INTRODUCTION: Isolated systolic hypertension (ISH) is very common but difficult to manage with conventional medication. We investigated whether slow breathing training, with and without an inspiratory load, could reduce the resting blood pressure of older well-managed ISH patients. METHODS: Thirty ISH patients (66 +/- 4 yr) were randomized into loaded breathing (six breaths per min, 18 cmH2O), unloaded breathing (six breaths per min, no load), or control (normal breathing) groups. After a 2-wk run-in, loaded and unloaded groups trained at home for 30 min every day for 8 wk. Morning home blood pressure and heart rate were measured daily throughout the study. At the end of training, all participants reverted to normal breathing, and blood pressure and heart rate were recorded for a further 8 wk. RESULTS: Compared to the pretraining run-in period, systolic blood pressure was reduced by 18 +/- 7 and 11 +/- 4 mmHg for loaded and unloaded groups, respectively (p < 0.001), the reduction being significantly larger for the loaded group (p < 0.05) after 8-wk training. There were no changes in the control group. After the end of training, systolic blood pressure remained below pretraining levels for a further 6 wk for the loaded group but for only 2 wk with the unloaded group. There was a small nonsignificant reduction in diastolic blood pressure with training, as there was for heart rate. Pulse pressures were reduced by 11 +/- 5 and 5 +/- 6 mmHg for loaded and unloaded groups, respectively (p < 0.01). CONCLUSION: Slow breathing training, especially with an inspiratory load, is very effective in reducing resting systolic and pulse pressures and could be a valuable adjunct in the management of ISH.

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