Hello, welcome back to the "Hypertension Medicine Course." I am Jessica.
After discussing dietary and exercise prescriptions, in this lecture,
we will talk about the third lifestyle intervention for lowering blood
pressure—relaxation.
I know that when you hear the term "relaxation" (or "entering
tranquility"), which has a religious connotation, most people
immediately think of two questions: First, does it really work to lower
blood pressure? Second, there are so many methods—meditation,
mindfulness, muscle relaxation, biofeedback, yoga, sitting quietly,
zoning out, etc.—which ones are actually effective?
This lecture will answer these two questions in detail.
Can Relaxation Lower Blood Pressure?
Relaxation sounds mysterious, as if I am about to guide you through
spiritual practice or Zen meditation. To be honest, even six or seven
years ago, this was a fringe topic in hypertension treatment, and no
doctor would pay attention to it. But in recent years, with the
development of relaxation techniques and more high-quality research, it
has been found that relaxation does have scientific evidence for
lowering blood pressure.
First, relaxation can reduce excessive sympathetic nervous system
activity.
This is easy to understand. As mentioned before, sympathetic nervous
system excitement increases heart rate and strength, raising blood
pressure. Conversely, reducing sympathetic activity naturally lowers
blood pressure.
Second, relaxation can reduce various types of vascular damage.
After most meditation practices, increased electrical activity is
detected in the left frontal lobe of the brain. This means positive
emotions and feelings of happiness increase. Modern science has
confirmed that such positive emotional experiences can reduce vascular
stiffness and damage, thereby stabilizing blood pressure.
Third, relaxation stably alters the autonomic nervous system.
The autonomic nervous system is a lower-level brain center that does
not control our thoughts or emotions but governs vital signs such as
breathing, heart rate, blood pressure, and body temperature. Numerous
experiments show that relaxation can improve the stability of the
autonomic nervous system, enabling it to correct itself in a timely
manner. For example, when blood pressure rises, it can quickly detect
and adjust it.
These three mechanisms have been confirmed by modern medicine and
widely recognized, so relaxation techniques have been included in the
2020 global hypertension treatment guidelines.
Specifically, current experimental conclusions are: relaxation can
lower systolic blood pressure by 0-11 mmHg and diastolic by 0-7 mmHg.
If you are observant, you will notice I said "0-11 mmHg" and "0-7
mmHg"—the range is quite large. Indeed, the effectiveness varies
greatly. On one hand, relaxation techniques are diverse, and only a few
have consistent medical evidence; most do not show clear effects. On
the other hand, the effects are inherently hard to evaluate, so the
data is less precise than for diet, exercise, or medication.
Therefore, although hypertension guidelines recognize relaxation as a
lifestyle intervention, it is recommended as an alternative therapy—try
it if other lifestyle changes are ineffective or if you are
particularly interested in relaxation.
Meditation
Now that we know relaxation can lower blood pressure, the next question
is: which techniques are truly effective?
Let's start with the most popular—meditation. Based on their core,
meditation techniques fall into three categories:
The first focuses on present-moment awareness—training the mind to
focus on the present, whether it's an object, a sound, your breath, or
bodily sensations, while avoiding judgment. The typical example is
mindfulness meditation, as well as Samatha and Vipassana meditation.
The second builds on present-moment awareness by cultivating
loving-kindness and compassion for oneself and others. The
representative is loving-kindness meditation.
The third also focuses on present-moment awareness but involves a
personalized "mantra" given by an experienced teacher, such as "I like
myself now" or "I am breathing in the forest," which is repeated
silently. The typical examples are Transcendental Meditation and Vedic
meditation.
So, how effective are these three types?
At first glance, mindfulness meditation seems more reliable, while
mantra-based Transcendental Meditation sounds mystical. But when all
the medical evidence is considered, Transcendental Meditation is the
only type with substantial evidence and a significant blood
pressure-lowering effect. Other types, including mindfulness
meditation, lack consistent evidence and are not recommended by medical
experts.
