Could stress be contributing to my high blood pressure?

DEAR DOCTOR K:

Could stress be causing my high blood pressure?

DEAR READER:

You bet it could. It surely contributed to my high blood pressure. Most of us experience a lot of stress. I’m not sure today’s world is more stressful than the world of our parents or grandparents. We may have different stressors than they did, but life has always been full of stress.

High blood pressure (hypertension) is on the rise. Like you, my patients often wonder if one (stress) is causing the other (hypertension). It turns out that stress can raise blood pressure, sometimes impressively.

The fortunate flip side is that reducing stress can lower blood pressure, and also tends to improve overall well-being. Deep, slow breathing is the oldest and best-known technique to decrease stress.

Let’s take a step back to understand how stress affects blood pressure. Stress revs up the autonomic nervous system — particularly the part that makes the hormone called adrenaline. This system directs many processes in our bodies that we don’t control with our consciousness, like our blood pressure and heart rate. For example, we consciously decide to lift a pan to the stove. But when our blood pressure gets a little low, our autonomic nervous system recognizes and corrects that: We aren’t even conscious of it.

For much of human evolution, our autonomic nervous system has protected us. When threatened, it helped us to do battle or to run — the so-called “fight or flight” response. But today this response is rarely needed and can even be harmful. (An imminent deadline at work should not trigger the same stress response as an imminent attack by a lion.)

We can interrupt our stress response by modifying our reactions to its triggers. Simply taking a deep breath is one way to start. I spoke to my Harvard Medical School colleague Dr. Naomi Fisher, an endocrinologist at the Brigham and Women’s Hospital. She advises her patients, particularly those who are prone to stress, to incorporate deep breathing in a daily routine.

One beginner method is called equal breathing. It is based on inhaling through the nose for a count of four and exhaling for a count of four. With time, this cycle can be prolonged to counts of eight in, eight out. Another method, called guided visualization, encourages users to hold on to calming mental images as they breathe deeply.

There is only one non-drug treatment approved for hypertension by the FDA, a device called RESPeRATE. It uses musical tones to guide deep abdominal breathing. Its goal is to reduce the number of breaths to under 10 per minute, and to prolong each exhalation. Clinical trials have shown that daily RESPeRATE use lowered blood pressure, sometimes as much as a blood pressure pill would have. This lowering effect also lasted long after each session.

Deep breathing may or may not eliminate the need for blood pressure medications, but it can be helpful. And if you can do it, think about how you might be able to reduce the major stressors in your life.