Yoga as a non pharmacological alternative or complementary therapy for

hypertension

Manoj Sharma, MBBS, Ph.D.

Session 3083; Board 1; Monday, October 31, 2011; 10:30 am

Introduction

Hypertension is an important risk factor for heart disease and stroke. Treatment of hypertension reduces this risk.

The Healthy People 2020 objective is to increase the proportion of adults with high blood pressure whose blood pressure is under control.

Prevalence of Hypertension

Prevalence of hypertension in the United States based on the data from NHANES 2007-2008 indicate 29% people have hypertension (95% CI: 27.6% - 30.5%) defined as systolic blood pressure ≥ 140 mm Hg or diastolic blood pressure ≥ 90 mm Hg.

Blood pressure was controlled in approximately 50.1% (95% CI 46.8% - 53.5%) of all patients with hypertension based on NHANES 2007-2008 data.

Not all patients accept pharmacological therapy.

Characteristics of yoga users

2002 National Health Interview Survey (NHIS) found about 5.1% of US population or over 14 million people were yoga users

85% Caucasians 76% females Means age of 39.5 years Hypertension was associated with lower use

(OR 0.78; 95% CI: 0.64-0.95)

Stages of Ashtangayoga

Yama: Techniques for successful living in society Niyama: Techniques for managing and purifying self Asaana: Postures for physical homeostasis & mental balance Pranayama: Breathing techniques for physical homeostasis &

mental balance Pratihara: Techniques for developing dispassion toward senses for

mental balance and equanimity Dharana: Concentration techniques for mental balance and

equanimity Dhyana: Meditation techniques for mental balance and equanimity Samadhi: Universal consciousness

Purpose

The purpose of this study was to examine whether yoga is beneficial as a non pharmacological alternative or complementary therapy for hypertension.

Methods

The method used in this study was a systematic qualitative review of interventions obtained from MEDLINE, CINAHL, & ERIC databases.

The criteria for including studies were: publication in English language, publication between 1975 and 2010, studies that measured blood pressure as an outcome, and studies that used yoga (from any school) as an intervention.

Results

A total of 16 articles met the criteria with one study reporting two interventions.

Eight interventions were from India, five from United Kingdom, three from United States, and one from Thailand.

Only five interventions used randomized controlled trials.

All the interventions demonstrated statistically significant beneficial effects of yoga on hypertension.

Studies 1, 2 (with 2 studies): 1975

Design n Duration Approach Res. Country

Age and sex matched control design

40 12 months

Relaxation, yoga & biofeedback

+ U.K.

(a) Same

(b)

Same

40

32

6 weeks

6 weeks

Yoga & Biofeedback

Yoga & Biofeedback

+

+

U.K.

U.K.

Studies 3, 4, 5: 1975, 1976, 1979

Design n Duration Approach Res. Country

RCT 34 6 weeks Yoga & Biofeedback

+ U.K.

Time series

7 6 months Transcendental meditation

+ USA

Pre-test Post test

44 4 weeks Asana + Pranayama

+ India

Studies 6, 7, 8: 1984, 1988, 1989

Design n Duration Approach Res. Country

Pre-test Post test

25 6 months Shava asana + India

Quasi exp.

60 4 weeks Shava asana + India

Case study

1 6 months Yoga & relaxation

+ USA

Studies 9, 10: 1998, 2000

Design n Duration Approach Res. Country

Two group pre-test post test

20 3 weeks Asanas incl. shava asana

+ India

RCT 33 11 weeks Asanas incl. shava asana

+ India

Studies 11, 12, 13: 2002, 2005, 2007

Design n Duration Approach Res. Country

Pre-test Post test

20 3 months Asana + pranayama

+ India

Quasi exp.

61 8 weeks Asana + pranayama

+ Thailand

Pre-test Post test

428 7 days Asana + pranayama

+ U.K.

Studies 14, 15, 16: all 2009

Design n Duration Approach Res. Country

RCT 57 12 weeks Iyengar yoga

+ USA

RCT 60 3 months Breathing exercises

+ India

RCT 113 8 weeks Asana + pranayama

+ India

Discussion…1

Almost all studies used shava asana (relaxation) which can be considered as the common denominator for effectiveness of yoga interventions for hypertension.

Only five studies used randomized controlled trial (RCT) as the design. Future studies must use the robust RCT or group randomized controlled designs.

Discussion…2

Most studies had small sample sizes (< 50). Such small sizes limit generalizability and do not allow for subgroup analyses. Future studies need to use larger sample sizes.

The duration of interventions ranged from 7 days to 12 months. This implies that duration is not associated with effectiveness. However, most interventions were between 6-8 weeks long and that seems to be most practical.

Discussion…3

It can be concluded that yoga is beneficial for management of hypertension and must be used more as a non pharmacological complimentary and alternative treatment of hypertension