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Effects of heart rate variability biofeedback on cardiovascular responses and autonomic sympathovagal modulation following stressor tasks in prehypertensives

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Abstract

Autonomic dysfunction is implicated in prehypertension, and previous studies have suggested that therapies that improve modulation of sympathovagal balance, such as biofeedback and slow abdominal breathing, are effective in patients with prehypertension at rest. However, considering that psychophysiological stressors may be associated with greater cardiovascular risk in prehypertensives, it is important to investigate whether heart rate variability biofeedback (HRV-BF) results in equivalent effects on autonomic cardiovascular responses control during stressful conditions in prehypertensives. A total of 32 college students with prehypertension were enrolled and randomly assigned to HRV-BF (n=12), slow abdominal breathing (SAB, n=10) or no treatment (control, n=10) groups. Then, a training experiment consisting of 15 sessions was employed to compare the effect of each intervention on the following cardiovascular response indicators before and after intervention: heart rate (HR); heart rate variability (HRV) components; blood volume pulse amplitude (BVPamp); galvanic skin response; respiration rate (RSP); and blood pressure. In addition, the cold pressor test and the mental arithmetic challenge test were also performed over two successive days before and after the invention as well as after 3 months of follow-up. A significant decrease in HR and RSP and a significant increase in BVPamp were observed after the HRV-BF intervention (P<0.001). For the HRV analysis, HRV-BF significantly reduced the ratio of low-frequency power to high-frequency power (the LF/HF ratio, P<0.001) and increased the normalized high-frequency power (HFnm) (P<0.001) during the stress tests, and an added benefit over SAB by improving HRV was also observed. In the 3-month follow-up study, similar effects on RSP, BVPamp, LF/HF and HFnm were observed in the HRV-BF group compared with the SAB group. HRV-BF training contributes to the beneficial effect of reducing the stress-related cardiovascular response in prehypertensives by improving autonomic sympathovagal modulation.

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References

  1. Vasan RS, Larson MG, Leip EP, Evans JC, O’Donnell CJ, Kannel WB et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med 2001; 345: 1291–1297.

    Article  CAS  PubMed  Google Scholar 

  2. Elliott WJ, Black HR . Prehypertension. Nat Clin Pract Cardiovasc Med 2007; 4: 538–548.

    Article  PubMed  Google Scholar 

  3. Pimenta E, Oparil S . Prehypertension: epidemiology, consequences and treatment. Nat Rev Nephrol 2010; 6: 21–30.

    Article  PubMed  Google Scholar 

  4. Gu D, Chen J, Wu X, Duan X, Jones DW, Huang JF et al. Prehypertension and risk of cardiovascular disease in Chinese adults. J Hypertens 2009; 27: 721–729.

    Article  CAS  PubMed  Google Scholar 

  5. Rozanski A, Blumenthal JA, Kaplan J . Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 1999; 99: 2192–2217.

    Article  CAS  PubMed  Google Scholar 

  6. Larkin KT . Stress and hypertension. In: Examining the Relation between Psychological Stress and High Blood Pressure. Yale University Press: New Haven, CT, USA, 2005.

    Chapter  Google Scholar 

  7. Player MS, King DE, Mainous AR, Geesey ME . Psychosocial factors and progression from prehypertension to hypertension or coronary heart disease. Ann Fam Med 2007; 5: 403–411.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Schwartz AR, Gerin W, Davidson KW, Pickering TG, Brosschot JF, Thayer JF et al. Toward a causal model of cardiovascularresponses to stress and the development of cardiovasculardisease. Psychosom Med 2003; 65: 22–35.

    Article  PubMed  Google Scholar 

  9. Ghiadoni L, Donald DE, Cropley M, Mullen JM, Oakley G, Taylor M et al. Mentalstress induces transient endothelial dysfunction in humans. Circulation 2000; 102: 2473–2478.

    Article  CAS  PubMed  Google Scholar 

  10. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 2003; 289: 2560–2572.

    Article  CAS  PubMed  Google Scholar 

  11. Steptoe A, Kivimäki M . Stress and cardiovascular disease: an update on current knowledge. Annu Rev Public Health 2013; 34: 337–354.

    Article  PubMed  Google Scholar 

  12. Tofler GH, Muller JE . Triggering of acute cardiovascular disease and potential preventive strategies. Circulation 2006; 114: 1863–1872.

    Article  PubMed  Google Scholar 

  13. Lucini D, Riva S, Pizzinelli P, Pagani M . Stress management at the worksite: reversal of symptoms profile and cardiovascular dysregulation. Hypertension 2007; 49: 291–297.

    Article  CAS  PubMed  Google Scholar 

  14. Lucini D, Di Fede G, Parati G, Pagani M . Impact of chronic psychosocial stress on autonomic cardiovascular regulation in otherwise healthy subjects. Hypertension 2005; 46 (5): 1201–1206.

