Responses on Arterial Stiffness and Cardiac Vagal Modulation to Breathing Exercises Through the Use of CardioBreath Application in Hypertension and Pre Hypertension; a Randomized Clinical Trial

Systemic Arterial Hypertension (SAH) affects 1.33 billion people globally, representing 10% of global health costs. In the US, a study published in 2019 estimated that annual spending due to hypertension was $56 billion. According to the Surveillance Survey of Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel), carried out in 2021 and with a report published in 2022, the frequency of adults (18 years or older) in Brazilian capitals who reported a medical diagnosis of hypertension was 26.3%. This represents an increase in relation to the data from 2011, when the percentage was 24.3%. Hypertension is the main risk factor for events such as Acute Myocardial Infarction (AMI) and Stroke (CVA). The mortality rate due to hypertension in Brazil reached the highest value in the last ten years, with 18.7 deaths per 100,000 inhabitants in 2021 .

The 2024 European Society of Cardiology (ESC) Guideline on the management of elevated blood pressure (BP) and hypertension presents significant changes from previous versions. The new title reflects the understanding of cardiovascular risk as a continuous spectrum, emphasizing the importance of accurate BP measurement, recommending the use of validated devices, standardized techniques, and out-of-office measurement.

Treatment strategies include lifestyle interventions and drug therapy, with an emphasis on lower BP targets and combination therapy from the outset, addressing the management of hypertension in specific populations, such as women, the elderly, patients with Chronic Kidney Disease (CKD) and Diabetes Mellitus (DM). Resistant and secondary hypertension are also discussed, with recommendations for diagnosis and treatment. Psychosocial aspects, such as communication of diagnosis and adherence to treatment, are highlighted. Self-care and BP monitoring are encouraged, with the caveat that evidence for digital tools is still limited, recommending the importance of a patient- centered approach and shared decision-making. Lifestyle change is considered an essential component in the management of high blood pressure and hypertension.

Within this context, the need to control blood pressure values is expressed in order to reduce risks and contain the progression of the pathology, the inclusion of non-pharmacological approaches becomes imperative. Referring to the genesis of hypertension, there is an imbalance in the Autonomic Nervous System (ANS), which presents a sustained increase in sympathetic neural activity and a reduction in vagal modulation, implying a reduction in

baroreflex sensitivity, the heart's beat-to-beat blood pressure regulatory mechanism, generating a sustained increase in blood pressure (BP) values and the establishment of hypertension.