Non-pharmacological Treatment for Essential Isolated Systolic Hypertension in Elderly
Condition: Systolic Essential Hypertension
MeSH terms: Hypertension; Essential Hypertension; Systolic Murmurs
Study type: Interventional

Summary: 
      The previous studies used the slow loaded breathing device for breathing training (Jones et
      al., 2010). It has been shown that slow loaded breathing training can reduce resting blood
      pressure and heart rate in essential hypertensive patients. However, this has not been
      studied in elderly with essential isolated systolic hypertensive patients. Not only highest
      prevalence of hypertension in Thailand was found in elderly but also physiological changes in
      the elderly are cause of interest in this special population. It has many advantages to use a
      slow loaded breathing training in elderly people. Firstly, it is low technology and easily
      implemented at home. Secondly, it can be practiced almost anytime and anywhere. Thirdly, the
      orthopedic complications of slow loaded breathing training are minimal. Finally, slow loaded
      breathing training may be enhancing cardiopulmonary function and other fitness traits, but it
      out of scope of this study. Moreover, slow loaded breathing exercise by itself should not
      result in any metabolic adaptation of skeletal muscles, such as the forearm, which had not
      been trained. If slow loaded breathing training modified some central component of the
      pressor reflex pathway in a way that single muscle training might work, as suggested above,
      then loaded breathing training would have a modulating effect on the pressor responses of
      muscles that had not been trained.

      We, therefore, aim to study the effect of slow loaded breathing training by using Breathmax
      on blood pressure at rest and exercise in elderly with essential isolated systolic
      hypertension and also investigate the autonomic function and others that may be involved with
      the changed blood pressure in elderly with essential isolated systolic hypertension. We
      hypothesized that slow loaded and unloaded breathing training could reduce resting and
      exercising blood pressure in elderly with essential isolated systolic hypertension.
    

Detailed description: 
      All subjects will be trained for blood pressure and heart rate measurement at home by using a
      digital arm blood pressure monitoring for 2 weeks control periods before start breathing
      training. After 2 weeks, subjects in both breathing training groups will trained to inspire
      deeply against the resistance setting by using Breathmax at the loaded of 18 centimeter of
      water (cmH2O) and 0 cmH2O (no resistance) with breathing frequency control at 6
      breaths/minute in loaded breathing (LB) and unloaded breathing (ULB) group, respectively.
      They will rest for 5 seconds after every 6 deep breathing. Breathing pattern will be
      controlled at duty cycle of 0.4 (inspiratory time = 4 sec and total respiratory time = 10
      sec). The paced breathing will be practice using metronome at the laboratory until the
      subjects can do independently without metronome. The breathing was performed normally in
      control groups (C). The training program will be performed at home for 30 minutes/day, 7
      days/week for 8 weeks.

      After 8 weeks of breathing training, the sustainability of breathing training effect will be
      assessed. Subjects in both breathing training groups (LB and ULB) will be stop breathing
      training with Breathmax and change to breathing normally. In contrast with the subjects in
      control group, they will be divided to 2 subgroups. The first subgroup performed loaded
      breathing training at the loaded of 18 cmH2O. The another subgroup performed unloaded
      breathing training at the loaded of 0 cmH2O. Breathing frequency will be control at 6
      breaths/minute in both subgroups. The training program will be performed at home for 30
      minutes/day, 7 days/week for 8 weeks.

      Data collection will be carried out for 4 times: (1) before control, (2) before training, (3)
      after training and (4) after stop training. All measurement will be done in the
      cardiovascular laboratory room, department of physical therapy, faculty of associated medical
      sciences. In addition, self measurement of blood pressure and heart rate will be conducted at
      home every morning after getting up at the same time throughout the study (from week 0 to
      18).
    

Intervention name(s): Loaded breathing training; Unloaded breathing training; Placebo
Intervention type(s): Other; Other; Other
Intervention description(s): 7 days/weeks, for 8 weeks; 7 days/week, for 8 weeks; 7 days/week, for 8 weeks
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment