Skip to main content
Log in

Device-Guided Breathing for Hypertension: a Summary Evidence Review

  • Device-Based Approaches for Hypertension (M Schlaich, Section Editor)
  • Published:
Current Hypertension Reports Aims and scope Submit manuscript


Persistently raised blood pressure is one of the major risk factors for diseases such as myocardial infarction and stroke. Uncontrolled hypertension is also associated with high rates of mortality, particularly in middle and high-income countries. Lifestyle factors such as poor diet, obesity, physical inactivity and smoking are all thought to contribute to the development of hypertension. As a result, the management of hypertension should begin with modifying these lifestyle factors. Beyond this, drug interventions are used as the predominant form of management. However, adherence to medications can be highly variable, medication side effects are common, and may require regular monitoring or, in some individuals may be ineffective. Therefore, additional non-pharmacologic interventions that lower blood pressure may be advantageous when combined with lifestyle modifications. Such interventions may include relaxation therapies such as slow breathing exercises, which can be initiated by means of specific devices. The technique of device-guided breathing (DGB) has been considered by guideline developers in the management of hypertension. One specific device, the Resperate, has received US FDA and UK NHS approval over the last few years. In this review, we summarise the evidence base on efficacy and find that although some clinical trials exist that demonstrate a BP-lowering effect, others do not. There is currently insufficient evidence from pooled data to recommend the routine use of device-guided breathing in hypertensive patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. WHO: Global Health Observatory (GHO) data. Raised blood pressure: situation and trends. (2015). accessed 20 Jan 2015

  2. NICE, editor. Hypertension: the clinical management of primary hypertension in adults: update of clinical guidelines 18 and 34. London: Royal College of Physicians; 2011.

    Google Scholar 

  3. Forman JP, Stampfer MJ, Curhan GC. Diet and lifestyle risk factors associated with incident hypertension in women. JAMA. 2009;302(4):401–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Poulter NR, Prabhakaran D, Caulfield M. Hypertension. Lancet. 2015;386(9995):801–12. An excellent summary that includes the epidemiology, pathophysiology and management of hypertension.

    Article  PubMed  Google Scholar 

  5. Jung O et al. Resistant hypertension? Assessment of adherence by toxicological urine analysis. J Hypertens. 2013;31(4):766–74.

    Article  CAS  PubMed  Google Scholar 

  6. Wang TJ, Vasan RS. Epidemiology of uncontrolled hypertension in the United States. Circulation. 2005;112(11):1651–62.

    Article  PubMed  Google Scholar 

  7. Will JC et al. Medication adherence and incident preventable hospitalizations for hypertension. Am J Prev Med. 2015.

  8. Conn VS et al. Interventions to improve medication adherence in hypertensive patients: systematic review and meta-analysis. Curr Hypertens Rep. 2015;17(12):94.

    Article  PubMed  Google Scholar 

  9. Bauer UE et al. Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA. Lancet. 2014;384(9937):45–52.

    Article  PubMed  Google Scholar 

  10. Johnson NB et al. CDC National Health Report: leading causes of morbidity and mortality and associated behavioral risk and protective factors—United States, 2005-2013. MMWR Surveill Summ. 2014;63 Suppl 4:3–27.

    Google Scholar 

  11. NICE: hypertension—not diabetic. Clinical Knowledge Summaries October 2014; Available from:!scenariorecommendation:2. accessed 20 Jan 2015

  12. Dickinson HO et al. Relaxation therapies for the management of primary hypertension in adults. Cochrane Database Syst Rev. 2008;1:CD004935.

    PubMed  Google Scholar 

  13. Guyenet PG. The sympathetic control of blood pressure. Nat Rev Neurosci. 2006;7(5):335–46.

    Article  CAS  PubMed  Google Scholar 

  14. Mancia G, Grassi G. The autonomic nervous system and hypertension. Circ Res. 2014;114(11):1804–14.

    Article  CAS  PubMed  Google Scholar 

  15. Sharma M, Frishman WH, Gandhi K. RESPeRATE: nonpharmacological treatment of hypertension. Cardiol Rev. 2011;19(2):47–51.

    Article  PubMed  Google Scholar 

  16. Schein MH et al. Treating hypertension with a device that slows and regularises breathing: a randomised, double-blind controlled study. J Hum Hypertens. 2001;15(4):271–8. One of the early randomised controlled trials that evaluated the efficacy of device-guided breathing in hypertensive patients.

    Article  CAS  PubMed  Google Scholar 

  17. Gallagher D, Terenzi T, de Meersman R. Heart rate variability in smokers, sedentary and aerobically fit individuals. Clin Auton Res. 1992;2(6):383–7.

    Article  CAS  PubMed  Google Scholar 

  18. Joseph CN et al. Slow breathing improves arterial baroreflex sensitivity and decreases blood pressure in essential hypertension. Hypertension. 2005;46(4):714–8.

    Article  CAS  PubMed  Google Scholar 

  19. Bai Z et al. Investigating the effect of transcendental meditation on blood pressure: a systematic review and meta-analysis. J Hum Hypertens. 2015;29(11):653–62.

    Article  CAS  PubMed  Google Scholar 

  20. Posadzki P et al. Yoga for hypertension: a systematic review of randomized clinical trials. Complement Ther Med. 2014;22(3):511–22.

