Impact of a short home-based yoga programme on blood pressure in patients with hypertension: a randomized controlled trial in primary care

Abstract

The present study was designed to evaluate yoga's impact on blood pressure (BP) and quality of life (QOL) and on stress, depression and anxiety in patients with hypertension in a primary care setting. We conducted a multi-centre randomized controlled trial with follow-up after 12-week intervention completion. Adult primary care patients diagnosed with hypertension were randomly allocated to yoga or usual care. The intervention group performed a short home-based Kundalini yoga programme 15 min twice-daily during the 12-week intervention period. At baseline and follow-up, the participants underwent standardized BP measurements and completed questionnaires on QOL, stress, anxiety and depression. Data obtained from 191 patients (mean age 64.7 years, s.d. 8.4) allocated to yoga intervention (n=96) and control group (n=95), with a total proportion of 52% women, showed a significant reduction in systolic and diastolic BP for both groups (−3.8/−1.7 mm Hg for yoga and −4.5/−3.0 mm Hg for control groups, respectively). However, the BP reduction for the yoga group was not significantly different from control. There were small but significant improvements for the yoga group in some of the QOL and depression measures (P<0.05, Hospital Anxiety and Depression scale, HADS-D) compared with control. The findings of our study, which is the largest study from an OECD country (Organization for Economic Co-operation and Development) to date, do not support the suggestion from previous smaller studies that yoga lowers the BP. Further clinical trials are needed to confirm these findings. However, the yoga patients had other health benefits.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Figure 1

References

  1. 1

    Chow CK, Teo KK, Rangarajan S, Islam S, Gupta R, Avezum et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA 2013; 310: 959–968.

  2. 2

    Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2013; 380: 2224–2260.

  3. 3

    Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2013; 380: 2095–2128.

  4. 4

    Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB et al. Executive summary: heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation 2012; 125: 188–197.

  5. 5

    Hyman DJ, Pavlik VN . Self-reported hypertension treatment practices among primary care physicians: blood pressure thresholds, drug choices, and the role of guidelines and evidence-based medicine. Arch Intern Med 2000; 160: 2281–2286.

  6. 6

    National Center for Complementary and Integrative Health (NCCIH). Yoga. (Web page) 2015 [cited 2015 6 October] Available from http://www.nccam.nih.gov/health/yoga.

  7. 7

    Zhang Y . American Adult Yoga Practice: preliminary findings from NHIS 2012 data. J Altern Complement Med 2014; 20: A122 (Abstract).

  8. 8

    Sujatha T, Judie A . Effectiveness of a 12-week yoga program on physiopsychological parameters in patients with hypertension. Int J Pharm Clin Res 2014; 6: 329–335.

  9. 9

    Hagins M, Rundle A, Consedine NS . Khalsa SBS. A randomized controlled trial comparing the effects of yoga with an active control on ambulatory blood pressure in individuals with prehypertension and stage 1 hypertension. J Clin Hypertens 2014; 16: 54–62.

  10. 10

    Cohen DL, Bloedon LT, Rothman RL, Farrar JT, Galantino ML, Volger S et al. Iyengar yoga versus enhanced usual care on blood pressure in patients with prehypertension to stage I hypertension: a randomized controlled trial. J Evid Based Complementary Altern Med 2011; 2011: 546428.

  11. 11

    Cramer H, Haller H, Lauche R, Steckhan N, Michalsen A, Dobos G . A systematic review and meta-analysis of yoga for hypertension. Am J Hypertens 2014; 27: 1146–1151.

  12. 12

    Joseph CN, Porta C, Casucci G, Casiraghi N, Maffeis M, Rossi M et al. Slow breathing improves arterial baroreflex sensitivity and decreases blood pressure in essential hypertension. Hypertension 2005; 46: 714–718.

  13. 13

    Khattab K, Khattab AA, Ortak J, Richardt G, Bonnemeier H . Iyengar yoga increases cardiac parasympathetic nervous modulation among healthy yoga practitioners. Evid Based Complement Alternat Med 2007; 4: 511–517.

  14. 14

    Banasik J, Williams H, Haberman M, Blank SE, Bendel R . Effect of Iyengar yoga practice on fatigue and diurnal salivary cortisol concentration in breast cancer survivors. J Am Acad Nurse Pract 2011; 23: 135–142.

  15. 15

    Whitworth JA, Mangos GJ, Kelly JJ . Cushing, cortisol, and cardiovascular disease. Hypertension 2000; 36: 912–916.

  16. 16

    Wolff M, Sundquist K, Larsson Lonn S, Midlov P . Impact of yoga on blood pressure and quality of life in patients with hypertension - a controlled trial in primary care, matched for systolic blood pressure. BMC Cardiovasc Disord 2013; 13: 111.

