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Biofeedback treatment of prehypertension: analyses of efficacy, heart rate variability and EEG approximate entropy

Journal of Human Hypertension volume 21, pages 973–975 (2007)Cite this article

The effect of relaxation-assisted electromyographic (EMG) biofeedback on blood pressure in 49 college students with prehypertension was observed. Following 10 sessions of biofeedback training, the participants could lower their systolic blood pressures 10.6 mm Hg and diastolic blood pressure 4.7 mm Hg with an remarkable increment in the high-frequency (HF) power spectrum of heart rate variability (HRV) and the approximate entropy of electroencephalogram at electrodes Fp1 and Fp2, but with a significant decrement in the low-frequency (LF) power spectrum of HRV and LF/HF ratio. This efficacy may be due to the effect that the relaxation-assisted EMG biofeedback could shift the autonomic interaction towards vagal dominance with the involvement of cognitive processing.

Prehypertension (blood pressure (BP) ranged 120/80–139/89 mm Hg) is a new category designated by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7) in 2003.1 The report showed that prehypertension is associated with an elevated risk of cardiovascular diseases.2 Managing prehypertension may benefit to prevent hypertension and other cardiovascular diseases. Biofeedback, as a non-pharmacological intervention, is effective to treat hypertension.3 A meta-analysis conducted by Nakao et al.4 showed that biofeedback intervention decreased systolic blood pressure (SBP) and diastolic blood pressure (DBP) more than non-intervention controls; but only the relaxation-assisted biofeedback and not the simple biofeedback significantly decreased both SBP and DBP versus sham or non-specific behavioural interventions. Whether biofeedback could decrease BP in prehypertensives is unclear. Therefore, in this study we determined the effect of relaxation-assisted electromyographic (EMG) biofeedback on prehypertension. We also assessed the changes of heart rate variability (HRV) (reflecting the sympatho–vagal interaction5) and electroencephalogram (EEG) approximate entropy (ApEn) (reflecting the complexity of a series of data6) to investigate the functional changes of autonomic nerve and brain activity during biofeedback training and supply some experimental data to elucidate the neural mechanism by which biofeedback regulates BP (Supplementary Tables 1 and 2 and Supplementary Figure 1).

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Acknowledgements

This study was partially supported by grants from the Ministry of Health of China (no. WSBKYJJ2002-1-004), Guangdong Provincial Department of Science & Technology (no. 2002C31209) and the Department of Health of Guangdong Province (no. 4202002).

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  1. Department of Physiology, Laboratory of Biofeedback, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, PR China

    X Y Xu, J Gao, D Ling & T H Wang

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  1. X Y Xu
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Correspondence to T H Wang.

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Supplementary Information accompanies the paper on the Journal of Human Hypertension website (http://www.nature.com/jhh)

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Xu, X., Gao, J., Ling, D. et al. Biofeedback treatment of prehypertension: analyses of efficacy, heart rate variability and EEG approximate entropy. J Hum Hypertens 21, 973–975 (2007). https://doi.org/10.1038/sj.jhh.1002237

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