    Article  PubMed  Google Scholar 

  21. Elliott WJ, Izzo Jr JL. Device-guided breathing to lower blood pressure: case report and clinical overview. Med Gen Med. 2006;8(3):23.

    Google Scholar 

  22. FDA: Summary For The Intercure Ltd. RESPeRATE. 2002; Available from: accessed 20 Jan 2015

  23. Intercure Ltd: Available from: accessed 20 Jan. 2015. Information about the device from the manufacturer.

  24. Weber MA et al. Clinical practice guidelines for the management of hypertension in the community a statement by the American Society of Hypertension and the International Society of Hypertension. J Hypertens. 2014;32(1):3–15.

    Article  CAS  PubMed  Google Scholar 

  25. NHS: Makes £200 Non-drug hypertension treatment device available on prescription. 2012; Available from: accessed 20 Jan 2015

  26. Mahtani KR, Nunan D, Heneghan CJ. Device-guided breathing exercises in the control of human blood pressure: systematic review and meta-analysis. J Hypertens. 2012;30(5):852–60. A systematic review and meta-analysis of available clinical trials that evaluates the efficacy of device-guided breathing demonstrating only modest effects, which were removed after sensitivity analysis excluding trials sponsored by, or involving, the manufacturer.

    Article  CAS  PubMed  Google Scholar 

  27. Howorka K et al. Effects of guided breathing on blood pressure and heart rate variability in hypertensive diabetic patients. Auton Neurosci. 2013;179(1-2):131–7.

    Article  PubMed  Google Scholar 

  28. Landman GW et al. Device-guided breathing as treatment for hypertension in type 2 diabetes mellitus: a randomized, double-blind, sham-controlled trial. JAMA Intern Med. 2013;173(14):1346–50. A relatively small trial, not sponsored by or involving the manufacturer of the device, demonstrating no overall benefit for the device as well as evidence of possible side effects.

    Article  PubMed  Google Scholar 

  29. Landman GW et al. Efficacy of device-guided breathing for hypertension in blinded, randomized, active-controlled trials: a meta-analysis of individual patient data. JAMA Intern Med. 2014;174(11):1815–21. An independent meta-analysis of individual patient data demonstrated no overall benefit for the device as well as reiterating the evidence of possible side effects.

    Article  PubMed  Google Scholar 

  30. Altena MR et al. Effect of device-guided breathing exercises on blood pressure in patients with hypertension: a randomized controlled trial. Blood Press. 2009;18(5):273–9.

    Article  PubMed  Google Scholar 

  31. Anderson DE, McNeely JD, Windham BG. Regular slow-breathing exercise effects on blood pressure and breathing patterns at rest. J Hum Hypertens. 2010;24(12):807–13.

    Article  CAS  PubMed  Google Scholar 

  32. Elliot WJ et al. Graded blood pressure reduction in hypertensive outpatients associated with use of a device to assist with slow breathing. J Clin Hypertens (Greenwich). 2004;6(10):553–9. quiz 560-1.

    Article  Google Scholar 

  33. Meles E et al. Nonpharmacologic treatment of hypertension by respiratory exercise in the home setting. Am J Hypertens. 2004;17(4):370–4.

    Article  PubMed  Google Scholar 

  34. Logtenberg SJ et al. Effect of device-guided breathing exercises on blood pressure in hypertensive patients with type 2 diabetes mellitus: a randomized controlled trial. J Hypertens. 2007;25(1):241–6.

    Article  CAS  PubMed  Google Scholar 

  35. Schein MH et al. Treating hypertension in type II diabetic patients with device-guided breathing: a randomized controlled trial. J Hum Hypertens. 2009;23(5):325–31.

    Article  CAS  PubMed  Google Scholar 

  36. Bristish Hypertension Society: Efficacy of the RESPeRATE device for lowering blood pressure: statement from the British hypertension society. 2012. accessed 20 Jan 2015

  37. NICE: Hypertension: Evidence Update. 2013 accessed 20 Jan 2015

  38. Brook RD et al. Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the American Heart Association. Hypertension. 2013;61(6):1360–83. The American Heart Association make a scientific statement on alternative approaches to lowering blood pressure and gives device-guided breathing a Class IIA, Level of Evidence B recommendation.

    Article  CAS  PubMed  Google Scholar 

  39. Elliott WJ, Brook RD. Response to Call for a re-evaluation of the American Heart Association’s standpoint concerning device-guided slow breathing using the RESPeRATE device. Hypertension. 2013;62(4):e18.

    Article  CAS  PubMed  Google Scholar 

  40. Brook RD et al. When and how to recommend ‘alternative approaches’ in the management of high blood pressure. Am J Med. 2015;128(6):567–70.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Kamal R. Mahtani.

Ethics declarations

Conflict of Interest

Drs. Mahtani, Beinortas, Bauza, and Nunan declare no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Device-Based Approaches for Hypertension

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mahtani, K.R., Beinortas, T., Bauza, K. et al. Device-Guided Breathing for Hypertension: a Summary Evidence Review. Curr Hypertens Rep 18, 33 (2016).

Download citation

  • Published:

  • DOI: