Sureerat Na Wichian et al. Effects of Music Embedded with Binaural and Superimposed Beats Controlling Hypertension in Older Adults: A Quasi Experimental Study Sureerat Na Wichian,* Jakkrit Klaphajone, Duangjai Phrompayak Abstract: Hypertension is a leading cause of premature death and disability worldwide. Controlling blood pressure to within normal limit is the most desirable goal but difficult to achieve. This quasi-experiment study aimed to test the effects of music embedded with binaural and superimposed beats on control of hypertension. Fifty-two older Thai adults with hypertension were allocated into either the experimental (n = 26) or control (n = 26) group. The experimental group received music embedded with binaural and superimposed beats at home during the day for 30 minutes per day, for at least 3 days a week over 4 consecutive weeks, while the control group did not. Systolic blood pressure and diastolic blood pressure were measured 4 times; before the intervention and 30 minutes after, at the third week of the intervention, and one week after complete the intervention. Data were analyzed using descriptive statistics, mixed model ANOVA, independent t-test, and one-way repeated measures ANOVA. Results indicated that after one week of completion the program, participants in the experiment group had significantly lower systolic and diastolic blood pressure than those in the control group, and participants in the experimental group had significantly lower systolic and diastolic blood pressure than before receiving the intervention program. These results indicate that music embedded with binaural and superimposed beats is an efficient complementary treatment to improve blood pressure control among older adults with hypertension. Nurses and other health care personnel can use this intervention program along with medications to help older adults with hypertension to better control their blood pressure but research with a wider sample in different parts of Thailand is recommended. Pacific Rim Int J Nurs Res 2021; 25(3) 345-358 Keywords: Binaural beats, Blood pressure control, Hypertension, Music therapy, Older adults, Superimposed binaural beats Received 5 April 2020; Revised 18 July 2020; Correspondence to: Sureerat Na Wichian, MNS., RN, (Teaching), Accepted 8 November 2020 Boromarajonani College of Nursing Buddhachinaraj, Phitsanulok, Thailand. E-mail: [email protected] Jakkrit Klaphajone, MD. Associate Professor, Faculty of Medicine, Introduction Chiang Mai University, Chiang Mai, Thailand. Duangjai Phrompayak, MNS., RN (Teaching), Boromarajonani College Hypertension is a leading cause of premature of Nursing Buddhachinaraj, Phitsanulok, Thailand. death worldwide.1 Many people have this condition without realizing it, for high blood pressure also brings stroke1 with escalating trend worldwide. According about other diseases such as myocardial infarction and to a survey of 180,335 people, there were 39.8% with Vol. 25 No. 3 345 Effects of Music Embedded with Binaural and Superimposed Beats Controlling Hypertension high blood pressure among those 45-54 years old Review of Literature and Conceptual whereas the prevalence in the age group of 65-74 and over 75 years old was 51.5% and 52%, respectively.2 Framework Hypertension is a major problem in the older adults The benefit of sound therapy can be explained that should be extensively managed. by the entrainment theory of binaural beats, superimposed There are two major types of treatments for high binaural beats and mechanism of sound therapy. This blood pressure among the older adults: pharmacological is using waves with a specific frequency to stimulate and non-pharmacological. In most cases, people will be the brain can induce brainwave frequency changes treated with antihypertensive drugs. Some experience following to those waves. The wave sources can be light the benefits of adjuvant non-pharmacological intervention 3 or sound. Various research articles have applied to the point where they can stop taking medication. This isochronic tones, monaural beats and binaural beats will help reduce possible side effects such as liver or or both (audiovisual stimulation).10 This study used kidney problems, metabolism alteration, and interrupted 4 a combination of binaural beats, superimposed binaural nutrient absorption. Complementary therapy such as beats and sound music. praying, meditating,5 slow breath training program,6 3 Mechanism of sound therapy: When the ears or using folk music are recommended. It has been perceive a sound, its energy is changed to electrical found that sound therapy is simple, practical, easy to energy in the brainstem and temporal lobe of cerebral learn, and does not have side effects. cortex.11 While the electrical energy is moving