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 European Journal of Preventive Cardiology
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The effect of essential oil on heart rate and blood pressure among solus por aqua workers
Kai-Jen Chuang, Hua-Wei Chen, I-Jung Liu, Hsiao-Chi Chuang and Lian-Yu Lin
European Journal of Preventive Cardiology 2014 21: 823 originally published online 29 November 2012
DOI: 10.1177/2047487312469474

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 EURO PEAN
SO CIETY O F
Original scientific paper CARDIOLOGY ®

European Journal of Preventive

Cardiology

The effect of essential oil on heart rate 2014, Vol. 21(7) 823–828
! The European Society of
Cardiology 2012
and blood pressure among solus por aqua Reprints and permissions:
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workers DOI: 10.1177/2047487312469474
ejpc.sagepub.com

Kai-Jen Chuang1,2, Hua-Wei Chen3, I-Jung Liu4,

Hsiao-Chi Chuang5,6 and Lian-Yu Lin7

Abstract
Background: Aromatherapy is widely used around the world for stress relief. Whether exposure to essential oil
increases the risk of cardiovascular events is still unknown. The purpose of this study was to investigate the effect of
essential oil on heart rate and blood pressure among solus por aqua (spa) workers.
Methods: We recruited 100 healthy workers from various spa centres in Taipei, Taiwan. Between July and August of
2010, three repeated measurements – resting heart rate (HR), systolic blood pressure (SBP), and diastolic blood pres-
sure (DBP) – were taken of each spa worker in our study room. Participants were exposed to essential oil vapour
generated from an ultrasonic atomizer in the study room for two consecutive hours. The total volatile organic com-
pound (VOC) level in the study room was measured during the study period. We used a linear mixed-effect model to
determine the association between the total VOC level and the participants’ HR, SBP, and DBP.
Results: For the times from 15 to 60 min after start of exposure, we found that the VOC level was significantly
associated with reduced 15-min mean BP and HR. After exposure for more than 1 hour, from 75 to 120 min after
start of exposure, we found that the VOC levels were associated with increased 15-min mean BP and HR.
Conclusions: Exposure to essential oil for 1 hour was found to be an effective method of relaxation, as indicated by
decreases in the HR and BP. Prolonged exposure for longer than 1 hour to essential oils may be harmful to cardiovascular
health among spa workers.

Keywords
Blood pressure, epidemiology, essential oils, heart rate, total volatile organic compounds
Received 18 May 2012; accepted 5 November 2012

Introduction 1
Department of Public Health, School of Medicine, College of Medicine,
Aromatherapy is widely used around the world for Taipei Medical University, Taipei, Taiwan
2
stress relief. The relationship between exposure to School of Public Health, College of Public Health and Nutrition, Taipei
Medical University, Taipei, Taiwan
essential oil and stress reduction has been found in sev- 3
Department of Cosmetic Application and Management, St. Mary’s
eral studies.1–4 Exposure to essential oil vapours gener- Medicine, Nursing and Management College, Yi-Lan County, Taiwan
ated from fragrant candles has been found to reduce 4
Department of Nursing, Cardinal Tien College of Healthcare and
test-taking anxiety among nursing school students in Management, New Taipei City, Taiwan
the USA1 and to decrease the level of psychoemotional
5
School of Respiratory Therapy, College of Medicine, Taipei Medical
University, Taipei, Taiwan
stress among students in Russia.2 A crossover study of 6
Division of Pulmonary Medicine, Department of Internal Medicine,
female high school students in Korea demonstrated Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
that there is an association between essential oil inhal- 7
Department of Internal Medicine, Division of Cardiology, National
ation and lower blood pressure (BP), pulse rates, and Taiwan University Hospital, Taipei, Taiwan
stress levels.3 Moreover, a clinical trial study in Korea
reported that aromatherapy massage could relieve Corresponding author:
Kai-Jen Chuang, Department of Public Health, School of Medicine,
menopausal symptoms in climacteric women.4 College of Medicine, Taipei Medical University, No. 250 Wu-Hsing
Essential oils are volatile organic compounds (VOCs) Street, Taipei 110, Taiwan.
composed of hundreds of aromatic chemicals.5 Several Email: kjc@tmu.edu.tw

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824
studies have reported an association between VOCs and
asthma,6 chronic bronchitis,7,8 adverse reproductive
effects,9 and adverse cardiovascular effects.10 A recent
epidemiological study found that the exposure to ambi-
ent VOCs is associated with an increased risk of cardio-
vascular death in heavily polluted cities.11 However,
whether exposure to essential oil increases the risk of
cardiovascular events in part through elevating BP and
heart rate (HR) is still unknown. Therefore, we designed
this panel study to investigate the association between
the exposure to essential oil and BP and HR among
solus por aqua (spa) workers.
Methods
Participants and study design
This study was designed to investigate an association
between exposure to essential oil and BP and HR
among spa workers. The exclusion criteria for partici-
pants were as follows: smoking or taking medication
that had the potential to affect cardiac rhythm, or
having any known cardiovascular disease or history of
cardiovascular disease, including coronary artery dis-
ease, arrhythmias, hypertension, diabetes mellitus, or
dyslipidaemia. Using invitations sent by mail, we
recruited healthy, young, non-smoking individuals
working in various spa centres in Taipei. After explaining
our research protocol to the potential study participants,
100 people were willing to participate in our study.
From June 2010 to September 2010, each of the 100
participants visited the study room three times, for a
total of 300 visits. The mean time between visits was
approximately 7 days. A baseline screening question-
naire was administered during the first visit, and age,
sex, body mass index (BMI), and medications were rec-
orded. All participants were exposed to essential oil
vapour generated from an ultrasonic ionizer (model
YHL668/I; Nature Creart, Taipei, Taiwan) in the
study room for 2 hours during each visit. We measured
the resting BP and HR in each participant during the 2
hours and concurrently monitored the total VOC level.
Prior to each participant entering the study room, 100%
pure bergamot essential oil was vaporized for 1 hour.
The dimensions of the study room were 4 m in height
by 3.5 m in length by 3.2 m in width. The distance
between the ultrasonic atomizer and indoor air pollution
monitor was 10 m. The study protocol was reviewed and
approved by the Human Subject Committee at St.
Mary’s Medicine Nursing and Management College.
BP and HR monitoring and recording
We measured each participant’s systolic BP (SBP), dia-
stolic BP (DBP), and HR at 15-min intervals during
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European Journal of Preventive Cardiology 21(7)
each of their visits using a portable BP monitoring
system (DynaPulse model 5000A; Pulse Metric, San
Diego, CA, USA). While in the study room, the par-
ticipants each held the DynaPulse system to monitor
their resting BP and HR for 2 hours. Each participant
yielded approximately 24 successful BP and HR meas-
urements over their three visits (eight measurements per
visit).
Monitoring and recording the total VOC level,
temperature and humidity
We monitored the total VOC level for 2 continuous
hours for each participant in the room. Personal expos-
ure to VOCs was measured using a total VOC monitor
(ppbRAE Plus, model PGM-7240; RAE Systems, San
Jose, CA, USA), a compact instrument with a micropro-
cessor control centre that uses a photoionization device
to detect a wide range of organic vapours. Organic
vapours pass through a UV lamp and are photoionized.
The ejected electrons are then detected as a current. The
calibration gas used is isobutylene. The temperature and
humidity were measured continuously using a portable
monitor (temperature and humidity sensor, model
1.153FH; Grimm Labortechnik, Ainring, Germany).
The raw data for the 1-min total VOC level, the
temperature, and the humidity measurements were
matched with the sampling time of the BP and HR
monitoring. These data were then analysed to deter-
mine the 15-, 30-, 45-, 60-, 75-, 90-, 105-, and 120-min
(2-hour) means.
Statistical analysis
A one-way analysis of the variance (ANOVA) with the
Scheffe’s mean comparison test was used to compare
BP, HR, the total VOC level, temperature, and humid-
ity for each visit. The association between the total
indoor VOC level, BP, and HR in the spa workers
was examined by applying a linear mixed-effect regres-
sion model using S-PLUS 2000 (MathSoft, Cambridge,
MA, USA). The outcome variables were SBP, DBP,
and HR, and the exposure variable was the total
VOC level at the 15-, 30-, 45-, 60-, 75-, 90-, 105-, and
120-min (2-hour) means. Each regression model
included fixed effects for age, sex, BMI, day of the
week, visit order, and random effects for participant-
specific terms. The models also adjusted for several
smooth function terms fit by a natural spline. These
terms included the temperature and humidity.
Estimates of the effects of the total VOC level were
scaled to an interquartile range (IQR), the difference
between the 25th and the 75th percentile, in levels for
the appropriate mean of the total VOC level.
Chuang et al. 825

(75.6, 71.1, 69.3, and 68.2 ppb). Likewise, the DBP

Results decreased by 0.45, 0.72, and 1.30 mmHg per IQR of
A total of 100 adult spa workers were recruited for this total VOC levels at the 15–45-min means. Decreases
study. A total of 300 visits with 2400 physiological and in HR of 1.08, 2.21, and 0.82 beat/min were also
environmental measurements were included in the data observed in response to the IQR changes of the
analyses. The age (mean  SD) of the population was 30–60-min mean total VOC levels. Accordingly, our
22.5  3.2 years, the BMI was 23.2  2.1 kg/m2, and the models showed that total VOC levels at the 45-min
male-to-female ratio was 1:1 (Table 1). None of the mean had greater effects on decreasing HR and BP
participants had cardiopulmonary disease, history of compared with total VOC levels at the 15-, 30-, and
smoking, or medication that might affect cardiac 60-min means (Figure 1).
rhythm. Table 2 summarizes the BP, HR, total VOC However, we found for the times from 75 to 120 min
levels, and indoor climate data for the 800 total meas- after start of exposure that the VOC levels were asso-
urements per visit for the 100 participants. The total ciated with increased 15-min mean BP and HR. For
VOC level was 82.2  11.7 ppb. The BP and HR were BP, SBP increased by 0.23, 1.40, 1.83, and
within the normal range.12,13 There were no significant 2.19 mmHg per IQR of the total VOC level at the
differences in BP, HR, total VOC level, temperature, 75–120-min means (67.5, 67.1, 66.8, and 66.4 ppb).
and humidity in the three visits per participant The DBP increased by 1.10, 1.45, and 1.76 mmHg per
(ANOVA, p-value > 0.05). The range of indoor tem- IQR of the total VOC level at the 90–120-min means.
perature was 21.0–24.3 C and indoor relative humidity Elevations in HR of 1.31, 1.42, and 1.70 beat/min were
was between 49.5 and 67.0% for all visits. also observed in response to the IQR changes of the
The significant associations (p-value < 0.05) between 90–120-min mean total VOC levels. These findings indi-
the total indoor VOC level, BP, and HR, which were cated that total VOC levels at the 120-min mean had
estimated using mixed-effects models, are shown in greater effects on HR and BP elevation (Figure 1).
Table 3. After adjusting for age, sex, BMI, day of the
week, and visit order in our mixed-effects model, we
found for the times from 15 to 60 min after start of
Discussion
exposure that the VOC level was significantly asso- This study focused on the short-term effect of essential
ciated with reduced 15-min mean BP. For BP, the oil on the cardiovascular health of healthy young spa
SBP decreased by 0.81, 1.62, 2.10, and 0.89 mmHg workers. The study results suggest that exposure to
per IQR of total VOC levels at the 15–60-min means essential oil for 1 hour would be effective in reducing
HR and BP. These findings confirm the effect of essen-
tial oil on stress relief reported in previous studies.
Table 1. Basic characteristics of 100 study participants McCaffrey et al.1 found that essential oil generated
from fragrant candles reduced the test-taking anxiety
Variable Study sample
of nursing school students. Komarova and Avilov’s
Sex (n, %) findings showed that essential oil-generated fragrant
Female 51 (51) candles could reduce the level of psychoemotional
Male 49 (49) stress in students.2 Seo3 reported an association
Age (years) between essential oil aroma inhalation and a lower
Mean  SD 22.5  3.2
BP and pulse rate in female high school students. Hur
et al.4 found that aromatherapy massage could relieve
Range 18–29
menopausal symptoms in climacteric women.
Body mass index (kg/m2)
Accordingly, exposure to essential oil might be a
Mean  SD 23.2  2.1 useful way for stress relief in healthy young subjects
Range 18.1–32.5 and adult women.
Heart rate (beat/min) The most interesting finding of our study is that
Mean  SD 71.2  6.8 exposure to essential oil over 1 hour was associated
Range 68.0–93.0 with elevated BP and HR. In our modelling results,
Systolic blood pressure (mmHg) the regression of the BP and HR on the 75–120-min
Mean  SD 124.5  22.6 means demonstrated a significantly positive association
Range 95.0–155.0 between the total VOC level and the SBP, DBP, and
Diastolic blood pressure (mmHg) HR. This finding also supports the results of previous
Mean  SD 84.1  20.2
epidemiological studies that found an association
between exposure to VOCs and cardiovascular
Range 62.0–122.0
effects.14 Theophanides et al.11 investigated the ambient

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826 European Journal of Preventive Cardiology 21(7)

Table 2. Statistical summary of the physiological and environmental measurements at the 15-min mean using over 800 total
measurements per visit for each of the 100 study participants

ANOVA

First visit Second visit Third visit Scheffe’s

(n ¼ 800) (n ¼ 800) (n ¼ 800) p-value test

SBP (mmHg)
Mean  SD 125.0  22.6 123.2  23.9 121.4  21.4 0.58 –
Range 91.0–163.0 98.0–159.0 85.0–167.0
DBP (mmHg)
Mean  SD 85.3  19.8 87.9  22.4 88.6  19.0 0.67 –
Range 63.0–124.0 59.0–126.0 78.0–123.0
HR (beats/min)
Mean  SD 80.1  6.9 75.6  7.3 79.1  5.8 0.48 –
Range 62.0–93.0 67.0–92.0 65.0–89.0
Total VOCs (ppb)
Mean  SD 80.1  11.2 84.0  12.8 82.5  12.1 0.71 –
Range 52.4–112.0 55.7–120.5 50.6–116.7
Temperature ( C)
Mean  SD 22.2  0.5 22.7  0.7 22.3  0.6 0.86 –
Range 21.1–23.8 21.0–24.3 21.1–24.2
Relative humidity (%)
Mean  SD 58.0  3.3 59.7  2.7 56.1  3.0 0.77 –
Range 51.1–67.0 52.0–66.5 49.5–63.0
DBP, diastolic blood pressure; HR, heart rate; SBP, systolic blood pressure; VOC, volatile organic compound.

Table 3. Changes (95% CI) in blood pressure and heart rate resulting from an interquartile range change in 15–120-min
means of total volatile organic compound levels in mixed-effects models

Mean time of
measurement
(min after start Systolic blood pressure Diastolic blood pressure
of exposure) (mmHg) (mmHg) Heart rate (beat/min)

15 0.81 (1.51, 0.11)* 0.45 (0.67, 0.23)* 0.11 (0.74, 0.52)

30 1.62 (2.49, 0.75)* 0.72 (1.18, 0.26)* 1.08 (1.63, 0.53)*
45 2.10 (2.80, 1.40)* 1.30 (1.90, 0.70)* 2.21 (2.81, 1.61)*
60 0.89 (1.77, 0.01)* 0.12 (0.72, 0.48) 0.82 (1.50, 0.14)*
75 0.23 (0.69, 1.15) 0.02 (0.68, 0.72) 0.21 (0.90, 0.48)
90 1.40 (0.39, 2.41)* 1.10 (0.23, 1.97)* 1.31 (0.41, 2.21)*
105 1.83 (0.72, 2.94)* 1.45 (0.55, 2.35)* 1.42 (0.60, 2.24)*
120 2.19 (0.79, 3.59)* 1.76 (0.66, 2.86)* 1.70 (0.93, 2.47)*
*p-value < 0.05.