Why is this? Medical researchers have analyzed:
First, Transcendental Meditation is a pure relaxation technique that
does not require complex reasoning about consciousness or the present
moment—just repeat the mantra.
Second, among all meditation types, Transcendental Meditation is the
easiest for people to enter a tranquil state. The mantra makes it
simple to focus attention, much like chanting in Pure Land Buddhism.
Evidence shows that Transcendental Meditation can lower systolic blood
pressure by an average of 5 mmHg and diastolic by 2.8 mmHg. After 8
years of follow-up, mortality dropped by 23%, and cardiovascular
mortality by 30%.
However, I believe that although Transcendental Meditation may be
truly effective, it is difficult to practice and hard to tell if you
have entered the meditative state, so the effect cannot be guaranteed.
Therefore, I do not recommend it.
Biofeedback Combined with Progressive Muscle Relaxation
If meditation is not as magical as imagined, let's look at the most
popular hospital-based relaxation technique—biofeedback combined with
progressive muscle relaxation.
Biofeedback uses the body's reward memory mechanism. Progressive muscle
relaxation is simple: guided instructions help you relax all your
muscles.
When combined, the patient's blood pressure is measured, then they are
guided with soothing music and instructions such as "relax your jaw,
don't clench your teeth," "relax your shoulders, let your arms hang
naturally," etc., and blood pressure is measured again. If blood
pressure drops, the patient is encouraged to reinforce this practice.
With repeated practice, blood pressure can be lowered.
Experiments show that for hypertensive patients, biofeedback combined
with progressive muscle relaxation lowers blood pressure by about 0.8-2
mmHg. Interestingly, in people with low fingertip temperature, low
daily blood pressure variability, and good psychological assessment,
the effect can be much greater—systolic pressure can drop by more than
5 mmHg.
For most people, the effect is modest, but for a small subset, it can
be significant. If you like it, you can try it, as there are no side
effects.
Slow Breathing
Is there a more reliable relaxation method?
Yes. This method is surprisingly simple—slow breathing.
Slow, deep breathing—less than 6 breaths in 30 seconds—is extremely
effective for blood pressure regulation, lowering systolic pressure by
4 mmHg in the short term. If you persist for more than 15 minutes
daily, or practice with music guidance, after 8 weeks, blood pressure
can drop further, with an average reduction of 6-7 mmHg.
Moreover, the effect is stable, unaffected by coach, environment,
gender, age, or antihypertensive medication use.
Therefore, slow breathing is the simplest and most evidence-based
relaxation technique, with a much higher recommendation level than
meditation or biofeedback.
Other Methods
Besides the above three, there are many other relaxation techniques—
For example, Tai Chi. The evidence is less robust, but most studies
show some blood pressure-lowering effect, possibly because Tai Chi
combines exercise and relaxation.
Yoga, whether physical or spiritual, shows highly variable results—some
studies show benefit, others do not, so it cannot be recommended.
Other methods, such as sitting quietly, Zen meditation, Qigong, or
spiritual practices, lack sufficient evidence for lowering blood
pressure and are not recommended.
In summary, the most effective relaxation technique for lowering blood
pressure is not the more advanced-sounding mindfulness meditation,
spiritual yoga, or Zen, but the simplest, most straightforward slow
breathing.
Similarly, I believe that universal truths are always the simplest.
Just as Buddhist scriptures begin with daily life—clothing in the
Diamond Sutra, eating in the Shurangama Sutra, illness in the
Vimalakirti Sutra—so too is the greatest wisdom found in ordinary life.
Preview of Next Lecture
Having covered all aspects of lifestyle therapy, we now move on to the
most powerful weapon against hypertension—medication.
Key Points
1. Among all meditation techniques, Transcendental Meditation is the
only one with sufficient evidence and a significant blood
pressure-lowering effect; others lack clear evidence.
2. Biofeedback combined with progressive muscle relaxation has little
effect for most hypertensive patients.
3. Of all relaxation techniques, the most effective is slow breathing.
Slow, deep breathing—less than 6 breaths in 30 seconds, practiced for
15 minutes daily—can stably lower blood pressure.
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