A group of experts has reviewed all the existing studies and concluded that there are indeed alternative treatments for lowering blood pressure – with aerobic exercise leading the pack as far as strong evidence goes.

Other alternative treatments – namely isometric handgrip and dynamic resistance exercises and guided breathing –– also got high grades when it came to reducing high blood pressure in some patients, according to a scientific statement from the American Heart Association published online in the journal Hypertension.

“The evidence is not as strong for transcendental meditation and acupuncture, but they may help as well,” said co–senior author Sanjay Rajagopalan, MD, professor of cardiovascular medicine at Ohio State University School of Medicine in Columbus.

For the report, an expert panel headed by the University of Michigan’s Robert D. Brook, MD, reviewed 1,000 studies published from 2006 to 2011. They divided the studies into three major classes of alternative treatments: behavioral therapies, noninvasive procedures and devices, and exercise. The panel did not review dietary and herbal treatments. Based on the level of evidence, they gave each an “A,” “B,” or “C” recommendation –– with “A” being the highest –– for implementation into clinical practice.

The panel found:

  • Exercise–based regimens did the best overall, with dynamic aerobic exercises getting an “A” class of recommendation, with a level of evidence of I, the highest possible.
  • Dynamic resistance exercises got a “B” and isometric handgrip exercises got a “C” grade, with levels of evidence of IIA and IIB, respectively.
  • Still, 4 weeks of isometric hand grip exercises resulted in some of the most impressive improvements in several studies –– a 10% drop in systolic and diastolic blood pressure. However, isometric exercise should be avoided among people with severely uncontrolled hypertension (180/110 mm Hg or higher).
  • As for noninvasive procedures or devices, device–guided breathing got a “B” with a level of evidence of II. Device–guided slow breathing proved most effective in lowering blood pressure when performed for 15–minute sessions three to four times a week. Acupuncture also got a “B,” but its level of evidence was III, meaning no benefit.
  • Among behavioral techniques, transcendental meditation and biofeedback both received “B” grades, with IIBs for levels of evidence. Yoga got a C, with level of evidence of III, or no benefit, as did other meditation techniques.
  • The alternative approaches that work reduce systolic blood pressure by only 2 to 10 mm Hg; whereas standard doses of a blood pressure–lowering drug reduce systolic blood pressure by about 10 to 15 mm Hg.
  • Alternative approaches are best for patients with blood pressure levels over 120/80 mm Hg who can’t tolerate or don’t respond well to standard medications.
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