Powerful Breathing Exercises to Lower Your Blood Pressure

Breathing exercises can temporarily lower your blood pressure and heart rate by activating the vagus nerve. The vagus nerve is part of the parasympathetic nervous system, sending signals to and from the brain, heart, and gut. The parasympathetic nervous system is responsible for rest and relaxation and counteracts the sympathetic nervous system's "fight or flight" response.

Several breathing techniques can temporarily lower blood pressure, and some, like inspiratory muscle strength training, may even have longer-lasting effects to help lower blood pressure in people with hypertension. However, breathing techniques should not replace the treatment plan and medication your healthcare provider prescribes.

1. 4-7-8 Breathing

The 4-7-8 breathing technique involves breathing in through the nose for four seconds, holding your breath for seven seconds, and exhaling through the mouth for eight seconds while making an audible "whooshing" sound. This method may be beneficial for calming feelings of anxiety and helping people to fall asleep.

Not many high-quality, published studies look specifically at this technique's effect on lowering blood pressure. However, one small study found that the systolic blood pressure was slightly lower (3 to 4 mm/Hg) after participants performed the 4-7-8 technique.

2. Diaphragmatic Breathing

Diaphragmatic breathing, sometimes referred to as belly breathing, is a technique that involves slow, deep breaths. This practice activates the diaphragm, which is a muscle that sits between the lungs and the abdomen.

Start by placing one hand on the belly and one hand on your stomach. Take a deep breath and focus on keeping your chest still while expanding your stomach. Aim for counts around six seconds for inhalation and six seconds for exhalation.

Studies suggest that diaphragmatic breathing may help those with lung diseases like chronic obstructive lung disease and asthma. Fewer studies have looked at its effect on blood pressure, but one study found lower blood pressure after diaphragmatic breathing sessions, particularly when combined with mindfulness exercises.

Another study evaluated the use of a breathing and mindfulness phone app in adults with elevated blood pressure and found that participants had lower blood pressure after one year of using the app.

3. Alternate Nostril Breathing

This technique involves breathing into one nostril while the other is held closed, and then alternating nostrils. There are various patterns for performing alternate nostril breathing. One technique is to hold the right nostril closed while exhaling and inhaling through the left nostril. Then switch to hold the left nostril closed while exhaling and inhaling through the right nostril.

Research has shown mixed results on the effect of nostril breathing on blood pressure, though some studies demonstrated a decrease in blood pressure in adults with hypertension.

4. Box Breathing

Box breathing, also known as tactical breathing, is a technique that involves breathing in, holding the breath, exhaling, and holding it again for the same amount of time, such as four seconds. It is taught to military members due to its effect on enhancing performance during stress. However, there is a lack of high-quality research on its blood pressure-lowering effects specifically.

5. Equal Breathing (Sama Vritti)

Equal breathing, known as sama vritti, is a practice that involves breathing in for counts (such as four seconds), then exhaling for the same number of counts. This is similar to the box breathing technique, though it does not have the pause after each inhale and exhale.

Breath work techniques with slow breathing can lower stress and temporarily lower blood pressure. Still, evidence does not support that one breath ratio (duration of inhale versus exhale) is better than another. One small study of 10 people on dialysis for chronic kidney disease found lower blood pressure in those performing sama vritti between dialysis sessions.

6. Pursed-Lip Breathing

Pursed-lip breathing is a technique in which a prolonged exhalation is performed through pursed lips. To perform pursed-lip breathing, inhale slowly through the nose for two counts and exhale slowly for four counts, blowing air through the lips in a puckered position.

The American Lung Association describes pursed-lip breathing as a technique that can help people with lung disease who are experiencing shortness of breath. One randomized control trial looked at the effectiveness of pursed-lip breathing in patients undergoing emergency room treatment for hypertensive urgency. The group of patients who performed the technique for 15 minutes each hour had significantly lower blood pressure after three hours.

7. Inspiratory Muscle Strength Training (IMST)

IMST is a special form of breath training that uses a device to provide resistance to inhaled air. IMST is performed by breathing through a small, handheld device. This makes you have to work harder to breathe air into your lungs. Breathing in this manner helps to strengthen the muscles between the ribs and the diaphragm.

A small study of adults with elevated blood pressure showed that people who practiced IMST using a device providing high resistance had lower systolic blood pressure compared to a group of people using a "sham" or fake device that did not provide resistance. Systolic blood pressure dropped by 9 mm/Hg after six weeks of performing IMST for 30 breaths for six days a week.

Should You Try Breathing Techniques?

If you have high blood pressure, breathing techniques may help temporarily lower your blood pressure. However, there is currently little compelling evidence to suggest that breathing exercises can help maintain an overall lower blood pressure or treat hypertension.

People should not perform certain breathing techniques during situations in which it would be dangerous to fall asleep, such as while driving. Additionally, people with chronic lung disease should speak with their healthcare provider before doing breathing exercises because techniques that involve prolonged breath holding may not be recommended. Stop the exercise if you feel lightheaded, dizzy, or otherwise unwell while performing breathing techniques.

Treating high blood pressure requires a multipronged approach. Lifestyle interventions such as a heart-healthy diet (such as the DASH diet or Mediterranean diet) and regular physical exercise are recommended to help manage hypertension. Medications are recommended if lifestyle changes alone do not sufficiently lower blood pressure. Talk with your healthcare provider about an individualized treatment plan. Breathing exercises should never replace the medications your healthcare provider prescribes.

Summary

Breathing exercises can temporarily lower blood pressure and heart rate through activation of the parasympathetic nervous system. Some studies suggest that certain techniques can help with hypertension. For example, pursed-lip breathing can help lower blood pressure in people experiencing hypertensive urgency, while inspiratory muscle strength training (IMST) may help lower blood pressure in the longer term with regular practice.