This paper was first written in 1998, it is now updated a decade later. A number of people have written to say that my suggestions have worked for them , but now after light editing I have added some additional notes at the end of the original article. Read carefully and the best of luck with your BP.



BLOOD PRESSURE

A New Approach

This is from William Harris, Prof. Em. Middlebury College, originally written from my own experience in l998. Although formally Doctor Philosophiae and outside the medical profession, I am much concerned with health issues as contributing to a long and healthy personal life history. Medicine is changing so fast these days, often with heavy reliance on drugs from the pharmaceutical houses, that a private person can hardly hope to keep up with new information. Drug hypes becloud the work of doctors who struggle under government, insurance and HMO loads. Remember that it is your business to take care of your own health, and although the medical profession can help considerably, yet it will be your responsibility to watch and monitor everything that affects your health and life.



It was only after retirement from a teaching career that I began to take a careful look at my overall health , and the first thing doctors noted was that my blood pressure was too high. Over the years I never paid much attention to the numbers for Systolic, Diastolic and PulseRate, considering myself a strong and healthy person. But the last years of teaching involved a lot of stress coming from the politics of the academic profession, and when I started building a new house which I designed and worked on continually, I realized my that I was under stress and would have to take better care.

Fortunately I had connected with an unusual doctor, Allan P. Curtiss Jr. MD, a cardiologist who runs a small country-style clinic in Shoreham, Addison County, VT. Here was a man suitable for my needs in finding out more about the operation of my body as well as attending to my immediate health concerns. He is a well trained cardiologist, but he had arranged his practice so that he could take a full hour to work up a full and detailed account with each patient. No more waiting hours after a brief interview with a nurse while the doctor went from room to room on a fifteen minute schedule, finally appearing for a short summary discussion. I had a doctor I could trust to do his best thinking on my behalf, and now I was ready to take his recommendations seriously. Unfortunately this kind of doctor is an endangered species in a world dominated by the HMO mentality with its fifteen minute appointment schedule.

My BP was initially in the range of 170/95/95, higher than I had suspected and he said it had to be adjusted down severely or I was in for an early demise. It was not a question of just how long I could live, but what condition I would be in after a stroke in my final years. He suggested that if he would dial for me numbers like 140/80/60 as ideal for that time, that would be ideal, so we went to work with various medication to reduce the BP risk.

I won't go into the long list of medications which I tried, since none of them worked well enough to offset the secondary effects which occurred. Niacin quickly turned up a bad skin rash, so we went to a diuretic for a while, but as it turned out, large amounts of uric acid were depositing in my feet which were first swollen and soon temporarily crippling. This was not gout which we suspected at first, and I refer you to another essay on this website about Secondary Gout from uric deposits in muscle (not the typical gouty bone joint). Secondary Gout was a condition not then recognized but it is now discussed in the medical community.

Other drugs followed, all causing some degree of weakness and 'muscle pain' which the warning on the package mentioned, along with fifty other adverse reactions. After a time with an angiotensin antagonist which didn't show much difference on my daily home BP readings, I tried a calcium channel blocker was the last and worst with severe muscle trouble, at which point I was ready for another route, when I came upon a surprising discovery.

I had been interested in meditation from the Indian materials which were fashionable several decades ago, and I had discussed with my students the work of Jung and his group in relation to hidden messages in the creation of new artwork. There is no question that body and mind are closely interleaved, one doesn't have to appeal to Psychsomatic Theory since this is a matter of common sense after all. But there is also a complex set of neural connections which we identify as the Sympathetic vs. Parasympathetic nervous concatenation, affecting all the responses of the central body. This "fright-or-flight" reaction of the psychologists, is something which affects our emotional states, it certainly shows up as a raised pulse rate when we are surprised, it is seen in sexual tensioning countered by orgasmic release, and the tightening up of the whole central body is often described as knocking the breath out of you. These reactions are emotional but not completely so, since they involve self-sustaining neural reactions coming from emotions and life situations as well. Breathing has always been a critical part of Yoga meditation and I filed this away for future consideration.

Some family members had remarked that I was not a deep breather. Watching me they felt my breathing was shallow, and I later associated this with the 5 mg Valium I took for some years as a sleep aid. Once I stopped the Valium, I began to breathe more energetically without doing anything special. I starting whistling again when walking around, something which I had forgotten a few years back. Feeling better and more energetic, I began to think of breathing as an important part of my daily operating system, and I investigated the myriad breathing-systems in print and those on the web, from Hindu prasana breathing to flower-odor sensing cults, and finally went back to consider the standard Yoga meditation which always starts from control of the breath.

It was about this time that I made a critical discovery. Fast breathing or hyperventilation is a well known and dangerous medical problem, but it took some searching in l998 to find any discussion of an optimal breathing regimen. I did find some references to a computer monitored health practice which involved a two second in-breath or "inspiration" followed by a controlled four second "expiration". These words had a medical meaning somewhat different from what an 'inspiring' artist or an 'expiring' patient would do. This should mean a six second cycle and it would add up to ten cycles per minute, somewhat more leisurely than the usual 18 second rate. I even found a company that sold a computer program which could monitor this rate as optimal for heart and body health. This was interesting!

Trying this six second cycling along with an Omron digital BP monitor, I found that although my high Elevated Systolic Pressure which the doctor had noted was near 170, it dropped after less than two minutes of breathing to 140. A thirty point Hg drop is more than significant, it is surprising and quite amazing, and all I had to do in preparations is sit a minute and breathe with a generally calm sense of meditation. This was not a deep meditation in the religious sense, just a calming of the mind and concentrating on the second hand of a clock, as it ticked off my two seconds for IN followed by four seconds for OUT. Trying this again and again, I always got a significant BP drop on the systolic, often with systolic under 140 diastolic down to 80 or under.

ADDENDUM 2002: I found that there was a seasonal difference between BP results in warm summer as against chilly winter weather, which is caused by automatic shrinkage of the vascular piping as a way of controlling blood flow and heat loss. I was surprised to find no mention of this in the on-line literature about the various heart medications, which gave 120--80 as the normal figure for a healthy person. For those of us who live in a temperature variable climate, this is important to know.

Once I found breathing results to be effective and regular, I stopped the BP medications with my doctor's approval, relying only on cholesterol lowering agents to bring my cholesterol levels down to a 'risk factor' of less than "1". I find that for several years now I have had reliably reduced BP figures of SYS 140 or less and DIA 78, with PULSE regularly near 60 unless exercising. At any point at which I think I am nervous and suspect the BP might be up, I sit and breath-meditate for two minutes. I don't even have to check the results, knowing that the figures will be back to a lowered rate.

There are some further points which I would like to recommend to anyone who wants to try this system of "ten breaths a minute". You should try to incorporate this good breathing cycle into your daily life. Every hour or less, take a mental break for a minute, stop to sit and breathe and limit your active thinking after which you can go back to work. The danger to the heart is a continually elevated pressure, so letting the pressure and emotional pressure drop for just one minute will set you onto a safety level. It will give a rest to the heart muscles, and hardly interrupt the course of your work or lifestyle.

When doing this breathing, get a good rhythm for the OUT first by letting you chest "collapse" as the air lets itself out, like a balloon with a small leak. Don't push the air out, that is unnecessary. It is the diaphragm which raises to push on the lungs and expire air from them for a new breath; now you let the diaphragm muscle relax and sink down in the central body. Let chest muscles and shoulders relax and fall down a bit. Just four seconds and the air is all out. That is the point at which you can start to let air come air in, perhaps pursing the lips slightly and breathing in through the mouth easily. Shoulders can automatically move slightly back as the chest expands while all the little muscles which bind the chest bones together do a slight relaxing on their own, thus increasing the chest and lung capacity. Stretch the neck up and tilt your head back slightly as the shoulders relax, completing the breathing in this complex action of the breathing cycle.

This may sound overly mechanical, it is what we normally do when breathing normally, but forget to do when we are hurried or worried. A poor breathing regimen not only deprives the lungs of fresh air to re-oxygenate the blood, it also tenses up the central body system and the heart, which has its own automatic cell-controlled beating cycle. Under tension the heart starts to toil and over-rev as it senses the constriction of the muscular and neural tightening of the central body.

