Blood Pressure

ISSN: 0803-7051 (Print) 1651-1999 (Online) Journal homepage: https://www.tandfonline.com/loi/iblo20

It is time to close the book on device-guided slow

breathing

Peter R. van Dijk, Kornelis J.J. van Hateren, Nanne Kleefstra & Gijs W.D.
Landman

To cite this article: Peter R. van Dijk, Kornelis J.J. van Hateren, Nanne Kleefstra & Gijs W.D.
Landman (2018) It is time to close the book on device-guided slow breathing, Blood Pressure,
27:3, 181-182, DOI: 10.1080/08037051.2018.1435260

To link to this article: https://doi.org/10.1080/08037051.2018.1435260

Published online: 06 Feb 2018.

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BLOOD PRESSURE, 2018
VOL. 27, NO. 3, 181–182
https://doi.org/10.1080/08037051.2018.1435260

LETTER TO THE EDITOR

It is time to close the book on device-guided slow breathing

Dear editor, irrelevant differences and is also important for aggrega-

tion of data in future meta-analyses.
Barros et al. reported the long-term effects of device-
Thirdly, it should be taken in mind that adverse
guided slow breathing (DGB) in hypertensive patients
effects have been reported using DGB. Previously
comparing DGB using a device called the REPeRATEV
R

reported side effects included shortness of breath, atyp-

(InterCure Ltd, Tel-Aviv, Israel) to listening to music
ical chest pain with shortness of breath that resulted in
[1]. The authors observed no significant effects whatso-
an emergency department visit and one patient died of
ever on blood pressure, concentrations of catechol-
respiratory failure due to underlying heart failure [3].
amines or muscle sympathetic nerve activity (SNA).
Therefore, we would like to inquire whether adverse
We have several remarks related to DBG and this inter-
events have taken place during the trial.
esting article.
In conclusion, we disagree with the authors’ con-
Firstly, we have serious concerns with the interpret-
clusion that ‘DGB still needs more evidence that
ation of previous literature. The last paragraph of the
demonstrates its real effectiveness. At the risk of stat-
discussion section is far too positive concerning the
ing the obvious: the aim of such a study would be
effectiveness of DBG and is not based on an accurate
to investigate if there is any effect of DBG on blood
interpretation of the evidence concerning this device
pressure, not to presume there is an effect. In add-
[2]. The authors mention that most studies concerning
ition, evidence from meta-analyses of randomized tri-
DGB published favorable effect in relation to office
als and systematic reviews have clearly demonstrated,
blood pressure in patients with hypertension. Of
as this study does (!), that DBG has no beneficial
course this is no argument that would favor DGB as
effects on reducing blood pressure. When performing
such. When considering the methodological quality,
another (identical) study there is risk of a type 1
the highest quality trials do not show any effect of
error, risk for patients and there is no clear scientific
DGB on blood pressure as was found in the only
need.
double-blind (and sham-controlled) trial [3].
Furthermore, the absence of any possible relevant
effect has been confirmed in meta-analyses of trials
using individual patient data of different trials and Disclosure statement
aggregated data of more trials without using individ- The authors have no conflicts of interest.
ual patient data [2,4].
Secondly, we have some questions concerning the
methodology. The primary endpoint of this study is the References
change in SNA and plasma catecholamines. We would [1] De Barros S, da Silva GV, de Gusm~ao JL, et al.
like to ask the authors to explain why they have chosen Effects of long term device-guided slow breathing on
for this endpoint instead of blood pressure, which is a sympathetic nervous activity in hypertensive patients: a
clinically relevant endpoint and has also been used in randomized open-label clinical trial. Blood Press. 2017;
26:359–365.
previous studies? Furthermore, randomization clearly
[2] Landman GW, van Hateren KJ, van Dijk PR, et al.
failed, as there is a relevant difference in using antihy- Efficacy of device-guided breathing for hypertension in
pertensive drugs between the two groups. It remains blinded, randomized, active-controlled trials: a meta-ana-
unclear whether the authors adjusted for this difference lysis of individual patient data. JAMA Intern Med.
in their analyses. Also, the authors should have per- 2014;174:1815–1821.
[3] Landman GW, Drion I, van Hateren KJ, et al.
formed intention-to-treat analyses, and we would
Device-guided breathing as treatment for hypertension
strongly like to ask the authors to present the differen- in type 2 diabetes mellitus: a randomized, double-
ces between groups with confidence intervals: this blind, sham-controlled trial. JAMA Intern Med. 2013;
enables the reader to interpret possible relevant or 173:1346–1350.
182 P. R. VAN DIJK ET AL.

[4] Mahtani KR, Nunan D, Heneghan CJ. Device-guided Nanne Kleefstra

breathing exercises in the control of human blood pressure:
systematic review and meta-analysis. J Hypertens. 2012;30:
852–860.
Peter R. van Dijk
Diabetes Centre, Isala, Zwolle,
The Netherlands
Department of Internal Medicine,
University Medical Center Groningen,
Groningen, The Netherlands
Kornelis J.J. van Hateren
Langerhans Medical Research Group, Zwolle,
The Netherlands
Department of Internal Medicine, University Medical
Center Groningen, Groningen, The Netherlands
Langerhans Medical Research Group, Zwolle,
The Netherlands
Gijs W.D. Landman
Langerhans Medical Research Group, Zwolle,
The Netherlands
Department of Internal Medicine, Gelre hospital,
Apeldoorn, The Netherlands
Received 11 January 2018; accepted 15 January 2018
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