Music versus lifestyle on the autonomic nervous system of prehypertensives and hypertensives—a randomized control trial

doi:10.1016/j.ctim.2015.08.003

Complementary Therapies in Medicine

Volume 23, Issue 5, October 2015, Pages 733-740

https://doi.org/10.1016/j.ctim.2015.08.003 Get rights and content

Highlights

•
Ragas of Indian music are said to be beneficial in normalizing blood pressure (BP).
•
Listening to raga bhimpalas and lifestyle modifications was the intervention used.
•
Stress levels and diastolic BP reduced after music intervention.
•
Heart rate variability showed a trend towards higher parasympathetic activity.
•
Males were particularly benefited by the intervention given.
•
A better autonomic balance may play a role in normalizing BP.

Abstract

Objectives

Ragas of Indian music are said to be beneficial in normalizing blood pressure (BP). The objective of this study was to evaluate the effect of passive listening to relaxing raga on the autonomic functions of hypertensives and prehypertensives and provide scientific evidence.

Methods

Ethical clearance was obtained from the institutional review board. A prospective, randomized controlled trial was done on hundred prehypertensives/stage I hypertensives, randomly divided into two groups (n = 50 in each). Group 1 received music intervention along with lifestyle modifications while Group 2 received only lifestyle modifications (according to Joint national committee VII guidelines). Group 1 listened to raga bhimpalas played on flute for 15 min daily for at least 5 days/week for 3 months. The main outcome measures were heart rate variability (HRV) (Power lab 15T, AD Instruments), BP and stress levels (State Trait anxiety inventory score). All HRV variables were log transformed for analysis. Statistical analysis was done using SPSS version 18.0 with P < 0.05 being considered statistically significant.

Results

Group 1 exhibited significant reduction in stress levels, diastolic BP and systolic BP decreased in Group 2 after intervention. Insignificant rise in parasympathetic parameters of HRV (SDNN, RMSSD, HF ms², HF nu) was seen after intervention in both the groups. We found significantly increased parasympathetic and lower sympathetic parameters (LF ms², LF nu, LF/HF) in Group 1 and 2 males and females of Group 2. The results suggest that females of Group 1 were least compliant with the given intervention.

Conclusions

Passive listening to Indian music along with conventional lifestyle modifications has a role in normalizing BP through autonomic function modification and thus can be used as a complementary therapy along with other lifestyle modifications.

Introduction

Hypertension, a multifactorial chronic disease, resulting from a complex interplay of various causative factors like the individual's genetic background, lifestyle, psycho-social factors, and exposure to various environmental toxins. Over time, this dynamic interplay leads to adverse structural and functional changes in the cardiovascular system, culminating in disease manifestation.1, 2 Among the myriad factors, psychosocial stress has been implicated to contribute significantly to hypertension.

Stress can be relieved via both pharmacological and non-pharmacological measures. The various non-pharmacological methods used recently to manage stress and high blood pressure (BP) include meditation, yoga, acupressure, biofeedback and music therapy. Combinations of the above, along with lifestyle modification modalities such as balanced nutrition, exercise and weight control would obviate the need for medications in many cases of stress-related hypertension.3, 4

Music has long been known to reduce anxiety and minimize the need for sedatives. Thus, it holds promise for non pharmacological management of hypertension. Listening to music, offers advantages of low cost, ease of administration, better compliance and safety. Hypertensive individuals can use music for stress reduction via active music making,⁵ as well as passive listening. Time and again, studies have proven the beneficial effect of music on hypertensives.6, 7, 8, 9, 10

Cardiac autonomic regulation is studied through non-invasive measurement of Heart rate variability (HRV), beat-to-beat alteration in heart rate (HR). A decrease in HRV is a strong predictor of mortality after acute myocardial infarction.¹¹ In the Framingham study, all time domain and frequency domain variables of HRV were reduced in untreated hypertensive men and women.¹² Hypertensives had greater LF (low frequency) nu (normalized units) and lower HF (high frequency) nu than normotensives.¹³

Music influences both physiological and psychological health, mainly by creating a balance in the autonomic functions.¹⁴ It has been quoted that autonomic nervous system “forms a sort of sounding-board, which every change of our consciousness, however slight, may evoke reverberations”.¹⁵ Whether music causes an increase or decrease in HR, remains a mystery.16, 17 Several studies reported that under various conditions music decreases sympathetic nervous system (SNS) and increases parasympathetic nervous system (PNS) activity as measured by HR and HRV, indicating physiological relaxation.17, 18, 19, 20, 21, 22, 23 A few investigations revealed no difference in HR or HRV,24, 25 while others have also reported an increase in HR.21, 26

We thus observe that there is varying literature available on the effects of music on HRV and the mechanism behind it. And, most of them have looked into acute effects of music on the heart. Very few of them have used music as an intervention and studied the effect of the same over a longer time on autonomic activity. The objective of this study was to evaluate the effect of passive listening to relaxing instrumental music (Indian) intervention on the autonomic functions of hypertensives and prehypertensives. We hypothesized that this would produce a relaxing effect on the ANS among prehypertensives and hypertensives.

Section snippets

Study design and source of subjects

After the study was ethically cleared by the institutional ethical and scientific review board a prospective open labelled randomized control trial (parallel group) was conducted. The study protocol was explained and informed consent was obtained. The subjects were informed about their rights to withdraw their participation from the study. Subjects aged 30–60 years were recruited from the out-patient department of a tertiary care hospital. BP was measured twice with a gap of 5 min in between

Results

Out of 100 subjects recruited, 7 subjects were lost during follow up. The two groups were comparable based on age, gender, stress levels, smoking and alcohol history on recruitment. Twelve and 14% of the subjects were smokers and 22 and 32% were current alcoholics in Group 1 and Group 2 respectively. No change was observed in history for smoking and drinking during or after intervention. Disease history or drug history did not vary significantly in both the groups after intervention (Table 1).

