Self Management of Hypertension in Diabetics through Device Guided Breathing The purpose of this study is to determine the optimal breathing rate for a Device Guided Breathing (DGB) intervention used as a self management tool to reduce blood pressure (BP) in diabetic patients with uncontrolled hypertension and generate preliminary data on the therapeutic efficacy of DGB intervention in the same patient population. The DGB device uses biofeedback to guide breathing to a 6-10/minute rate for 15 minutes/day which has been shown to substantially lower BP in several small studies. Despite the high prevalence of hypertension in diabetics, previous studies have uniformly excluded this group;the therapeutic efficacy is thus unknown in that patient population. Previous studies suggest that the low frequency respiration used by guided breathing interventions maximizes the natural respiratory sinus arrhythmia (RSA) amplitude (the heart rate difference between inhalation and exhalation). Regularly reaching maximal RSA amplitude may reduce BP by increasing the sensitivity of the vagally-mediated cardiac baroreflex, responsible for acute control of BP. Although a standard breathing rate of 6 breaths/minute is uniformly used in paced breathing techniques, recent studies suggest that the actual rate that maximizes RSA amplitude may instead be a highly individual rate known as the Resonance Frequency (RF) and therefore necessitate individual evaluation for maximum therapeutic efficacy. This study will determine the optimal breathing rate among diabetic hypertensives and test the efficacy of this nursing relevant, inexpensive, non-invasive, and potentially beneficial self management tool to control blood pressure in this growing patient population. The proposed study has two components: (1) a laboratory-based correlational study evaluating RF, RSA amplitude, and baroreflex sensitivity in 60 subjects at time 1 (baseline) and time 2 (after 8 weeks of the DGB intervention) and (2) a feasibility pilot study evaluating the effect on BP and baroreflex sensitivity in the same 60 subjects after 8 weeks of two intervention conditions: Intervention 1, DGB at the standard 6breaths/min (N = 30) and Intervention 2, DGB at the individual RF (N = 30). Data gathered at time point 1 will be used to determine the degree of variation of RF among these diabetic subjects with uncontrolled HTN, uncover the narrowness of range for RF within subjects, and determine if there is a significant difference in RSA amplitude between the standard 6 breaths/min and the individual RF. Data gathered at time point 2 (after 8 weeks of the DGB intervention) will be used to determine if RF and baroreflex sensitivity changes over time with the DGB intervention and if the intervention was successful at lowering BP. Results will be used as preliminary data for a subsequent R01 submission.
Showing the most recent 10 out of 60 publications
