Hypertension remains a significant global health challenge, often requiring lifelong management. While pharmacological treatments are standard, there is increasing interest in non-pharmacological interventions like resonant breathing. This technique, characterized by slow, rhythmic breathing at 4.5-7 breaths per minute, is thought to lower blood pressure by enhancing parasympathetic activity and restoring autonomic balance.

This study is a randomized, parallel-group controlled trial conducted in community rehabilitation centers in Lahore, Pakistan. A total of 50 participants diagnosed with stage I hypertension will be enrolled and allocated into two groups using a computer-generated randomization sequence with allocation concealment.

Participants in both groups will undergo standard physiotherapy consisting of general warm-up exercises and stretching, performed under supervision three times per week for eight weeks. The intervention group will additionally receive resonant breathing training, delivered as a structured breathing exercise performed for approximately 20 minutes per session.

Resonant breathing is a slow-paced breathing technique performed at approximately 4.5-7 breaths per minute with equal inhalation and exhalation phases. It is intended to improve autonomic balance by enhancing parasympathetic activity and reducing sympathetic nervous system dominance, thereby potentially improving cardiovascular and psychological outcomes.

Outcome assessments will be conducted at baseline and after 8 weeks. Primary outcomes include systolic blood pressure, diastolic blood pressure, heart rate, and perceived stress.

Blood pressure and heart rate will be measured using a validated automated digital sphygmomanometer. Perceived stress will be assessed using the Perceived Stress Scale (PSS-10).

Statistical analysis will be performed using SPSS version 26. Within-group comparisons will be analyzed using paired t-tests, while between-group comparisons will be assessed using independent t-tests. Effect size will be calculated using Cohen's d, with statistical significance set at p < 0.05.

Inclusion Criteria:

• Adults age 30-65 years
• Patients with hypertension stage I
• Patients with no serious comorbidities
• Not currently in any breathing therapy or rehabilitation programs

Exclusion Criteria:

• Age under 30 or over 65
• Patients with severe hypertension (stage II or III)
• Patients with serious comorbidities
• Patients taking medicines affecting blood pressure or heart rate
• Current use of tobacco or materials that may have an effect on blood pressure or stress level