Discussion

In this study we hypothesised that relaxing music would create better autonomic balance among prehypertensives and hypertensives. Lifestyle modifications recommendation as per JNC VII guidelines was given to both the groups. In addition to that Group 1 received music intervention in the form of Indian instrumental classical music heard by all the subjects for a duration of 3 months.

The music we used was Indian instrumental music played on flute for 22 min based on raga bhimpalas, to be heard for

Conclusions

The results of this study further emphasize the fact that even passive listening to Indian music along with conventional lifestyle modifications does have a role in normalizing blood pressure, particularly diastolic BP. We found higher parasympathetic activity after music intervention. One of the results of music could be achieving a better autonomic balance. Thus, music can be included as an adjunct or complementary therapy along with JNC VII recommendations. There is however, a need for long

Conflict of interest

None declared.

Funding

This research was supported by non-communicable diseases division, Indian Council for Medical Research, New Delhi, Government of India [Grant number—2010-13440].

Acknowledgments

The authors acknowledge Indian Council of Medical Research (ICMR), New Delhi for funding the project and Vidhwan Pravin Godhkhindi for the musical piece. We also wish to thank all the participants of this study for volunteering and cooperation.

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Jue tone is a kind of sound, using 3-mi as the main tone, and is melodious, profound, makes people feel comfortable and pleasant. This study aimed to explore the probable mechanism of Jue tone to reduce blood pressure (BP) in hypertensive rats with a liver-fire hyperactivity pattern by observing changes in BP as well as physiochemical indexes in plasma.
Sixteen male spontaneous hypertensive rats (SHR) with a liver-fire hyperactivity pattern were randomly divided into a control group and a Jue tone group. The rats in the Jue tone group were treated with Jue tone (55–65 dB, played by the five elements of music rhythm instrument, a kind of physiotherapy regimen music played by Shen Wu) once a day for 4 weeks. The BP levels in each group were measured twice a week, on Monday and Friday. The levels of angiotensin II (Ang- II), thromboxane B2 (TXB2), endothelin-1 (ET-1), calcitonin gene-related peptide (cGRP), norepinephrine (NE), cortisol (CORT), and 5-hydroxytryptamine (5-HT). in plasma were detected by enzyme-linked immunosorbent assay after 4 weeks of intervention.
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On the one hand, exposure to music enhances positive cardiac responses [9,11,12]. On the other hand, there are anxiolytic effects of musical auditory stimulation leading to decreased consumption of sedative medications [11–13]. The autonomic nervous system (ANS) function is fundamental to adjust the inherited body functions for establishing and maintaining homeostasis to adapt to the surrounding conditions [14].
and purpose: The impact of music on the human body extends beyond an emotional response. Music can bring benefits to the cardiovascular system by influencing heart rate variability (HRV), which is a well-accepted method to analyze the oscillations of the intervals between successive heartbeats and investigate the cardiovascular autonomic nervous system (ANS). This study is a systematic review to examine the effect of musical interventions on HRV.
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29 original articles (24 pre-post intervention studies and five randomized controlled trials) with a total of 1368 subjects were available and eligible to be included in the systematic review. Within the whole, only three studies reveal no significant impact of music on HRV, which might be due to using a small sample size and a concise duration of music administration. Interestingly, the rest of the studies have suggested a positive impact of music on HRV with a 0.05 level of significance.
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View all citing articles on Scopus

View full text

Music versus lifestyle on the autonomic nervous system of prehypertensives and hypertensives—a randomized control trial

Highlights

Abstract

Objectives

Methods

Results

Conclusions

Introduction

Section snippets

Study design and source of subjects

Results

Discussion

Conclusions

Conflict of interest

Funding

Acknowledgments

Trends Pharmacol Sci

Prim Care

Rev Esp Cardiol

Comp Ther Med

Trends Cognit Sci

Appl Nurs Res ANR

Intensive Crit Care Nurs Off J Br Assoc Crit Care Nurs

Int J Psychophysiol Off J Int Organ Psychophysiol

J Am Colloid Cardiol

Int J Psychophysiol Off J Int Organ Psychophysiol

Int J Psychophysiol Off J Int Organ Psychophysiol

J Psychosom Res

The triple helix—gene, organism and environment

Heredity

Stress and hypertension

WMJ Off Publ State Med Soc Wis

Music interventions for preoperative anxiety

Cochrane Database Syst Rev

Effects of audio relaxation programs for blood pressure reduction in older adults

Eur J Cardiovasc Nurs J Work Group Cardiovasc Nurs Eur Soc Cardiol

Implementation of MP3 player for music therapy on hypertension

Conf Proc Ann Int Conf IEEE Eng Med Biol Soc

Treating hypertension with a device that slows and regularises breathing: a randomised, double-blind controlled study

J Hum Hypertens

Reduced heart rate variability and new-onset hypertension: insights into pathogenesis of hypertension: the Framingham Heart Study

Hypertension

Sympathetic predominance in essential hypertension: a study employing spectral analysis of heart rate variability

J Hypertens

What is an emotion?

Mind

Heart rate in professional musicians

J Occup Med Toxicol Lond Engl

An Investigation into the Physiological Effects of Music of the Patients Choice Played During Osteopathic Treatment

Integral Transforms for Engineers