Hypertension Journal

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Yoga and Hypertension
Yoga and Hypertension
1Sunita Tiwari, 2Arvind K Pal
1Head, 2Senior Resident
1,2Department of Physiology, King George's Medical UniversityLucknow, Uttar Pradesh, India
Corresponding Author: Sunita Tiwari, Head, Department ofPhysiology, King George's Medical University, Lucknow, UttarPradesh, India
e-mail: sunita_kgmu@yahoo.com
High blood pressure (BP) is a major public health problemworldwide. It is an important risk factor for acute myocardialinfarction, cerebrovascular disease, chronic renal failure,and congestive heart failure. Lifestyle modifications play animportant role in prehypertensive individuals and also act asan adjunct to antihypertensive therapy. Yoga practices havebeen shown to be effective in reducing BP in hypertensivepopulation. The probable mechanism by which yoga reducesBP is by reduction in sympathetic activity, facilitating autonomicbalance, which reduces chemoreceptor responses, andenhancing baroreflex sensitivity. Yoga is also effective as anadjunct therapy in reducing antihypertensive medication use.There is a need for recognition of yoga by our health systemas a complementary therapy for treating hypertension (HPT).
Keywords: High blood pressure, Lifestyle modification, Yoga.
How to cite this article: Tiwari S, Pal AK. Yoga and Hypertension.Hypertens J 2017;3(4):189-192.
Source of support: Nil
Conflict of interest: None


Hypertension is an important health problem worldwide.1 Hypertension is defined as the BP level thatincreases the vascular risk substantially to requireintervention. Normal systolic BP (SBP) ranges between100 and 140 mm Hg and diastolic BP (DBP) between60 and 90 mm Hg. It is estimated that HPT affectsmore than 36% of the adult population in the southeastAsia region. It is responsible for 9.4 million prematuredeaths and 64 million disability-adjusted lifeyears every year.2 It is estimated that, by the year 2025,1 in 3 adults worldwide (approximately 1.56 billionpeople) will have HPT.3

High BP is an important risk factor for acute myocardialinfarction, stroke, chronic renal failure, arterialaneurysm, and congestive heart failure. Every incrementalrise of 20/10 mm Hg in BP increases the risks of mortalityand morbidity associated with cardiovascular and cerebrovascular diseases.4-7 Antihypertensive therapyis associated with a reduction in the stroke incidence of35 to 40%, myocardial infarction incidence for 20 to 25%,and heart failure for more than 50% of patients.2

Approximately 90 to 95% of the cases of high BP isprimary HPT; the rest are categorized as secondary HPT.Secondary HPT refers to HPT secondary to renal, endocrine,or nervous system diseases. The prevention andmanagement of high BP is a major public health challenge.Over a period of time, many antihypertensive drugswere developed for lowering BP. Epidemiological evidenceprovides clear evidence that lowering the BP canremarkably reduce the risk of cardiovascular mortalityand morbidity. Treating high BP also slows down theprogression of retinopathy, renal disease, and all-causedeaths.8

However, the long-term use of antihypertensivedrugs will produce side effects, and may even produceresistance and affect therapeutic efficacy.4 Therefore,seeking an alternate method of treatment is an importantissue in BP therapy. Lifestyle modifications play arole in preventing HPT in prehypertensive individuals.It also plays an important role before the start of drugtherapy in hypertensive individuals, and acts as anadjunct to drug therapy.9 Lifestyle modifications alonecan reduce SBP up from 3 to 32 mm Hg and DBP from2 to 18 mm Hg.10 Complementary and alternative medicinein the form of yoga are recommended for loweringBP in hypertensive patients. Yoga has been shown to beuseful in managing HPT, cardiovascular disease (CVD),and diabetes.11-13

The term yoga comes from the Sanskrit word "YUG,"which means yoke or union. Yoga is a total science ofstrengthening and improving the physical, mental, andspiritual states of being. The disciplines pertaining tothe physical aspects of yoga focus on improving thehealth and augmenting the strength of the body. Yogictechniques include the practice of pranayama or breathingexercise, asana or specific postures, and meditation.

The classic yogic practices include hatha yoga, karmayoga, chi yoga, kundalini yoga, and raja yoga. Chi yoga isrelated to a culture of knowledge, hatha yoga includes thespirit system and the body system; karma yoga advocatesthe inner practice leading to perfect behavior, and rajayoga is related to mind and breath.

Hatha yoga has become increasingly popular, inrecent years, for improving quality of life, dealing with stress and a number of psychiatric and psychosomaticdisorders as well as improving psychological function.14Hatha yoga includes a diverse range of mind-body practices,such as breathing practices (pranayama), meditationtechniques (dhyana), and physical postures (asanas).15The probable mechanism by which yoga may reduce BPis by inducing slow rhythmic proprioceptive and exteroceptiveimpulses.

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It also reduces peripheral adrenergic activity, facilitatesautonomic balance, which reduces chemoreceptorresponses, and enhances baroreflex sensitivity.16-18 Yogahas been used to reduce high BP and help to effectivelymanage obesity, lipid profile, glycemic control, and otherCVD risk factors.

Yoga can be used for the treatment of many stressinduceddisorders like anxiety, insomnia, depression, andbronchial asthma. Yoga has also improved many metabolicfunctions, such as carbohydrate metabolism, lipidprofile, and BP. Health care workers have now becomeaware of yoga for its ability to improve various healthconditions. However, still, yoga has not been widely usedfor reducing high BP.

