Abstract
An attempt was made to reduce blood pressure by increasing the baroreflex sensitivity (BRS) via biofeedback. Six patients with mild essential hypertension and 5 normotensive participants were studied during 8 biofeedback sessions. Each session consisted of 5 trials, 5 min each. The first and the last trials served as baselines of heart rate, blood pressure, respiration, and BRS. During the3 middle trials the BRS was calculated online using the sequencing technique. The resulting value was used as a visual analogue feedback signal. Participants were asked to increase BRS. The mean BRS was 8.3 [ms/mmHg] for the hypertensive patients and 12.2 [ms/mmHg] for the normotensive participants. During biofeedback trials as well as across sessions neither the hypertensive nor the normotensive group showed a statistically significant increase of BRS, only heart rate variability increased significantly. Contrary to expectation blood pressure increased in both groups. One hypertensive subject made significant progress during the training by performing valsalva maneuvers.
The data show that BRS is reduced in hypertensive subjects. The increase of the heart rate variability could be a sign of the activation of the baroreflex although the BRS itself did not increase. Despite the successful technical and organizational im plementation of this biofeedback approach, it was not effective to systematically reduce blood pressure. A further development in the direction of guiding the patient to use the valsalva breathing pattern and/or a prolonged duration of the biofeedback training might be promising.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Backensfeld, M. (1996).Optimierung und Evaluation eines Barorezeptor-Sensitivitäts-Feedback [Optimisation and evaluation of a baroreceptor-sensitivity biofeedback]. Unpublished thesis, Rheinische Friedrich-Wilhelms-Universität, Bonn, Germany.
Benson, W., Shapiro, D., Tursky, B., & Schwartz, G. E. (1971). Decreased systolic blood pressure through operant conditioning techniques in patient with essential hypertension.Science, 73, 740.
Bertinieri, G., Di Rienzo, M., Cavallazi, A., Ferrari, A. U., Pedotti, A., & Mancia, G. (1985). A new approach to the arterial baroreflex.Journal of Hypertension, 3(Suppl. 3), 79–81.
Birbaumer, N., Rockstroh, B., Elbert, T., Wolf, P., Düchting-Röth, A., Reker, M., et al. (1994). Biofeedback of slow cortical potentialsin epilepsy. In J. Carlson, R. Seifert & N. Birbaumer (Eds.), Clinicalapplied psychophysiology (pp. 29–42). New York: Plenum.
Brest, A. N., Wiener, L., & Bachrach, B. (1972). Bilateral carotid sinus stimulation in the treatment of hypertension.American Journal of Cardiology, 29(6), 821–825.
Bristow, J. D., Honour, A. J., Pickering, G. W., Sleight, P., & Smyth, H. (1969). Diminished baroreflex sensitivity in high blood pressure.Circulation, 39, 48–54.
Chalmers, J., MacMahon, S., Mancia, G., Whitworth, J., Berlin, L., Hansson, L., Neal, B., Rodgers, A., Ni Mhurchu, C., & Clark,T. (1999). 1999 World Health Organization-International Society of Hypertension Guidelines for the management ofhypertension. Guidelines sub-committeeof the World Health Organization.Clinical and Experimental Hypertension, 27, 1009–1060.
Conway, J., Boon, N., Vann Jones, J., & Sleight, P. (1983). Involvement of the baroreceptor reflexes in the changes in blood pressure with sleep and mental arousal.Hypertension, 5(5), 746–748.
Daly M. B. de (1995) Aspects of the integration of the respiratory and cardiovascular system. In: D. Jordan & J. Marshall (Eds.),Cardiovascular regulation (pp. 15–35). London: Portland Press.
Floras, J. S., Hassan, M. O., Jones, J. V., Osikowska, B. A., Sever, P. S., & Sleight, P. (1988). Consequences of impaired arterial baroreflexes in essential hypertension: Effects on pressor responses, plasma noradrenaline and blood pressure ariability.Journal of Hypertension, 6, 525–535. Glasgow, M. S., Gaardner,K. R., & Engel, B. T. (1982). Behavioral treatment of high blood pressure II. Acute and sustained effects of relaxation and systolic blood pressure biofeeedback.Psychosomatic Medicine, 44(2), 155-170.
Gribbin, B., Pickering, T. G., Sleight, P., & Peto, R. (1979). Effect of age and high blood pressure on baroreflex sensitivity in man.Circulation Research, 29, 424–431.
Guyton, A. C. (1980).Arterial pressure and hypertension. Philadelphia: W. B. Saunders.
Iellamo, F., Legramante, J. M., Raimondi, G., Castrucci, F., Massaro, M., & Peruzzi, G. (1996). Evaluation of reproducibility of spontaneous baroreflex sensitivity at rest and during laboratory tests.Journal of Hypertension, 14, 1099–1104.
Kristt, D. A., & Engel, B. T. (1975). Learned control of blood pressure in patients with high blood pressure.Circulation, 51, 370.
Linden, W., & Chambers, L. (1994). Clinical effectiveness of non-drug treatment for hypertension: A meta analysis.Annals of Behavioral Medicine, 16, 35–45.
Mancia, G., Ludbrook, J., Ferrari, A., Gregorini, L.,& Zanchetti, A. (1978). Baroreceptor reflexes in human hypertension.Circulation Research, 43(29), 170–177.
