International Journal of Cardiology 169 (2013) e6–e8

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International Journal of Cardiology

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Letter to the Editor

Effects of slow breathing rate on blood pressure and heart rate variabilities
Qinghua Chang a, Renguang Liu a,⁎, Zhongyuan Shen b
a
Cardiovascular Institute of the First Affiliated Hospital of Liaoning Medical College, Jinzhou 121001, Liaoning Province, China
b
Shanghai University of Traditional Medicine, Shanghai 200030, China

a r t i c l e i n f o We observed that RRI and blood pressure cyclical changes coincided

with the respiratory cycle. Typically, heart rate accelerated and blood
Article history: pressure fallen during inspiration and heart rate slowed down and
Received 9 August 2013 blood pressure raised during expiration. As breathing rate reduced,
Accepted 29 August 2013
amplitude of RRI and blood pressure oscillation increased, heart rate
Available online 8 September 2013
slowed (all P b 0.001), and respiratory peak shifted toward left (all
Keywords: P b 0.001). When breathing rate was at 12 breaths/min, it was located
Breathing rate at the conjunction between standard LF band and HF band while
Heart rate variability when breathing rate was at 8 breaths/min, it was located at LF band
Blood pressure
(Fig. 1A, B, C and Table 1). Compared to 16 breaths/min, traditional spec-
Blood pressure variability
Autonomic nervous system tral analysis showed a decreased HF power, increased LF power and LF/HF
Spectral analysis ratio of HRV and BPV at a rate of 8 breaths/min (all P b 0.01; Table 2). As
the breathing rates decreased gradually, corrected spectral analysis
showed increased HF power, decreased LF power and LF/HF ratio of
HRV and BPV at a rate of 8 breaths/min (all P b 0.01 except statistically
Heart rate variability (HRV) is a suitable parameter which is repre-
significant respiratory rate effect was not found in LF power of BPV;
sentative of the type of autonomic control [1]. Blood pressure variability
Table 3).
(BPV) seems to be a reliable parameter indicating the balance of neuro-
LF power of HRV represents of sympathetic and parasympathetic
humoral and endocrinic regulation, which is closely related to the risk of
vasomotor modulation. HF component of HRV predominantly reflects
cardiovascular complications [2–4]. Several studies have shown that
parasympathetic modulation, which is due to changes in respiration
breathing rate plays a pivotal role in the regulation of HRV and BPV
[9]. LF power of BPV has been proposed as an index of sympathetic mod-
[5–7]. The objective of this study is to investigate the effects of slow
ulation of cardiovascular regulation. LF power of BPV is also believed to
breathing rate on HRV and BPV in healthy subjects.
arise from changes in vascular tone and peripheral resistance. HF power
53 healthy volunteers underwent three periods of controlled breath-
of BPV appears to be associated with respiratory rate and it is considered
ing at 8, 12 and 16 breaths/min. All of the subjects gave their informed
to reflect parasympathetic activity [10–12]. The effect of respiration on
consent, and the study was approved by the local Ethics Committee.
HRV and BPV is displayed as respiratory peak, which is located in HF
ECG (RR), respiratory and blood pressure signal were recorded continu-
band. In our study, slow breathing rate can induce respiratory peak
ously and simultaneously. In our study, the influence of the respiration
shifting. It is important to point out that when breathing slows down
on RR interval (RRI) and blood pressure was observed. Simultaneously,
to about 8 breaths/min, respiratory peak shifts to the LF range, creating
we studied the effect of slow breathing rate on RRI, amplitude of blood
a sharp decrease in HF power and increase in LF power with traditional
pressure oscillation, respiration peak, heart rate, high-frequency (HF)
spectral analysis. This is consistent with the established literature [13]
power, low-frequency (LF) power and LF/HF ratio of HRV and BPV. In
and it seems to suggest parasympathetic withdrawal and sympathetic
order to correct the effect of slow breathing rate on respiratory peak
increase. In order to correct the effect of slow breathing rate on respira-
shift which in turn influences spectral analysis, we used Central Fre-
tory peak shift which in turn influences the spectral analysis, we refer-
quency of Respiration Peak at 0.65 Hz to correct the conjunction be-
ence enhanced method of Aysin et al. [8] and used Central Frequency
tween LF band and HF band which was proposed by Aysin et al. [8]
of Respiration Peak at 0.65 Hz to correct the conjunction between LF
(Fig. 1a, b, c). The results were given as means ± s.d. Paired t tests
band and HF band of HRV and BPV. Corrected spectral analysis demon-
were used to determine the effects of slow breathing rate on respiratory
strates that slow respiration can cause increase in HF power and de-
peak, heart rate, HF power, LF power and LF/HF ratio of HRV and BPV. All
crease in LF power and LF/HF ratio. These demonstrate that slow
statistical analysis was performed using SPSS version 19.0 (IBM, Chicago,
breathing is indeed capable of increasing vagal activities and shifting
USA). A P-value b0.05 was considered significant.
sympatho-vagal balance toward vagal activities. Thus, in the absence
of simultaneous analysis of respiration rate, the changes in LF power,
⁎ Corresponding author at: The Cardiovascular Institute of the First Affiliated
Hospital of Liaoning Medical College, Renmin Street, 121001 Jinzhou, Liaoning
HF power and LF/HF ratio should not be taken as clear evidence of
Province, China. Tel.: + 86 15940657851, +86 13009336139; fax: +86 416 4197105. changes in autonomic balance. Autonomic dysfunction (increased sym-
E-mail address: liurenguanglaoshi@126.com (R. Liu). pathetic activity and decreased parasympathetic activity) has a major

0167-5273/$ – see front matter © 2013 Elsevier Ireland Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.ijcard.2013.08.121
Q. Chang et al. / International Journal of Cardiology 169 (2013) e6–e8 e7
e8 Q. Chang et al. / International Journal of Cardiology 169 (2013) e6–e8

Table 1
The effect of slow breathing rates on CFRP of HRV, BPV.

16 breaths/min 12 breaths/min 8 breaths/min

HR 82.6670 ± 9.8743 79.3040 ± 9.3677▲ 79.3270 ± 9.2837▲

CFRP 0.1964 ± 0.0246 0.1536 ± 0.0198▲ 0.1023 ± 0.0128▲

Note: Values are means ± s.d. n = 53. HR, heart rate; CFRP, Central Frequency of Respiration Peak; BR, breathing rate; CFRP = RF/HR, compare with 16 breaths/min, ▲ indicates
P b 0.001.

Table 2
The effect of slow breathing rates on HRV and BPV (traditional spectral analysis).

BR HRV BPV

LF HF LF/HF LF HF LF/HF

16 breaths/min 191.95 ± 182.10 951.00 ± 780.80 0.26 ± 0.19 0.04 ± 0.03 0.13 ± 0.08 0.35 ± 0.17
12 breaths/min 252.29 ± 170.37※ 1552.90 ± 1079.82 0.20 ± 0.13 0.05 ± 0.03※ 0.17 ± 0.09※ 0.36 ± 0.22
8 breaths/min 2405.10 ± 1060.42▲ 631.05 ± 438.80● 4.54 ± 1.59▲ 0.18 ± 0.11▲ 0.05 ± 0.03▲ 3.57 ± 1.79▲

Note: Values are means ± s.d. n = 53. BR, breathing rate; HRV, heart rate variability; BPV, blood pressure variability; LF, low frequency; HF, high frequency; compare with 16 breaths/min,
※ indicates P b 0.05, ● indicates P b 0.01, and ▲ indicates P b 0.001.

Table 3
The effect of slow breathing rates on HRV and BPV (corrected spectral analysis).

BR HRV BPV

LF HF LF/HF LF HF LF/HF

16 breaths/min 191.95 ± 182.10 951.00 ± 780.80 0.26 ± 0.19 0.04 ± 0.03 0.13 ± 0.08 0.35 ± 0.17
12 breaths/min 182.62 ± 120.78 1763.70 ± 1380.22▲ 0.15 ± 0.14▲ 0.04 ± 0.03 0.20 ± 0.15● 0.27 ± 0.22※
8 breaths/min 120.34 ± 76.97● 3051.40 ± 2212.04▲ 0.06 ± 0.05▲ 0.03 ± 0.03 0.21 ± 0.17● 0.21 ± 0.18▲

Note: Values are means ± s.d. n = 53. BR, breathing rate; HRV, heart rate variability; BPV, blood pressure variability; LF, low frequency; HF, high frequency; compare with 16 breaths/min,
※ indicates P b 0.05, ● indicates P b 0.01, and ▲ indicates P b 0.001.

role in the etiology of a number of cardiovascular diseases. These
include hypertension, coronary artery disease, and heart failure [14].
Our data shows that slow-breathing promotes a modulation of the auto-
nomic cardiovascular regulation, characterized by increased parasym-
pathetic activity, reduced sympathetic activity and shifted sympatho-
vagal balance toward vagal activities. This opens a new area of future
research in the better management of patients with cardiovascular
autonomic dysfunction.
Acknowledgments
We would like to thank all the people who participated in the study.
Sources of funding
This research is supported by the National Natural Science Founda-
tion of China under grant no. 81072853.
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Fig. 1. Power spectra of respiratory, RR interval and BP signal during controlled respiration at 16, 12, and 8 breaths/min in one subject. LF and HF components of HRV and BPV of traditional
spectral analysis (0.15 Hz is the conjunction between standard LF band and HF band) at breathing rate of 16 breaths/min (A), 12 breaths/min (B), and 8 breaths/min (C). LF and HF com-
ponents of HRV and BPV of corrected spectral analysis (we used Central Frequency of Respiration Peak at 0.65 Hz to correct the conjunction between LF band and HF band) at breathing
rate of 16 breaths/min (a), 12 breaths/min (b), 8 breaths/min (c).