title: Psychological predictors of the antihypertensive effects of music-guided slow breathing.
abstract: BACKGROUND
  The possibility that daily sessions of music-guided slow breathing may reduce 24-h ambulatory blood pressure (ABP), and predictors of efficacy were explored in a randomized, placebo-controlled trial with parallel design.
  
  
  METHODS
  Age-matched and sex-matched hypertensive patients were randomized to music-guided slow breathing exercises (4-6 breaths/min; 1: 2 ratio of inspiration: expiration duration) (Intervention; n = 29) or to control groups who were thought to relax while either listening to slow music (Control-M; n = 26) or reading a book (Control-R; n = 31). At baseline and at follow-up visits (1 week and 1, 3 and 6 months), ABP monitoring was performed.
  
  
  RESULTS
  At mixed model analysis, intervention was associated with a significant reduction of 24-h (P = 0.001) and night-time (0100-0600 h) (P < 0.0001) systolic ABP. The average reduction of systolic 24-h ABP at 6 months was 4.6 mmHg [confidence limits at 95% 1.93-7.35] and 4.1 mmHg (95% confidence limits 1.59-6.67) vs. Control-M and Control-R groups, respectively, (P < 0.001 for both). Antihypertensive treatment was selected as negative predictor of BP reduction at multivariate stepwise analysis. When antihypertensive treatment was inserted as covariate in a generalized linear model, psychological subscales assessed at baseline by the Mental Health Inventory questionnaire were found to affect systolic blood pressure reduction at 6-month follow-up (general positive affect P < 0.001; emotional ties, P < 0.001; loss of behavioral control, P = 0.035). In particular, a level of general positive affect higher than the 75th percentiles was found to be significantly associated with low treatment efficacy (odds ratio 0.09; 95% confidence limits 0.01-0.93).
  
  
  CONCLUSIONS
  Daily sessions of voluntary music-guided slow breathing significantly reduce 24-h systolic ABP, and psychological predictors of efficacy can be identified.
authors.affiliation: Department of Critical Care Medicine, University of Florence, Italy. pamodesti@unifi.it
authors.forename: Pietro Amedeo
authors.initials: PA
authors.lastname: Modesti
authors.forename: Antonella
authors.initials: A
authors.lastname: Ferrari
authors.forename: Cristina
authors.initials: C
authors.lastname: Bazzini
authors.forename: Giusi
authors.initials: G
authors.lastname: Costanzo
authors.forename: Ignazio
authors.initials: I
authors.lastname: Simonetti
authors.forename: Stefano
authors.initials: S
authors.lastname: Taddei
authors.forename: Annibale
authors.initials: A
authors.lastname: Biggeri
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Parati
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
authors.forename: Saulo
authors.initials: S
authors.lastname: Sirigatti
mesh_terms: D000368:Aged; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D001945:Breathing Exercises; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D009147:Music Therapy / Q000379:methods*; D056152:Respiratory Rate; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome