Beyond medications and diet: Alternative approaches to lowering blood pressure: A scientific statement from the american heart association

Robert D. Brook, Lawrence J. Appel, Melvyn Rubenfire, Gbenga Ogedegbe, John D. Bisognano, William J. Elliott, Flavio D. Fuchs, Joel W. Hughes, Daniel T. Lackland, Beth A. Staffileno, Raymond R. Townsend, Sanjay Rajagopalan

Research output: Contribution to journalArticle

Abstract

Many antihypertensive medications and lifestyle changes are proven to reduce blood pressure. Over the past few decades, numerous additional modalities have been evaluated in regard to their potential blood pressure-lowering abilities. However, these nondietary, nondrug treatments, collectively called alternative approaches, have generally undergone fewer and less rigorous trials. This American Heart Association scientific statement aims to summarize the blood pressure-lowering efficacy of several alternative approaches and to provide a class of recommendation for their implementation in clinical practice based on the available level of evidence from the published literature. Among behavioral therapies, Transcendental Meditation (Class IIB, Level of Evidence B), other meditation techniques (Class III, Level of Evidence C), yoga (Class III, Level of Evidence C), other relaxation therapies (Class III, Level of Evidence B), and biofeedback approaches (Class IIB, Level of Evidence B) generally had modest, mixed, or no consistent evidence demonstrating their efficacy. Between the noninvasive procedures and devices evaluated, device-guided breathing (Class IIA, Level of Evidence B) had greater support than acupuncture (Class III, Level of Evidence B). Exercise-based regimens, including aerobic (Class I, Level of Evidence A), dynamic resistance (Class IIA, Level of Evidence B), and isometric handgrip (Class IIB, Level of Evidence C) modalities, had relatively stronger supporting evidence. It is the consensus of the writing group that it is reasonable for all individuals with blood pressure levels >120/80 mm Hg to consider trials of alternative approaches as adjuvant methods to help lower blood pressure when clinically appropriate. A suggested management algorithm is provided, along with recommendations for prioritizing the use of the individual approaches in clinical practice based on their level of evidence for blood pressure lowering, risk-to-benefit ratio, potential ancillary health benefits, and practicality in a real-world setting. Finally, recommendations for future research priorities are outlined.

Original languageEnglish (US)
Pages (from-to)1360-1383
Number of pages24
JournalHypertension
Volume61
Issue number6
DOIs
StatePublished - 2013

Fingerprint

American Heart Association
Diet
Blood Pressure
Meditation
Yoga
Relaxation Therapy
Equipment and Supplies
Aptitude
Insurance Benefits
Acupuncture
Antihypertensive Agents
Life Style
Consensus
Respiration
Therapeutics
Research

Keywords

  • AHA Scientific Statement
  • blood pressure
  • cardiovascular diseases
  • complementary therapies
  • hypertension
  • prehypertension
  • preventive medicine

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Beyond medications and diet : Alternative approaches to lowering blood pressure: A scientific statement from the american heart association. / Brook, Robert D.; Appel, Lawrence J.; Rubenfire, Melvyn; Ogedegbe, Gbenga; Bisognano, John D.; Elliott, William J.; Fuchs, Flavio D.; Hughes, Joel W.; Lackland, Daniel T.; Staffileno, Beth A.; Townsend, Raymond R.; Rajagopalan, Sanjay.

In: Hypertension, Vol. 61, No. 6, 2013, p. 1360-1383.

Research output: Contribution to journalArticle

Brook, RD, Appel, LJ, Rubenfire, M, Ogedegbe, G, Bisognano, JD, Elliott, WJ, Fuchs, FD, Hughes, JW, Lackland, DT, Staffileno, BA, Townsend, RR & Rajagopalan, S 2013, 'Beyond medications and diet: Alternative approaches to lowering blood pressure: A scientific statement from the american heart association', Hypertension, vol. 61, no. 6, pp. 1360-1383. https://doi.org/10.1161/HYP.0b013e318293645f
Brook, Robert D. ; Appel, Lawrence J. ; Rubenfire, Melvyn ; Ogedegbe, Gbenga ; Bisognano, John D. ; Elliott, William J. ; Fuchs, Flavio D. ; Hughes, Joel W. ; Lackland, Daniel T. ; Staffileno, Beth A. ; Townsend, Raymond R. ; Rajagopalan, Sanjay. / Beyond medications and diet : Alternative approaches to lowering blood pressure: A scientific statement from the american heart association. In: Hypertension. 2013 ; Vol. 61, No. 6. pp. 1360-1383.
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