This Breathing Operation which I have been outlining is fairly complex, but it is performed in one semi-automatic procedure, after you have got your body used to it. And when it is operational and automatic, you don't have to think about it, except once in a while do a BP monitor check to note the exact level before and after to and check on the significant BP drop which is what we are after.

ADDENDUM 2002: Having reduced my BP from 180/95/80 five years ago to about 135/76/60 or less now, and expecting further systolic drop as I lose weight and get more regular exercise, I can aim for a hopeful 120/78/60. I have no hesitation in advising this "system" to anyone concerned with his BP levels. If necessary you can do this while on medications, and you can titrate your medications down with doctor's approval very slowly as you master the breathing routine. What you do will be determined by the level of BP drop in breathing through this light breathing-meditation, and when you see it working, you will stick to it as a regular part of your regimen.

This is not a cure-all. It may not be for everybody. I take my information from a number of years of careful observations on the one patient whom I can monitor completely, which is myself. Other have written to me about their use of the 'breathing exercises', and it seems to be applicable to people in many parts of the world where there are social pressure in work and living. There is nothing involved beyond trying this out for yourself, there are no training lessons, no drugs or quitting other medications, so there is nothing to lose other than a few hours of trial and testing. If it works for you, you have an unusual tool which is not something which you may not learn from your family doctor, who will be surprised and perhaps incredulous of your report of a twenty point BP drop on your command. But give it a try, and the best of luck.

ADDENDUM 2005: The main BP raising factor is of course "stress" and any factors of transient anxiety. Only recently I discovered something that my cardiologist knows but did not discuss with me, that the autonomic sympathetic and its opposite parasympathetic nervous systems are intimately connected with BP regulation. This double-function system operates in complex patterns out of the spinal column, reaching all the body organs to activate or to relax their functions, in variations of the fight-or-flight syndrome.

But there is a triggering action which works to switch between these two neural functions, and this lies in the baro-neuro-sensors in the walls of the aorta and carotid arteries, which operate by measuring the expansion or contraction of the arterial wall. These constitute the regulating BaroReflex, which monitors the BP indirectly through a measurement of artery wall elasticity, then relaying to the Sympathetic/Parasympathetic pathways in the spinal column orders for raising or lowering the blood pressure. It does happen that this BaroReflex system can fail and the BP can not be properly regulated, but there have been studies in "resetting the baroreflex" by exercise, a process being experimentally studies, which you should discuss with your cardiologist.

ADDENDUM 2006: There is a condition doctors call the Isolated Systolic Hypertension, which means that the systolic reading is always high and stays that way. But some ISH cases may be connected with a Baro Reflex Failure BRF, which can be involved. To check if your Baro reflexes are working, take a BP measurement before 20 minutes or so of strong exercise in a comfortable (stress) situation in warm weather (for reasons as above), and then after resting five minutes take it again and see if there has been a significant drop in the Systolic number. If in repeat tests this does show a significant drop, for example from systolic 160 to 120 range, then you are not locked into an inflexible ISH. The high and low pressure sensors in the aorta are working as they should, and the regular sue of mild exercise should become part of your daily regimen.

ADDENDA 2008: We are all familiar with the "White Coat Syndrome" which takes place when a doctor or the hospital takes your brood pressure reading. The fact that this is done in a medical surrounding does seem to raise the results in many people. For this reason is often advisable to get an electronic blood pressure testing unit to use at home in a more normal and relaxing ambiance. I found the hand action of pumping up an initial pressure with a hand-bulb did give slightly higher results than the automatic pump unit which I bought. The attention paid to pumping the bulb is just enough to constitute a mild white-coat reaction, and I found the Omron unit which can work on house 120- volt current to be another way of doing the test without thinking about it.

But there can be a mild and unconscious anxiety about BP testing at home, as you wait for the unit to deliver its results. I found that having a book at hand to read while the test was running did lower the test results, and now always read something interesting and preferably involving as I run the Omron tester. With the breathing regimen firmly established by practice, and my mind occupied by what I am reading during the test, I get another slight lowering of the test results. I was surprised to find this after many years of breathing-meditation alone and have now added this to my BP testing routine. I always find hard reading occupies my mind best and this often shows up in the lowered numbers returned.



William Harris
Prof. Em. Middlebury College
harris@middlebury.edu
www.middlebury.edu/~harris