An exploratory, ecological, clinical investigation of relationships among heart rate variability, blood pressure and respiratory sinus arrhythmia biofeedback in a hypertensive patient with chronic stress syndrome: Private practice generated data and findings from a Universal Clinical Trial pilot site

Roland Carlstedt, PhD, ABSP

McLean Hospital – Research Associate

Scientific Abstract


A hypertensive patient with chronic stress syndrome was trained to self-monitor heart rate variability (HRV) and blood pressure (BP) and engage in respiratory sinus arrhythmia biofeedback (RSA) to lower BP and increase HRV. The aim of this study was to determine the extent to which HRV may impact BP and vice-versa at baseline and in the context of individual differences mediated RSA performance. RSA is a well established intervention in which patients are trained to mechanistically induce and condition cyclic patterns of breathing that are designed to facilitate vasodilation to reduce BP, increase HRV and reduce the hyper-sympathetic nervous system activation that is associated with chronic stress. This study was part of a Universal Clinical Trial in Mental Healthcare for Private Practices pilot initiative. The UCT initiative advances clinician and patient technology and biomarker-guided monitoring, assessment and intervention efficacy analytics in an attempt to bring more analytic accountability to the therapeutic process.


 The patient self monitored his BP and HRV each morning and evening after work for a period of 3 months. Three Protocols were carried out: I. AM. vs. PM BP & HRV; II. RSA with pre & post-2 minute HRV; III. Pre-RSA HRV vs. HRV during RSA.


Protocol I: paired sample t-tests revealed that AM. heart rate (HR) was significantly different (SDiff) than PM. HR (77 vs. 72 p < .001) a conceptually inconsistent (CI) finding; AM low-high ratio (LH) HRV was SDiff than PM LH (5.7 vs. 3.2 p=.002) a CI finding. Protocol II: Pre RSA Systolic BP vs. Post RSA SYS-BP was SDiff (132 vs. 129, p=.02) a conceptually consistent (CC) finding. Protocol III. SDNN-HRV and Very Low Frequency HRV (VL) during RSA was Sdiff than Pre-RSA SDNN and VL (341 vs.150 & 75 vs. 79 respectively; (p <.001 for both) CC findings. Additional exploratory and clinically significant findings of note will be noted in the full presentation.


This investigation revealed both conceptually consistent and inconsistent BP and HRV responses in baseline, pre and post and during RSA conditions that will be elaborated on in the full presentation.


Live Zoom Session – March 9th

research Areas


Roland A. Carlstedt, PhD, Megan Clarke, MS, Kylie Dykgraaf

Principal Investigator

Roland A. Carlstedt, PhD