Breathing Practices With Heart Conditions or High or Low Blood Pressure: Cautions

Urgent help first

Chest pain, or pain that spreads to the arm, neck, jaw, stomach or back, can be a sign of a heart attack, according to the NHS (United Kingdom).[1] MedlinePlus advises calling 911 if you have heart attack symptoms, even if you are not sure it is a heart attack.[2] The NHS also lists chest pain together with feeling sweaty, sick, light headed or short of breath as a reason for an emergency call.[1] Stop any breathing practice and get help. Do not try to breathe your way through these symptoms.

Who this page is for

This page is for people who have high blood pressure, low blood pressure, heart failure, a heart rhythm problem or another heart condition, and for anyone who cares for them. It is information only. It cannot tell you what is safe for your heart. Your cardiologist or primary care clinician knows your history, your medicines and your readings, so ask them before starting a new breathing practice.

Gentle, comfortable breathing is the only kind this library describes. Forceful, fast or breath-holding styles are covered only as cautions, on the page about intensive breathwork and the page on who should not do intensive breathwork.

High blood pressure: what trials of slow breathing found

High blood pressure usually causes no symptoms, and the only way to find out whether you have it is to have it measured.[1] That matters here: feeling calm after a breathing session tells you nothing about your readings. The NHS says a reading of 140/90 or higher at a clinic counts as high.[1]

1. Does regular slow breathing lower blood pressure?

   Unclear

   A 2019 meta-analysis of 17 trials (people with high or borderline-high blood pressure, or on blood pressure medicine) found an average drop of about 5.6 mmHg (systolic) and 3.0 mmHg (diastolic). It included device-guided and non-device (pranayama) methods.[3] Heterogeneity, meaning how much the trials differed, was high.[3]

   Promising but limited

2. What do the summaries say?

   Unclear

   NCCIH says the studies differed in how they were done, had short follow-up and a high risk of bias.[4] They did not look at health outcomes such as stroke or heart attack.[4]

   Surrogate outcome only

3. Do breathing devices work?

   Unclear

   A 2012 meta-analysis of device-guided breathing found small drops, but five of the eight trials were sponsored by or involved the device makers.[5] Without them there was no overall effect on blood pressure.[5] The authors asked for longer, independent trials.[5]

   Mixed; industry involvement

4. How do experts rate it overall?

   Unclear

   A 2019 review of systematic reviews rated the evidence generally low and gave weak recommendations for most non-drug therapies, including device-guided breathing.[6]

   Low certainty

Breathing trials cannot be blinded, so expectation may play a part in self-reported outcomes. Blood pressure itself is measured, which helps, but the trials were short.

NCCIH notes that the 2019 reviewers suggested slow breathing may be a reasonable first treatment for people with prehypertension or low-risk high blood pressure.[4] Whether you are in that group is a decision for you and your clinician. NCCIH also stresses following the treatment plan your provider prescribed, and discussing any complementary approach with them.[4] Most blood pressure medicines are taken once a day,[1] so do not skip or change them because you are practicing breathing.

Low blood pressure and dizziness

The NHS defines low blood pressure as a reading under 90/60 mmHg. It can cause lightheadedness or dizziness, and some people feel it on standing up (postural hypotension).[7] For some people it is simply normal, for example because they are fit and healthy.[7] Breathing too fast or too deeply lowers carbon dioxide in the blood, and MedlinePlus lists feeling lightheaded or dizzy among the results.[8]

So if you already tend to feel dizzy, practice sitting or lying down, keep the breathing easy, and stand up slowly afterward, as the NHS suggests for everyday low blood pressure.[7] Our page on dizziness, tingling and fainting during breathing exercises explains the causes.

One small lab study in 16 healthy young adults found that breathing at six breaths a minute lengthened the time before near-fainting during a tilt test.[9] That is a physiology result in healthy people, not advice for anyone with low blood pressure. Proper evidence not found for slow breathing practice as a treatment for low blood pressure or postural hypotension in patients; we searched PubMed for slow breathing and orthostatic hypotension and found only that healthy-volunteer study and a heart failure study described below.

Heart failure

A 2026 meta-analysis of seven trials (246 people with chronic heart failure) found that breathing training combined with aerobic exercise improved exercise time and quality of life, with no significant effect on measures of heart function.[10] The authors said the number and quality of studies were limited and that findings need confirming.[10] These were structured programs, not self-guided practice.

In a 40-person open crossover trial of device-guided slow breathing in treated heart failure patients, the share who developed a drop in blood pressure on standing was low (10%) and did not change during the study.[11] The authors said the results should be confirmed in a larger sample.[11] Open trials without blinding are weak evidence.[11]

Heart failure treatment plans usually include medicine,[12] and breathing practice does not replace it. The NHS advises seeking an urgent appointment if you feel breathless when lying down or during everyday activity.[13]

Heart rhythm problems

Symptoms of an arrhythmia can include a fast, slow or fluttering heartbeat, dizziness or fainting. MedlinePlus advises emergency care for chest pain or shortness of breath.[14] Proper evidence not found on whether self-directed breathing practice is safe or helpful in arrhythmia: we searched PubMed for slow or paced breathing with arrhythmia and atrial fibrillation and found no trial we could read. Ask your cardiologist.