    Article  CAS  PubMed  Google Scholar 

  15. Lucini D, Mela GS, Malliani A, Pagani M . Impairment in cardiac autonomic regulation preceding arterial hypertension in humans: insights from spectral analysis of beat-by-beat cardiovascular variability. Circulation 2002; 106: 2673–2679.

    Article  PubMed  Google Scholar 

  16. Rosengren A, Hawken S, Ounpuu S, Sliwa K, Zubaid M et al. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 case and 13648 controls from 52 countries (The INTERHEART study): case-control study. Lancet 2004; 364: 953–962.

    Article  PubMed  Google Scholar 

  17. Julius S . Sympathetic hyperactivity and coronary risk in hypertension. Hypertension 1993; 21: 886–893.

    Article  CAS  PubMed  Google Scholar 

  18. Brotman D, Golden SH, Wittstein IS . The cardiovascular toll of stress. Lancet 2007; 370: 1089–1100.

    Article  PubMed  Google Scholar 

  19. Vrijkotte TG, van Doornen LJ, de Geus EJ . Effects of work stress on ambulatory blood pressure, heart rate, and heart rate variability. Hypertension 2000; 35: 880–886.

    Article  CAS  PubMed  Google Scholar 

  20. Genovesi S, Pieruzzi F, Giussani M, Tono V, Stella A, Porta A et al. Analysis of heart period and arterial pressure variability in childhood hypertension: key role of baroreflex impairment. Hypertension 2008; 51: 1289–1294.

    Article  CAS  PubMed  Google Scholar 

  21. Flaa A, Mundal HH, Eide I, Kjeldsen S, Rostrup M . Sympathetic activity and cardiovascular risk factors in young men in the low, normal, and high blood pressure ranges. Hypertension 2006; 47: 396–402.

    Article  CAS  PubMed  Google Scholar 

  22. Xu XY, Gao J, Ling D, Wang TH . Biofeedback treatment of prehypertension: analyses of efficacy, heart rate variability and EEG approximate entropy. J Hum Hypertens 2007; 21: 973–975.

    Article  CAS  PubMed  Google Scholar 

  23. Wang SZ, Li S, Xu XY, Lin GP, Shao L, Zhao Y et al. Effect of slow abdominal breathing combined with biofeedback on blood pressure and heart rate variability in prehypertension. J Altern Complement Med 2010; 16: 1039–1045.

    Article  PubMed  Google Scholar 

  24. Lin G, Xiang Q, Fu X, Wang S, Wang S, Chen S et al. Heart rate variability biofeedback decreases blood pressure in prehypertensive subjects by improving autonomic function and baroreflex. J Altern Complement Med 2012; 18 (2): 143–152.

    Article  PubMed  Google Scholar 

  25. Wheat AL, Larkin KT . Biofeedback of heart rate variability and related physiology: a critical review. Appl Psychophysiol Biofeedback 2010; 35: 229–242.

    Article  PubMed  Google Scholar 

  26. Montano N, Porta A, Cogliati C, Costantino G, Tobaldini E, Casali KR et al. Heart rate variability explored in the frequency domain: a tool to investigate the link between heart and behavior. Neurosci Biobehav Rev 2009; 33: 71–80.

    Article  PubMed  Google Scholar 

  27. Brosschot JF, Pieper S, Thayer JF . Expanding stress theory: prolonged activation and perseverative cognition. Psychoneuroendocrinology 2005; 30: 1043–1049.

    Article  PubMed  Google Scholar 

  28. Lehrer PM, Vaschillo E, Vaschillo B . Resonant frequency biofeedback training to increase cardiac variability: rationale and manual for training. Appl Psychophysiol Biofeedback 2000; 25: 177–191.

    Article  CAS  PubMed  Google Scholar 

  29. Pagani M, Lombardi F, Guzzetti S, Rimoldi O, Furlan R, Pizzinelli P et al. Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympatho-vagal interaction in man and conscious dog. Circ Res 1986; 59 (2): 178–193.

    Article  CAS  PubMed  Google Scholar 

  30. Yamamoto Y, Hughson RL . Coarse-graining spectral analysis: new method for studying heart rate variability. J Appl Physiol 1991; 71: 1143–1150.

    Article  CAS  PubMed  Google Scholar 

  31. Mancia G, Bjorn Folkow A . Lecture: the sympathetic nervous system in hypertension. J Hypertens 1997; 15: 1553–1565.

    Article  CAS  PubMed  Google Scholar 

  32. Mancia G, Grassi G, Giannattasio C, Seravalle G . Sympathetic activation in the pathogenesis of hypertension and progression of organ damage. Hypertension 1999; 34: 724–728.

    Article  CAS  PubMed  Google Scholar 

  33. Lucini D, Solaro N, Pagani M . May autonomic indices from cardiovascular variability help identify hypertension? J Hypertens 2014; 32 (2): 363–373.

    Article  CAS  PubMed  Google Scholar 

  34. Peper E, Harvey R, Lin IM, Hana T, Donald M . Is there more to blood volume pulse than heart rate variability, respiratory sinus arrhythmia, and cardiorespiratory synchrony? Biofeedback 2007; 35 (2): 54–61.

