Non-invasive sound therapy may reduce blood pressure

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Patients with high blood pressure can make lifestyle changes and take medication, but the latter may bring side effects such as dizziness, headaches and dry mouth. Researchers at Wake Forest School of Medicine are studying another possible solution: balancing brain frequencies with sound to reduce blood pressure. The technique helped decrease a small study group’s systolic blood pressure by 16 mmHG (millimeters of mercury). Although study findings are early, the technique hasn’t resulted in any detectable side effects.

The Wake Forest team has studied the technology, known as HIRREM (high-resolution, relational, resonance based, electroencephalic mirroring), for multiple symptoms, including insomnia, military-related stress, and concussion in athletes and published five studies. For their work on hypertension, which was presented on Sept. 15 at the American Heart Association's Council on Hypertension 2016 Scientific Session, researchers looked at a subset of individuals enrolled in other projects. The 10 enrollees all had existing hypertension. The group was divided evenly by gender and had a mean age of 47.2.

HIRREM is a noninvasive closed-loop feedback technology that uses sensors placed on the scalp to measure brain electrical activity and identify right-left imbalances. The Wake Forest team purchases the devices, which have been available commercially for at least 10 years, from Brain State Technologies in Scottsdale, Arizona. The technology is not classified as a medical device but used as a modality for relaxation, and Wake Forest is the first to apply it for a medical model for research.

“There’s a lot of ways people are trying to engage the brain,” Dr. Charles H. Tegeler IV, professor of neurology at Wake Forest Baptist Health and principal investigator for the HIRREM research team, told “As far as I can tell, this is unique in the approach.”

Previous studies on alternative therapies, such as meditation, diet and exercise, haven’t shown the gains that the Wake Forest team has found, said Dr. Raymond R. Townsend, director of the hypertension program at the Hospital of the University of Pennysvlania, who was not involved in the research. For example, with yoga, researchers have seen 2 to 4 mmHG blood pressure improvement after six to 12 weeks. With sound therapy, the team saw a 16-point improvement over 10.2 in-office visits.

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“I’ve got to admit, it’s intriguing. There are a number of things happening that are utilizing ways to capture brain activity and try to do something with it,” Townsend told “There’s some plausible science underneath it.”

“I’m holding my breath here for the future,” he added. “I still think it’s an intriguing observation about the imbalance they can detect with electrodes on the surface in the skull and the use of tones to align discordant degrees of activity.”

Tuning an instrument

Once patients are enrolled, researchers conduct an assessment of their brains’ electrical pattern. They place sensors on different parts of their heads, and record data when patients’ eyes are closed, partially open and fully open to monitor brain activity at rest and while interacting with the environment.

Then they start the 90- to 120-minute sessions using paired sensors on the scalp that track brain electrical frequency and amplitude. A computer identifies the dominant frequency, which a software algorithm translates into an audible tone. Within eight milliseconds, the tone is replayed to the patient through earbuds.

“Your brain constantly changes. What you hear is a series of tones in your ear— figuratively speaking, it gives you the chance to hear the song your brain is playing,” Tegeler said. “Somehow that rapid updating allows the brain the opportunity to autocalibrate and relax, or reset from a stuck pattern.”

With this subgroup of patients, researchers observed brain shifts that balanced electrical activity and reduced hypertension. After an average of 17.7 HIRREM sessions over 10.2 in-office visits, hypertensive patients showed an average reduction in their systolic blood pressure from 152 to 136 mmHG and a reduction of diastolic pressure from 97 to 81 mmHG. According to the Centers for Disease Control and Prevention (CDC), normal blood pressure levels are a systolic level less than 120 mmHg and a diastolic level less than 80 mmHg.

With all of their projects with HIRREM, researchers observed that changing the brain’s stress response pattern improved downstream autonomic cardiac function and heart rate and decreased systolic blood pressure.

Tegeler likened the HIRREM process to a musical instrument tuning itself.

“What we see, with no conscious cognitive activity, no trying to train the brain to do something, the brain will shift on its own,” he said. “What we have come to expect now, in five years of work and over 400 people in all these studies, is we expect to hear about reduction in symptoms of … insomnia, depression, stress and anxiety. [We also see] many specific things like migraine, athletes’ persistent concussions, PTSD, even ADHD.”

Researchers used different protocols in which the individuals’ eyes were open and they were allowed to sit up and read, or their eyes were closed. Regardless of the scenario, study authors saw the same positive effect.

The hypertension project did not have a control group of participants, Tegeler noted, but in other studies they have used a randomized trial with a control group on a waitlist and a sham experiment wherein the tones are randomly generated and not related to brain waves.

Tegeler and his team have not seen any serious adverse events or side effects in the over 400 people they’ve enrolled in their various HIRREM studies.

However, Townsend said that doesn’t mean the technique is risk-free and noted further study would be needed to confirm HIRREM’s safety. With Vioxx, for example, it took 18 months before doctors realized it was causing small but definite increases in cardiovascular death. The NSAID was withdrawn from the market.

“You find what you’re looking for,” he said. “If you don’t ask, you don’t find them.”

For their blood pressure research, the team followed participants for one to two weeks after their sessions. With other projects, they’ve followed patients for as long as six months.

While the long-term benefit of using HIRREM to manage blood pressure has yet to be studied, the short-term reduction in hypertension is probably not a harmful thing, Townsend said.

Letting the brain get ‘unstuck’

Normally, the brain’s electrical activity is fairly well balanced, but when faced with a threat, it has to use its fight-or-flight survival responses.  With repetitive threat and trauma, the brain’s plasticity can shift its patterns, leading to getting stuck in a dysfunctional pattern of the autonomic system, which controls involuntary actions such as heartbeat, and a widening and narrowing of blood vessels.

“In essence, your accelerator is stuck all the time,” Tegeler said. “The result is maybe you can’t sleep, can’t focus, maybe you have blood pressure issues.”

HIRREM therapy allows the brain a chance to “rest and get unstuck from those patterns,” he said, adding that this change has been observed to go with improved cardiovascular regulation.

When it comes to blood pressure, Townsend calls the brain the “final frontier,” because the involuntary nervous system is one of the more important controllers of blood pressure and heart rate, but currently available drugs are inadequate.

“They either don’t get in there because the blood-brain barrier prevents [absorption] or the drugs are like using a 12-gauge shotgun to shoot a mosquito— they wipe out everything,” he said.  “Around the world, the spectrum of standard of living, blood pressure is the single most important factor that predicts premature death or disability from damage like heart attack, stroke, kidney failure. It outranks everything else in the World Health Organization list, including tobacco, alcohol, low birth weight and unsafe sex.”

As for their work with HIRREM, Tegeler hopes to get funding for a multi-center study and to share their protocols with other institutions.

“People are looking at all kinds of other non-invasive kinds of practices, such as yoga, mindfulness meditation,” Tegeler said. “I think there’s great interest among the populace, as far as some of these other kinds of approaches.”