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Wednesday, May 29, 2013

Hypertension (High Blood Pressure) and Yoga: An Overview

by Baxter

Complexity in Nature by Brad Gibson
On these hallowed blog pages, we have previously addressed several conditions that involve our cardiovascular system (heart and blood vessels), such as arrhythmias, strokes, hypotension and hypertension (also referred to as High Blood Pressure and Hypertension, or HTN). We even have at least six posts that at least mention HTN. However, due to the large percentage of adults who will develop HTN over the course of their lifetimes, I thought it worth revisiting. In 1999-2002, 28.6% of the U.S. population had hypertension. And this number seems to be on the rise. Plus, there is yet another study that demonstrates yoga’s beneficial effect on lowering blood pressure in those with mild to moderate hypertension! (For background information about what blood pressure is, see So, what is blood pressure, anyway?)

Why all the hype about HTN or high blood pressure, anyway?  Well, if you have HTN, you are at an increased risk of developing other more serious health problems, including heart attacks, strokes, rupture of your largest blood vessel (the aorta), chronic kidney disease, congestive heart failure, decreased blood supply to your legs, and problems with your vision. Some people develop HTN secondary to the presence of some other health condition that leads to high blood pressure, such as chronic kidney disease (hey, wasn’t that just mentioned?!), diseases of the adrenal and parathyroid glands (part of our endocrine system), pregnancy, and medications such as birth control pills, diet pills, some cold meds, just to mention a few. 

And some people are at a higher risk of developing HTN, if any of the following factors are present for you: obesity, chronic stress and anxiety, excessive alcohol consumption, excessive salt in diet, family history of HTN, diabetes, smokers, and African American ancestry. Part of the frustration for people who are diagnosed with HTN is that they often don’t have any really noticeable symptoms. I can’t tell you how many times I diagnosed a patient in my family practice with high blood pressure when they came in for a routine annual exam with no real complaints, or were in the office for some unrelated complaint, like a cold or headaches. This is why HTN is often referred to as the “silent killer,” as you may not know you have it until one of its complications like stroke or heart attack strike you.

It’s been known now for at least 40 years that yoga practices can help lower blood pressure in people with HTN, starting back in the 60s and 70s with the work of Herbert Benson, MD, a cardiologist who used a particular kind of yogic meditation popular at the time (TM or transcendental meditation) to help lower the blood pressure in his patients who were not responding as expected to the newest medications of that era. Since then, other studies have shown similar results, including the newest study from the University of Pennsylvania, Philadelphia, still in progress, which is following 120 patients with mild to moderate elevations in their blood pressure. Already, with 58 people completing the study so far, there is small but significant decreases in blood pressure readings in the yoga group. This could be of greatest importance to patients who are labeled with “pre-hypertension,” where the blood pressure readings fall between 120/80 and 140/90.  This group of people is at much higher risk of going on to develop full HTN and is at higher risk than the general population of serious situations such as stroke and heart attack. However, if treated with yoga, they could drop their numbers low enough to avoid the need for medications to do the job.  In previous posts, Nina and Shari have talked about kinds of asana practices that have been shown to lower blood pressure, such as forward bends and certain inversions, as well as the effect on the baroreceptors that monitor and influence blood pressure moment by moment.  See Blood Pressure: Talking About Baroreceptors and Yoga and Just in Time for the Holidays: Inverted Poses.

As to how you might incorporate yoga practices into your efforts to lower your own rising blood pressure, you would likely want to add it to a broader approach to treatment, instead of substituting yoga for medications, for instance. Usually, a combination of aerobic activity, dietary changes, appropriate salt restriction, stopping tobacco use, lowering stress, and achieving an optimal body weight are the first line actions recommended when you are diagnosed with HTN. As we have shown before, yoga can help with many of those goals, such as weight management and stress, as well as improving will power, which could help with establishing all of those changes suggested from your usual dietary and lifestyle habits. But, independent of that, as this newest study again points out, yoga helps lower blood pressure on its own. It can do it via a balanced asana practice, via meditation practices and via breathing techniques. It is, of course, frustrating for those of us familiar with this data, that mainstream medicine has not embraced this cost-effective modality to any significant degree. If it were a pill, I suppose, it would be a no-brainer. 

And for those interested in developing a home practice for hypertension, due to the multiple factors that could influence your unique situation, I highly recommend you work one-on-one with an experienced yoga instructor to create the optimal practice for you. Yoga for high blood pressure? You bet!  

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