MANAGING ANXIETY AND STRESS IN HYPERTENSION: DEVELOPMENT OF HEART RATE VARIABILITY BIOFEEDBACK WITH PSYCHOLOGICAL SUPPORT

Abstract

Objective: How can digital wearable Heart Rate Variability (HRV) biofeedback and psychological support be used to improve the management of anxiety and stress in hypertension? Design and method: A mixed methods study was used to develop and evaluate initial outcomes from a HRV biofeedback intervention for the management of anxiety and stress in hypertension. We used systematic review evidence to guide a series of patient and stakeholder consultations to co-design a HRV biofeedback intervention to assess and treat anxiety and cardiovascular stress reactivity in a hypertension specialist outpatient's service. We evaluated initial outcomes from case studies of 15 patients who attended 2-5 x 1 hour face to face sessions with a Health Psychologist. Sessions involved: 1) assessment of anxiety and stress responses; 2) resonance frequency breathing training with HRV biofeedback with a respiration rate (between 6.5 and 4.5 breaths/minute) to produce optimal baroreflex stimulation and blood pressure regulation; 3) psychological skills development for dealing with anxiety and stress. Results: At 8 weeks follow up, 45% patients reported a 5-10 mmHg systolic reduction in blood pressure and 55% reported a reduction of 10-20 mmHg. 85% of patients reported increased morning HRV readiness scores and improvements in patient reported psychological outcomes (e.g. improvements in BP, anxiety reduction and increase in valued activities). 11 patients reported improved health behaviour change (increased physical activity, improved diet, reduction in alcohol intake). Whitecoat hypertension was improved in 70% of patients. Conclusions: Biofeedback with psychological support can help improve anxiety and stress symptoms, as well as improvements in systolic blood pressure within an integrated specialist hypertension team.