Friday Q&A: Yoga Solutions for Hypertension

Q: I'm wondering if you could help me ID some yoga resources for my sig other.  He suffered an aortic dissection last Nov while visiting me here from Italy. Barely made it to the ER and surgeon's table on time. Five hour surgery later, he had a new synthetic 4 inch segment replacing his aorta just above the heart and a new lease on life. Six months out he's doing great. He does have a little bit of chance of recurrence, but overall the outlook for his continued recovery is good.

The present goal apparently is to keep his BP down. He's been on medication for it, but our family doctor took him off of it recently as his pressure was quite low before the dissection. He works out lightly at the gym and takes long walks.

He's never done yoga but wants to begin, and I want to help him do that. I'm wondering if you've published (or know anyone good who's published) any videos/sequences of asanas/instructional materials on yoga and BP OR if there's simply a good beginner DVD you might recommend for an older (a young 63 year-old) fit man who's been through what he went through. I've searched around a lot, but am a bit lost in the flood of materials for beginners and finding nothing, on the other hand, other some short articles in YJ, on yoga related to BP.

A: I am so pleased that your partner survived his aortic dissection, which is often, sadly, not the case. And it sounds like for the time being he no longer is showing blood pressure reading of high blood pressure that he had prior to the tear in his aorta. That could change as he gets back to normal activities and eating and such. It is great that he is already doing some weight/strength training and aerobic activity with his gym visits and walks. 

And I can understand your frustration and desire to start off his venture into yoga in a safe way. Please start by checking out the posts we have done here on blood pressure and yoga (see Hypertension and Yoga: An Overview). It is hard to say for sure what kind of beginner practice will be right for him, as he may have other age-related health issues and old injuries to take into account. You can certainly think about having him work with one of the senior teachers in your area individually, initially focusing on stress-reducing practices. There are some general cautions to be mindful of when designing a home practice, like not holding standing poses for very long, skipping and modifying most inversions, other than Downward-Facing Dog and Legs Up the Wall (Viparita Karani) poses, if his blood pressure is elevated at rest. And generally, doing milder forms of most poses including forward bends and twists that also could increase intra-abdominal pressure. Guided meditation, basic breath awareness and yoga nidra would be good to include, with a focus on visualizing a calm and strong heart and vascular system. 

For additional helpful suggestions regarding asana and other yoga practices, there are some written sources that talk about hypertension that you can look over. In Timothy McCall’s book Yoga as Medicine, he devotes a chapter to the subject, featuring experienced yoga teacher Aadil Palkhaivala.  Aadil. He categorizes two kinds of HTN, which he calls “jittery” and “pent-up,” and approaches each a bit differently. Timothy’s book goes on to share three series that Aadil teaches, as well as some specific standing, seated, and reclining poses he recommends. A great warning that Timothy also mentions is avoiding what is known as the “Valsava Maneuver,” in which you hold your breath and bear down, like you would to pass a bowel movement. Doing so can cause a major spike in blood pressure. 

In their book The Woman’s Book of Yoga and Health, Linda Sparrowe and yoga teacher Patricia Walden also devote a chapter to cardiovascular health, and Patricia offers a nice sequence for HTN that is mostly supported restorative poses. This sequence includes one supported Standing Forward Bend and one Downward-Facing Dog (the only two “active poses” in the sequence). 

And finally, Gary Kraftsow’s Yoga for Wellness also has a chapter on cardiovascular system, and he offers an example practice that he did with one of his students that utilizes the Krishnamacharya method of mini-vinyasas. In this case, the opening four poses are either seated or using a chair to modify the depth of the pose, followed by a Cat/Cow variation, dynamic Cobra vinyasa, supine Apanasana (Knees to Chest) sequence, and of course, Savasana.

Although I was not able to find the exact sequence used in the recent study on Yoga for HTN that I referenced in my last post, that would be interesting to review if you can get a copy of the actual study as it likely describes all the poses and practices utilized.

I hope that these ideas will help you to get your sweetie on his way to a safe and effective yoga practice to assist in keeping his blood pressure in a healthy range. 

—Baxter