Studies have demonstrated the value of total bodyrelaxation postures, Savasana, for HPT.19,20 For seekingthe best clinical evidence of yoga in making decisionsfor hypertensive patients, an increasing number of metaanalysisand systematic reviews have been conducted toknow the efficiency of yoga for controlling HPT.

It is demonstrated that yoga could reduce risk factorsof HPT like high cholesterol, overweight, high glucoselevel and also reduce BP.21-23 A review study suggesteda definitive role for yoga in the primary and secondaryprevention of ischemic heart disease.24 However, a systematicreview concluded put forth strong evidence thatthe benefits of yoga in conjunction with other medicationhelp in the prevention and treatment of coronary heartdisease, but it also showed that yoga alone leading toreductions in BP was poor.25 Another systematic reviewfound the beneficial effects of yoga for people with metabolicsyndrome.22 A subset analysis of the above studiesfound that in individuals with metabolic syndrome, yogapractice was helpful in producing short-term reductionsin BP.22 A further review found evidence for the efficacy ofyoga in significant reductions in body weight, cholesterol,and blood glucose as well as in reducing BP.26

One review reported benefits of yoga for hypertensivepatients. Yoga was cheaper than pharmacological therapiesand, despite there being very few randomized controlledtrials , the review suggested that yoga may serveas an alternate to drugs in controlling HPT.21 Anotherreview study on yoga and HPT revealed that a diversityof yoga practices were consistently effective in reducingblood cholesterol, blood glucose, and body weight.27

Research performed over the past 40 years with variousyoga interventions, including studies with differentexperimental designs, consistently reported reductionsin BP together with reductions in other cardiovascularrisk factors, such as lipid profile, glycemic index, weight,and heart rate.

The BP reductions reported with yoga were foundin diverse populations, including adolescents and theelderly as well as both normotensive and hypertensivepopulations and unfit and athletic individuals.Yoga not only reduces BP in hypertensive patients, butalso reduces the dose of medications already takenby patients. Yoga practices generally lead to a calm,quiet, hypometabolic, meditative state associated withautonomic balance and characterized by positive physiologicalchanges and improved cardio, circulatory, andrespiratory functions.

Therefore, yoga may influence BP through reducingthe stress response, increasing parasympathetic activation,and altering baroreceptor sensitivity. Rise in BP is apart of the sympathetic response that is associated withtension, aggression, excitement, anxiety, and anticipationin stressful situations.28 Substantial evidence has alsobeen shown that sympathetic activation and psychologicalstress are important risk factors for coronary arterydisease, HPT, and cardiovascular mortality.29,30 Evidencehas also shown that individuals who exhibit exaggeratedcardiovascular response during mental stress areat increased risk for developing HPT in future.31,32 Yogatechniques are associated with reduction of basal cortisoland catecholamine secretion, a decrease in sympatheticactivity, with a corresponding increase in parasympatheticactivity.33 Other such evidence suggests thatyoga also improves autonomic stability in diabetic andhypertensive individuals.16 Many different yoga practicesadapted or individualized by teachers and practitioners,but having a common element for these practices appearto be the practical application of mind-body integration,with the use of the breath as a focus for the link betweenbody and mind.

It is still not clear, however, which aspects of yoga aremore important in reducing BP. The variations of yogapractices and lack of standardized research make it difficultto formulate clinical guidelines or prescriptionsinvolving yoga. This difficulty is acknowledged in theguidelines of the British Hypertension Society, whichstates that "interventions to reduce stress management,meditation, yoga, cognitive therapies, breathing exercises,and biofeedback have been shown to result in short-termreductions in BP, but the interventions studied have beenso varied, it is difficult to be prescriptive with regardto an effective strategy."34 Thus, while these guidelinesdiscuss the importance of lifestyle modifications for all hypertensive patients, they focus on aerobic exercise,dietary control, weight reduction, smoking cessation,alcohol reduction, salt restriction, and do not mentionyoga, relaxation, or other stress-reduction practices.


Yoga and Hypertension

The Canadian Hypertension Education Program doesrecommend stress management in the form of cognitivebehavioral interventions in hypertensive individuals inwhom BP elevation is due to stress, but does not consideryoga as a stress-management strategy.35


Yoga practices have been shown to be effective in reducingBP in hypertensive population.

Yoga is also effective as an adjunct therapy in reducingantihypertensive medication use. It appears that yoga ismost commonly used as a spiritual and personal developmentpath for specific medical conditions, and this hasresulted in many different yoga practices being used.

The lack of long-term studies, standardized protocols,and conclusive results from meta-analyses makesit difficult to recommend any specific yoga practice forHPT, and this has resulted in stress-reduction strategies,such as meditation and yoga, being omitted fromclinical HPT guidelines. Physicians are reluctant torecommended yoga for their hypertensive patient, ifthey cannot ensure the quality or relevance of particularyoga practices.

Yoga alone or combined with medication has beenwidely used for treating HPT. There is a need to providebetter recognition of yoga by the health system, which canserve as a complement to conventional medical therapy.Future research should focus on high-quality clinicaltrials with standardized yoga practices and long-termfollow-up, together with possessing the knowledge of themechanisms of action of different practices.

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