    Google Scholar 

  35. Eliasson K, Hjemdahl P, Kahan T . Circulatory and sympatho-adrenal responses to stress in borderline and established hypertension. J Hypertens 1983; 1: 131–139.

    Article  CAS  PubMed  Google Scholar 

  36. Manuck SB . Cardiovascular reactivity in cardiovascular disease: “once more unto the breach”. Int J Behav Med 1994; 1: 4–31.

    Article  CAS  PubMed  Google Scholar 

  37. Schwartz JE, Warren K, Pickering TG . Mood, location, and physical position as predictors of ambulatory blood pressure and heart rate: application of a multi-level random effects model. Ann Behav Med 1994; 16: 210–220.

    Google Scholar 

  38. Carels RA, Blumenthal JA, Sherwood A . Emotional responsivity during daily life: relationship to psychosocial functioning and ambulatory blood pressure. Int J Psychophysiol 2000; 36: 25–33.

    Article  CAS  PubMed  Google Scholar 

  39. Ebrahim S . Ann bowling. In: Handbook of Health Research Methods: Investigation, Measurement and Analysis. Open University Press: New York, NY, USA, 2005.

    Google Scholar 

  40. Billman GE . The LF/HF ratio does not accurately measure cardiac sympatho-vagal balance. Front Physiol 2013; 4: 26.

    PubMed  PubMed Central  Google Scholar 

  41. Sun P, Zhou K, Wang S, Li P, Chen SJ, Lin GP et al. Involvement of MAPK/NF-κB signaling in the activation of the cholinergic anti-inflammatory pathway in experimental colitis by chronic vagus nerve stimulation. PLoS One 2013; 8 (8): e69424.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Pagani M, Montano N, Porta A, Malliani A, Abboud FM, Birkett C et al. Relationship between spectral components of cardiovascular variabilities and direct measures of muscle sympathetic nerve activity in humans. Circulation 1997; 95 (6): 1441–1448.

    Article  CAS  PubMed  Google Scholar 

  43. Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med 2004; 116 (10): 682–692.

    Article  PubMed  Google Scholar 

  44. Thompson PD, Buchner D, Pina IL, Balady GJ, Williams MA, Marcus BH et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology. Circulation 2003; 107 (24): 3109–3116.

    Article  PubMed  Google Scholar 

  45. Nolan RP, Floras JS, Harvey PJ, Kamath MV, Picton PE, Chessex C et al. Behavioral neurocardiac training in hypertension: a randomized, controlled trial. Hypertension 2010; 55: 1033–1039.

    Article  CAS  PubMed  Google Scholar 

  46. Nolan RP, Kamath MV, Floras JS, Stanley J, Pang C, Picton P et al. Heart rate variability biofeedback as a behavioral neurocardiac intervention to enhance vagal heart rate control. Am Heart J 2005; 149: 1137.

    Article  PubMed  Google Scholar 

  47. Porges SW . Cardiac vagal tone: a physiological index of stress. Neurosci Biobehav Rev 1995; 19 (2): 225–233.

    Article  CAS  PubMed  Google Scholar 

  48. Porges SW . The poly vagal perspective. Biol Psychol 2007; 74: 116–143.

    Article  PubMed  Google Scholar 

  49. Elliott WJ, Izzo JL . Device-guided breathing to lower blood pressure: case report and clinical overview. MedGenMed 2006; 8 (3): 23.

    PubMed  PubMed Central  Google Scholar 

  50. Meles E, Giannattasio C, Failla M, Gentile G, Capra A, Mancia G . Nonpharmacologic treatment of hypertension by respiratory exercise in the home setting. Am J Hypertens 2004; 17: 370–374.

    Article  PubMed  Google Scholar 

  51. Elliot WJ, Izzo JL Jr, White WB, Rosing DR, Snyder CS, Alter A et al. Graded blood pressure reduction in hypertensive outpatients associated with use of a device to assist with slow breathing. J Clin Hypertens (Greenwich) 2004; 6 (10): 553–559.

    Article  Google Scholar 

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Acknowledgements

This study was supported by the Fund of Science and Technology projects in Guangdong Province (No. 2010B031600075). We gratefully acknowledge the efforts of all volunteers who participated in this study.

Author Contributions

SJC, PS and THW conceived and designed the experiments. SJC, PS, SW and GPL performed the experiment. SJC, PS and THW analyzed the data. THW contributed reagents/materials/analysis tools. SJC, PS and THW wrote the paper.

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Correspondence to T Wang.

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Supplementary Information accompanies this paper on the Journal of Human Hypertension website

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Chen, S., Sun, P., Wang, S. et al. Effects of heart rate variability biofeedback on cardiovascular responses and autonomic sympathovagal modulation following stressor tasks in prehypertensives. J Hum Hypertens 30, 105–111 (2016). https://doi.org/10.1038/jhh.2015.27

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