BREATHE: the development and assessment of a breathing-based intervention for hypertension management

Hypertension is the leading preventable risk factor for cardiovascular disease, stroke and premature death (Zhou et al., 2021a), affecting 1.2 billion people worldwide (Zhou et al., 2021b). Hypertension is typically managed with medication, but optimal blood pressure management can be affected by factors such as stress, psychological wellbeing and multiple drug intolerances. The ESC/ESH 2018 (Williams et al., 2018) guidelines recommended a holistic approach to hypertension, including lifestyle modifications and medication. The updated ESH guidelines (Mancia et al., 2023) incorporated the impact of anxiety and stress on hypertension. Health psychology represents an approach that can inform and support the holistic management of hypertension. Specifically, the use of behavioural and self-management interventions to mediate the effect of psychological wellbeing on hypertension.

This PhD was born out of the unique arrangement of an integrated specialist health psychology clinic within a hypertension outpatient clinic. To improve access and implementation of health psychology in hypertension management, this PhD sought to develop an intervention informed by health psychology, yet suitable for wide scale roll out in the National Health Service (NHS). A review of existing literature and a health psychology clinic demonstrated that breathing practice and biofeedback were well-suited interventions for patients with hypertension.

Consequently, the PhD developed an intervention that integrated breathing practice and biofeedback into hypertension management: BREATHE (Biofeedback REactivity and Awareness To HEalth). The intervention was directly informed by feedback from patients with hypertension and NHS stakeholders. This ensured that BREATHE reflected patient preferences, whilst remaining feasible and suitable for NHS implementation. BREATHE was assessed in an ongoing feasibility study to inform continued development.

This PhD demonstrated how health psychology can support the holistic management of hypertension, specifically the effect of psychological wellbeing. The development of BREATHE will continue beyond the scope of this PhD, in the ongoing feasibility study, grant applications for larger studies, and ultimately, NHS implementation.