Device and nondevice‐guided slow breathing to reduce blood pressure in hypertensive patients: A systematic review and meta‐analysis

Backgroud and Aims Hypertension (HTN) is a multifactorial chronic disease. Considering the high prevalence rates of this disease, treatment of HTN is necessary, not only to reduce blood pressure (BP) levels but also to prevent the development of cardiovascular, cerebrovascular, and kidney diseases. This treatment can be through medication, which will be determined according to the BP values, obtained either in medical consultations or at home; presence of cardiovascular risk factors, and the presence of target organ damage identified during anamnesis. The aim of this systematic review and meta‐analysis is to summarize the effects of device‐guided slow breathing (DGSB) and nondevice‐guided slow breathing (NDGSB) on BP levels of patients with HTN. Methods This study is a systematic review and meta‐analysis of randomized clinical trials, pertaining to hypertensive patients, with or without comorbidity, over 18 years old, of both sexes, and with or without hypertensive medication. The selected studies showed comparisons between groups that performed DGSB and/or NDGSB with control conditions. The primary outcome was the value of systolic blood pressure (SBP) and diastolic blood pressure (DBP) after the interventions. Results Twenty‐two studies involving 17,214 participants were included in the quantitative analysis. Considerable heterogeneity was revealed between studies. Using random effect model, it was found that DGSB did not significantly reduce SBP and DBP compared to usual care, both in terms BP values and in relation to their variations (SBP, mean difference [MD]: −2.13 mmHg, (95% confidence interval [CI]: −12.71 to 8.44), 288 individuals; I2 = 93%, high heterogenity: DBP, MD: −0.90, 95% CI: −3.97 to 2.11, 288 individuals; I2 = 63%, substantial heterogenity. SBP variations MD: −2.42, 95% CI: −7.24 to 2.40, 443 individuals; I2 = 85% high heterogenity/DBP variations MD: −1.67, 95% CI: −4.57 to 1.24, 443 individuals; I2 = 80%, high heterogenity). Conclusion Based on these results it appears that DGSB did not reduce BP in hypertensive patients and NDGSB is a new path for the future.