title: Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the american heart association.
abstract: Many antihypertensive medications and lifestyle changes are proven to reduce blood pressure. Over the past few decades, numerous additional modalities have been evaluated in regard to their potential blood pressure-lowering abilities. However, these nondietary, nondrug treatments, collectively called alternative approaches, have generally undergone fewer and less rigorous trials. This American Heart Association scientific statement aims to summarize the blood pressure-lowering efficacy of several alternative approaches and to provide a class of recommendation for their implementation in clinical practice based on the available level of evidence from the published literature. Among behavioral therapies, Transcendental Meditation (Class IIB, Level of Evidence B), other meditation techniques (Class III, Level of Evidence C), yoga (Class III, Level of Evidence C), other relaxation therapies (Class III, Level of Evidence B), and biofeedback approaches (Class IIB, Level of Evidence B) generally had modest, mixed, or no consistent evidence demonstrating their efficacy. Between the noninvasive procedures and devices evaluated, device-guided breathing (Class IIA, Level of Evidence B) had greater support than acupuncture (Class III, Level of Evidence B). Exercise-based regimens, including aerobic (Class I, Level of Evidence A), dynamic resistance (Class IIA, Level of Evidence B), and isometric handgrip (Class IIB, Level of Evidence C) modalities, had relatively stronger supporting evidence. It is the consensus of the writing group that it is reasonable for all individuals with blood pressure levels >120/80 mm Hg to consider trials of alternative approaches as adjuvant methods to help lower blood pressure when clinically appropriate. A suggested management algorithm is provided, along with recommendations for prioritizing the use of the individual approaches in clinical practice based on their level of evidence for blood pressure lowering, risk-to-benefit ratio, potential ancillary health benefits, and practicality in a real-world setting. Finally, recommendations for future research priorities are outlined.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Brook
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Appel
authors.forename: Melvyn
authors.initials: M
authors.lastname: Rubenfire
authors.forename: Gbenga
authors.initials: G
authors.lastname: Ogedegbe
authors.forename: John D
authors.initials: JD
authors.lastname: Bisognano
authors.forename: William J
authors.initials: WJ
authors.lastname: Elliott
authors.forename: Flavio D
authors.initials: FD
authors.lastname: Fuchs
authors.forename: Joel W
authors.initials: JW
authors.lastname: Hughes
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Lackland
authors.forename: Beth A
authors.initials: BA
authors.lastname: Staffileno
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Townsend
authors.forename: Sanjay
authors.initials: S
authors.lastname: Rajagopalan
mesh_terms: D000572:American Heart Association; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology*; D019468:Disease Management; D006801:Humans; D006973:Hypertension / Q000178:diet therapy / Q000188:drug therapy / Q000503:physiopathology; D008019:Life Style; D017410:Practice Guidelines as Topic; D014481:United States
chemical_list: D000959:Antihypertensive Agents
keywords: AHA Scientific Statement; blood pressure; cardiovascular diseases; complementary therapies; hypertension; prehypertension; preventive medicine