into Sound therapy is generally the use of music or the brain, it stimulates a physiological response related sounds with music elements (melody, rhythm, tempo, to sound waves, namely music sound and binaural beats.11 volume, pitch, tone, and harmony) as a therapeutic When the rhythm of binaural beats and superimposed tool to achieve individual treatment goal. Ideally the 7 binaural beats is perceived with different frequencies, songs and melodies have to be approved by experts. they will interact with each other.9 A music with a slow Sound therapy also includes rearranging songs and tempo makes the body adjust to save energy and melodies or creating new playlist of songs with changing consequently lower pulse and blood pressure.12 elements. Moreover, slow tempo music also enhances the alpha Various types of music can be used in music brainwave level which leads to relaxation, stimulates therapy. A previous study using sound therapy to pituitary gland to secrete endorphin.13 This makes a control blood pressure in the older adults reported only person happy and experience less pain. Music also music effects on controlling blood pressure such as 3 affects the parasympathetic nervous system which folk music, popular music, instrumental, and classical brings about muscle relaxation, reduced heart rates, Thai music.8 A study using binaural beats in older 5 deeper and more consistent breathing, reduced oxygen adults with insomnia and superimposed binaural beats 13 9 consumption and blood pressure. in student revealed more decreased anxiety. Therefore, Binaural beats (BB): The mechanism of BB in this study, the combined music with the binaural beats effect arises from bilateral input of slight sound beats and superimposed binaural beats as a therapeutic frequency difference via the ascending auditory sound was applied for 30 minutes per day to control pathway. BB act on the limbic system causing effects blood pressure in older persons. This method of study to mood, and on the brainstem changing the physiological has never been conducted in Thailand and could pave response including the brainwave entrainment. BB the way for a specific adjuvant therapy for treating can be created from the difference in the two pure high blood pressure in the future. 346 Pacific Rim Int J Nurs Res • July-September 2021 Sureerat Na Wichian et al. tones of constant frequency of less than 35 Hz.14 BB Apart from music embedded with BB and SBB are low-frequency sounds produced by the interference which could induce alpha brainwaves leading to improve of two carrier sounds with few different frequencies quality of rest and reduce blood pressure,15 having and can stimulate the brain through listening and by older adults sit in a comfortable position during sound conducting sound waves through the skull. If the therapy session for 30 minutes once a day, at least 3 frequency of sound presented to the left ear or passing days a week for 4 weeks would be likely to have through the skull is 305 Hz, and 295 Hz on the right, pronounced balancing in their blood pressure. the intracranial binaural beat frequency will be approximately 10 Hz (305 - 295 Hz).14 The brain Study Aim and Hypothesis wave at any active or awake state shows a majority of 30 Hz or beta wave in most parts of the brain, whereas This study aimed to test the effectiveness of during a relaxed state, brain wave frequency is mainly music embedded with BB and SBB on blood pressure in the alpha wave level or 10 Hz. In order to change among older adults with hypertension. The following the awake state to relaxed state, initial attunement with hypothesis was set: one week after completion of the a sound therapy with the beat frequency of about 30 intervention, both systolic and diastolic blood pressure Hz is preferred and then the beat frequency is gradually of the experiment group would be significantly lower changed to 10 Hz at the end of the song.9,15 than those in the control group, and be significantly Superimposed binaural beats (SBB) is a new lower than before receiving the intervention. binaural beat which is synthesized on the basis of frequent shifting of the sound waves from each musical Method instrument, except for drum sounds (due to their extremely low frequency), in addition to the original Design: A quasi-experimental design was used. BB created by the standard method of pure tone sine Sample and sample size: The population of wave-frequency differentiation. The binaural frequency this study consisted of both male and female older difference is kept constant despite changing frequencies adults >60 years with essential hypertension. The of the carrier sound waves.9 sample size was calculated by using a power analysis Mixed BB and SBB have been shown to effectively in which