Mancia, G., Parati, G., Pomidossi, G., Casadei, R., Di Rienzo, M., & Zanchetti, A. (1986). Arterial baroreflexes and blood pressure andheart rate variabilitiesinhumans.Hypertension, 8(2), 145–153.
Mulder, L. M. J. (1985). Model based measures of cardiovascular variability in the time and in the frequency domain. In J. F. Orlebeke, G. Mulder, & L. J. P. Doornen (Eds.),Psychophysiology of cardiovascular control (pp. 333–352). New York: Plenum.
Nakao, M., Nomura, S., Shimosawa, T., Yoshiuchi, K., Kumano, H., Kuboi, T., etal. (1997). Clinical effects of blood pressure biofeedback treatment on hypertension by auto-shaping.Psychosomatic Medicine, 59(3), 331–338.
Olson, R. P., & Kroon, J. S. (1987). Biobehavioral treatment of essential hypertension. In M. S. Schwartz (Ed.),Biofeedback: A practitioner’s guide (pp. 316–339). New York: Guilford.
Parati, G., Omboni, S., Frattola, A., Di Rienzo, M., Zanchetti, A., & Mancia,G. (1993). Dynamic evaluation of the baroreflex in ambulant subjects. In Di M. Rienzo, G. Mancia, G. Parati, A. Pedotti, & A. Zanchetti (Eds.),Blood pressure and heart rate variability (pp. 123–137). Amsterdam: IOS Press.
Peters, T. K., Koralewsky, H. E., & Zerbst, E. (1989). Search for optimal frequencies and amplitudes of therapeutic electrical carotid sinus nerve stimulation by application of the evolution strategy.Artificial Organs, 13(2), 133–143.
Rau, H., Furedy, J. J., & Elbert, T. (1996). PRES- and orthostatic-induced heart-rate changes as marker of labile hypertension: Magnitude and reliability measures.Biological Psychology, 42, 105–115.
Reyes del Paso, G. A. (1999). A biofeedback system of barorezeptor cardiac reflex sensitivity.Applied Psychophysiology and Biofeedback, 24(1), 67–77.
Richter-Heinrich, E., Lori, M., Knust, U., & Schmidt, K. H. (1982). Comparison of Blood pressure biofeedback and relaxation training in essential hypertension. In E. Richter-Heinrich & N. E. Miller (Eds.),Biofeedback-basic problems and clinical applications (pp. 107–120). Berlin, Germany: VEB Deutscher Verlag der Wissenschaften.
Robbe, H. W. J., Mulder, L. J. M., Rüddel, H., Langewitz, W. A., Veldman, J. B. P., & Mulder, G. (1987). Assessment of baroreflex sensitivity by mean of spectral analysis.Hypertension, 10, 538–543.
Schwartz, S. I., Griffith L. S., Neistadt, A., & Hagfors, N. (1967). Chronic carotid sinus nerve stimulation in the treatment of essential hypertension.American Journal of Surgery, 114(1), 5–15.
Sleight, P. (1991). Role of the baroreceptor reflexes in circulatory control, with particular reference to hypertension.Hypertension, 18(5), 31–34
Steptoe, A., Kearsley, N., & Walters, N. (1993). Cardiovascular activity during mental stress following vigorous exercise in sportsmen and inactive men.Psychophysiology, 30, 245–252.
Steptoe, A., & Sawada, Y. (1989). Assessment of baroreceptor reflex function during mental stress and relaxation.Psychophysiology, 26, 140–147.
Steptoe, A., & Vögele, C. (1990). Cardiac baroreflex function during postural change assessed using non-invasive spontaneous sequence analysisinyoung men.Cardiovascular Research, 24, 627–637.
Vaitl, D. (1993). Biofeedback. In D. Vaitl & F. Petermann (Hrsg.),Handbuch der Entspannungsverfahren. Band I. Grundlagen und Methoden [Handbook of relaxation techniques. Volume I. Basis and methods.] (pp. 272–315). Weinheim, Germany: Psychologie Verlags Union.
Vaitl, D., & Gruppe, H. (1987). Kardio-Respiratorische Kohärenz: Ein Versuch, sie sanft zu verändern. Zeitschrift für experimentelle und angewandte [Cardio-respiratory coherence. An attempt to alter it softly].Psychologie, 34, 628–648.
Walter, B., Rüddel, H.,& v. Eiff, A.W. (1988). Efficiencyofbehavioral interventionin hypertension. In T. Elbert, W. Langosch, A. Steptoe, & D. Vaitl (Eds.),Behavioral medicine in cardiovascular disorders (pp. 101–111). New York: John Wiley & Sons.
Wesseling, K. H. (1991). Finapres, continuous noninvasive finger arterial pressure based on the method of Peñáz. In H.Rüddel & I.Curio (Eds.),Non-invasivecontinuous blood pressure measurement(pp. 9–17). Frankfurt am Main: Verlag Peter Lang.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Overhaus, S., Rüddel, H., Curio, I. et al. Biofeedback of baroreflex sensitivity in patients with mild essential hypertension. Int. J. Behav. Med. 10, 66–78 (2003). https://doi.org/10.1207/S15327558IJBM1001_06
Issue Date:
DOI: https://doi.org/10.1207/S15327558IJBM1001_06