control arm was 10.5mmHg compared to 8.3mmHg (p<0.001) in intervention group. Diastolic blood pressure (DBP) reduction in control and intervention groups were 5.2 mmHg (p<0.001) and 5.6 mmHg (p<0.001) respectively. The absolute difference in SBP reduction from baseline in IG & CG was -2.2 (95%CI: -7.8 to 3.5) and DBP was -0.4 (95%CI: -2.9 to 3.6). However, blood pressure reduction between the two groups was not significant. CONCLUSIONS: Both listening to music and deep breathing exercise were associated with a clinically significant reduction in SBP and DBP. However, deep breathing exercise did not augment the benefit of music in reducing BP.

Beta-blockers for heart failure: an evidence based review answering practical therapeutic questions.

Beta-blockers are underutilised in heart failure because clinicians may be unsure whether all beta-blockers are useful, how therapy should be initiated and whether beta-blockers are contraindicated in some patients. Bisoprolol, carvedilol and metoprolol succinate have been clearly proven to reduce mortality and hospitalisation in patients with Class II to IV heart failure; limited evidence also support short-acting metoprolol tartrate and nebivolol. Initiating dose should be very low (1.25 mg bisoprolol, 3.125 mg carvedilol, 12.5 mg metoprolol succinate) and increased gradually over weeks. Treatment benefit appears proportional to magnitude of heart rate reduction and thus target dose should be the maximum tolerated for adequate bradycardia. Even in decompensated heart failure or those with coexisting bronchospasm, beta-blockers are not contraindicated although the dose may have to be reduced or withheld temporarily. The consistent trial data should reassure clinicians and encourage them to confidently initiate beta blockers in patients with systolic heart failure.