VOCs created by industry and traffic in areas near the
city of Kavala and the mortality of citizens in the
region. The results showed that aromatic and aliphatic
hydrocarbons and other gaseous pollutants were asso-
ciated with an increased risk of cardiopulmonary death
and cancer. We recently explored the association
between indoor total VOCs and cardiovascular health
in a panel of healthy, young workers in hair salons in
Taipei. The results indicated that exposure to indoor
total VOCs over a 1-hour period was associated with
systemic inflammation, oxidative stress, and autonomic
dysfunction.10 These findings suggest that overexposure

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Chuang et al. 827

Change in HR (beat/min) and BP (mmHg)

3

per IQR increase in total VOCs

2

-1

-2

-3

-4
15 30 45 60 90 120

HR minute
SBP
DBP

Figure 1. Changes (95% confidence interval) in blood pressure and heart rate for the interquartile range changes in the total volatile
organic compound levels using a mixed-effect model.
DBP, diastolic blood pressure; HR, heart rate; SBP, systolic blood pressure; VOC, volatile organic compound.

to essential oil might be harmful to cardiovascular study may not be sufficient to fully control for inter-
health. individual differences in health outcomes in our mixed-
The inhalation of air pollutants has been reported to effects model. Third, we cannot completely rule out the
induce pulmonary oxidative stress, inflammation, and possibility of unmeasured confounders, although we
autonomic dysfunction.15 These potential biological have adjusted for a set of individual-level confounders
processes may also be applied to the adverse effects of (odour preferences, level of anxiety, etc.). Fourth, it is
the total VOC exposure on cardiovascular health. still unknown whether small, short-term fluctuations of
Ozone (O3) is a secondary air pollutant formed by the BP and HR are associated with a higher risk of clinical
photochemical oxidation of VOCs derived from solv- cardiovascular diseases even if elevated BP and HR can
ents or other sources. Previous studies reported that O3 serve as markers for increased risks of cardiovascular
could induce a pulmonary inflammatory response16 and diseases.19 Finally, the present study applied only one
an alteration in the central nervous system function in exposure regime. Therefore, it is not fully clear if the
humans.17 These effects might be induced by VOC increase of BP and HR after 60 min needs prolonged
exposure, although at this time there is no proof avail- exposure or if 1 hour of exposure would suffice.
able for this hypothesis. Our findings imply that risk- In conclusion, although we have some limitations in
based aromatherapy should focus not only on the effect our study design, we believe our findings generally indi-
of essential oil on stress relief but should limit overex- cate that exposure to essential oil over a 1-hour period
posure to essential oil to minimize cardiovascular could be a useful method of stress relief. Prolonged
health risk. exposure for longer than 1 hour to essential oils may
Several limitations should be addressed in our study. be harmful to cardiovascular health in young, healthy
First, the association of the total VOC level with subjects. Further studies with more detailed measure-
increased and decreased BP and HR found in the ments of cardiopulmonary and psychological endpoints
study could be confounded by other unmeasured over time are still needed to elucidate the time sequence
indoor air pollutants.18 Second, the limited number of of chronic effects of various essential oils on cardiopul-
intra-individual measurements we conducted in this monary endpoints in susceptible or general population.

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828
Funding
This study was supported by the National Science Council of
Taiwan (grant no. NSC 99-2314-B-562-001-MY2).
Conflict of interest
None.
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