Deep Breathing Exercises for Lowering Blood Pressure: Evidence and Techniques

01Why

Why breathing affects blood pressure

The autonomic nervous system controls heart rate and the tone of blood vessels. Stress activates the sympathetic system, raising heart rate and blood pressure, while slow breathing increases the activity of the vagus nerve and the parasympathetic system. Slow breathing also improves the sensitivity of baroreceptors, sensors in the arteries that help keep blood pressure stable.

For this reason slow breathing lowers blood pressure during and shortly after practice, and regular practice may contribute to modest lasting changes. See how to calm your nervous system.

02Evidence

What the evidence shows

• A scientific statement from the American Heart Association concluded that device-guided slow breathing can be considered as an addition to standard treatment, with average reductions of a few mmHg.
• Studies of slow breathing, meditation and yoga breathing show short-term reductions in blood pressure, with variable long-term results.
• A randomised trial of inspiratory muscle strength training in adults over 50 with above-normal blood pressure found a reduction in systolic blood pressure of about 9 mmHg after 6 weeks.
• Benefits are modest and depend on regular practice.

Breathing exercises are a supplement to, not a substitute for, proven measures such as diet, exercise and medicines when needed.

03Technique

Slow breathing step by step

• Sit comfortably with your back supported and feet on the floor, or lie down.
• Place one hand on your chest and one on your belly.
• Breathe in gently through your nose for 4 to 5 seconds, letting the belly rise.
• Breathe out slowly through your nose or pursed lips for 5 to 6 seconds.
• Aim for about 6 breaths per minute, without forcing or holding your breath.
• Practise for 10 to 15 minutes once or twice a day.

Apps or a simple timer can help with pacing. If you feel dizzy, return to normal breathing.

04Variations

Other breathing techniques

• Diaphragmatic (belly) breathing: focusing on the belly rising and falling.
• Extended exhale: breathing out for longer than you breathe in, for example 4 in and 6 to 8 out.
• Box breathing: 4 seconds in, hold 4, out 4, hold 4; holds should be gentle and are not suitable for everyone.
• Alternate nostril breathing: a yoga technique that also slows breathing.

05IMST

Inspiratory muscle strength training

Inspiratory muscle strength training uses a small handheld device that makes it harder to breathe in. Typical protocols involve 30 strong breaths against resistance, about 5 minutes a day, most days of the week. In research, this has reduced systolic blood pressure in people with above-normal readings and improved the function of blood vessels.

It is safe for most people but should be discussed with a doctor first, especially for those with heart or lung disease or a history of a collapsed lung or ear problems.

06Diet

Combining breathing with diet

Diet has a larger and better-proven effect on blood pressure than breathing alone. A DASH-style diet, rich in fruit, vegetables, wholegrains, pulses, nuts and low-fat dairy and low in salt, can lower systolic blood pressure by several mmHg. Reducing salt, limiting alcohol, eating more potassium-rich foods and losing weight if needed all add to the benefit.

See DASH diet for high blood pressure and foods to avoid with high blood pressure.

07Lifestyle

Other lifestyle measures

• At least 150 minutes of moderate aerobic activity per week, plus some strength training.
• Good-quality sleep and screening for sleep apnoea if you snore.
• Not smoking.
• Managing stress with relaxation, social support or therapy.
• Measuring blood pressure at home to track progress.

08Measuring

Measuring your blood pressure correctly

• Sit quietly for 5 minutes before measuring, with your back supported and arm resting at heart level.
• Avoid caffeine, exercise and smoking for 30 minutes before.
• Take 2 readings a minute apart, morning and evening, for a week.
• Use a validated upper-arm monitor and the right cuff size.

Measuring before and after breathing practice shows the short-term effect, but long-term averages matter most.

10Summary

Key points to remember

• Slow breathing at about 6 breaths per minute can lower blood pressure modestly.
• Inspiratory muscle training has shown promising results in research.
• Diet, exercise, weight and limiting alcohol and salt have bigger effects.
• Never stop medicines without medical advice.