  17. 17

    Mediyoga. (Web page) 2015 [cited 2015 6 October]. Available from http://en.mediyoga.com.

  18. 18

    Pan Y, Yang K, Wang Y, Zhang L, Liang H . Could yoga practice improve treatment-related side effects and quality of life for women with breast cancer? A systematic review and meta-analysis. Asia Pac J Clin Oncol (e-pub ahead of print 6 Jan 2015; doi: 10.1111/ajco.12329.

  19. 19

    Javnbakht M, Kenari RH, Ghasemi M . Effects of yoga on depression and anxiety of women. Complement Ther Clin Pract 2009; 15: 102–104.

  20. 20

    Pilkington K, Kirkwood G, Rampes H, Richardson J . Yoga for depression: the research evidence. J Affect Disord 2005; 89: 13–24.

  21. 21

    World Health Organization. WHOQOL-BREF: introduction, administration, scoring and generic version of the assessment: field trial version, December 1996. Available from http://apps.who.int/iris/handle/10665/63529.

  22. 22

    Cohen S, Kamarck T, Mermelstein R . A global measure of perceived stress. J Health Soc Behav 1983; 24: 385–396.

  23. 23

    Zigmond AS, Snaith RP . The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361–370.

  24. 24

    Schulz KF, Altman DG, Moher D and CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ 2010; 340: c332.

  25. 25

    Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013; 34: 2159–2219.

  26. 26

    O'Brien E, Asmar R, Beilin L, Imai Y, Mancia G, Mengden T et al. Practice guidelines of the European Society of Hypertension for clinic, ambulatory and self blood pressure measurement. J Hypertens 2005; 23: 697–701.

  27. 27

    Bjelland I, Dahl AA, Haug TT, Neckelmann D . The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosom Res 2002; 52: 69–77.

  28. 28

    Vickers AJ, Altman DG . Analysing controlled trials with baseline and follow up measurements. BMJ 2001; 323: 1123–1124.

  29. 29

    Hanley JA, Negassa A, Forrester JE . Statistical analysis of correlated data using generalized estimating equations: an orientation. Am J Epidemiol 2003; 157: 364–375.

  30. 30

    Wang J, Xiong X, Liu W . Yoga for essential hypertension: a systematic review. PLoS ONE 2013; 8: e76357.

  31. 31

    Posadzki P, Cramer H, Kuzdzal A, Lee MS, Ernst E . Yoga for hypertension: a systematic review of randomized clinical trials. Complement Ther Med 2014; 22: 511–522.

  32. 32

    Chen KM, Fan JT, Wang HH, Wu SJ, Li CH, Lin HS . Silver yoga exercises improved physical fitness of transitional frail elders. Nurs Res 2010; 59: 364–370.

  33. 33

    Mourya M, Mahajan AS, Singh NP, Jain AK . Effect of slow-and fast-breathing exercises on autonomic functions in patients with essential hypertension. J Altern Complement Med 2009; 15: 711–717.

  34. 34

    Cramer H, Lauche R, Langhorst J, Dobos G . Are Indian yoga trials more likely to be positive than those from other countries? A systematic review of randomized controlled trials. Contemp Clin Trials 2015; 41C: 269–272.

  35. 35

    Cramer H, Lauche R, Langhorst J, Dobos G . Effectiveness of yoga for menopausal symptoms: a systematic review and meta-analysis of randomized controlled trials. Evid Based Complementary Altern Med 2012; 2012: 863905.

  36. 36

    Hodgkinson J, Mant J, Martin U, Guo B, Hobbs F, Deeks J et al. Relative effectiveness of clinic and home blood pressure monitoring compared with ambulatory blood pressure monitoring in diagnosis of hypertension: systematic review. BMJ 2011; 342: d3621.

Download references

Acknowledgements

We would like to thank the staff and management group at Löddeköpinge, Hjärup and Bara Primary Health Care Centres. A special thanks to general pracitioner Beata Borgström Bolmsjö and Camilla Richardson for their willingness to commit time and effort for the research on yoga and hypertension. We are grateful to Göran Boll, the founder of the IMY, who has provided inspiration, knowledge and educational materials. This study was funded by the Faculty of Medicine at Lund University, the Ekhaga Foundation, the Swedish Heart-Lung Foundation and the Swedish Southern Health Care Region, Agreement for Medical Education and Research (ALF) funding from Region Skåne and a Swedish Research Council grant awarded to Kristina Sundquist.

Author information

Correspondence to M Wolff.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies this paper on the Journal of Human Hypertension website

Supplementary information

Supplementary appendix 1 (DOC 196 kb)

Supplementary appendix 2 (DOC 87 kb)

Supplementary appendix 3 (DOC 49 kb)

Supplementary appendix 4 (DOC 60 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Further reading