High blood pressure (BP) is a major public health problem worldwide. It is an important risk factor for acute myocardial infarction, cerebrovascular disease, chronic renal failure, and congestive heart failure. Lifestyle modifications play an important role in prehypertensive individuals and also act as an adjunct to antihypertensive therapy. Yoga practices have been shown to be effective in reducing BP in hypertensive population. The probable mechanism by which yoga reduces BP is by reduction in sympathetic activity, facilitating autonomic balance, which reduces chemoreceptor responses, and enhancing baroreflex sensitivity. Yoga is also effective as an adjunct therapy in reducing antihypertensive medication use. There is a need for recognition of yoga by our health system as a complementary therapy for treating hypertension (HPT).
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Tiwari S, Pal AK. Yoga and Hypertension. Hypertens J 2017;3(4):189-192.
Wang J, Xiong X, Liu W. Yoga for essential hypertension: a systematic review. PLoS One 2013 Oct;8(10):e76357.
WHO. Prevention of cardiovascular diseases. Geneva: World Health Organization; 2007.
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet 2005 Jan;365(9455):217-223.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003 Dec;42(6):1206-1252.
Lewington S, Clarke R, Qizilbash N, Peto R, Collins R; Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002 Dec;360(9349):1903-1913.
IGH-II. Indian hypertension guidelines. In: API, editor. The Association of Physicians of India, Cardiologist Society of India, Indian College of Physicians, Hypertension Society of India; 2007.
Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, et al. 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 2007 Jun;28(12):1462-1536.
Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, Ford E, Furie K, Go A, Greenlund K, et al. Heart disease and stroke statistics—2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009 Jan;119(3):480-486.
Cleophas TJ, Grabowsky I, Niemeyer MG, Mäkel WM, van der Wall EE; Nebivolol Follow-Up Study Group. Paradoxical pressor effects of beta-blockers in standing elderly patients with mild hypertension: a beneficial side effect. Circulation 2002 Apr;105(14):1669-1671.
Gupta R, Gupta S. Strategies for initial management of hypertension. Indian J Med Res 2010;132(5):531.
Yeh GY, Wang C, Wayne PM, Phillips RS. The effect of Tai Chi exercise on blood pressure: a systematic review. Prev Cardiol 2008 Spring;11(2):82-89.
Bijlani RL, Vempati RP, Yadav RK, Ray RB, Gupta V, Sharma R, Mehta N, Mahapatra SC. A brief but comprehensive lifestyle education program based on yoga reduces risk factors for cardiovascular disease and diabetes mellitus. J Altern Complement Med 2005 Apr;11(2):267-274.
Ravinder M. Ayurveda and yoga in cardiovascular diseases. Cardiol Rev 2005 May-Jun;13(3):156-162.
Birdee GS, Legedza AT, Saper RB, Bertisch SM, Eisenberg DM, Phillips RS. Characteristics of yoga users: results of a national survey. J Gen Intern Med 2008 Oct;23(10):1653-1658.
Harinath K, Malhotra AS, Pal K, Prasad R, Kumar R, Kain TC, Rai L, Sawhney RC. Effects of Hatha yoga and Omkar meditation on cardiorespiratory performance, psychologic profile, and melatonin secretion. J Altern Complement Med 2004 Apr;10(2):261-268.
Shambhu N. Stress management through yoga and meditation. New Delhi: Sterling Paperbacks; 1992.
Bernardi L, Passino C, Spadacini G, Bonfichi M, Arcaini L, Malcovati L, Bandinelli G, Schneider A, Keyl C, Feil P, et al. Reduced hypoxic ventilatory response with preserved blood oxygenation in yoga trainees and Himalayan Buddhist monks at altitude: evidence of a different adaptive strategy? Eur J Appl Physiol 2007 Mar;99(5):511-518.
Bernardi L, Gabutti A, Porta C, Spicuzza L. Slow breathing reduces chemoreflex response to hypoxia and hypercapnia, and increases baroreflex sensitivity. J Hypertens 2001 Dec;19(12):2221-2229.
Chaudhary AK, Bhatnagar HN, Bhatnagar LK. Comparative study of the effect of drugs and relaxation exercise (yoga shavasan) in hypertension. J Assoc Physicians India 1988 Dec;36(12):721-723.
Mogra AL, Singh G. Effect of biofeedback and yogic relaxation exercise on the blood pressure levels of hypertensives: a preliminary study. J Aviat Med 1986 Dec;30(2):68-75.
Okonta NR. Does yoga therapy reduce blood pressure in patients with hypertension?: an integrative review. Holist Nurs Pract 2012 May-Jun;26(3):137-141.
Yang K. A review of yoga programs for four leading risk factors of chronic diseases. Evid Based Complement Altern Med 2007 Dec;4(4):487-491.
Mizuno J, Monteiro HL. An assessment of a sequence of yoga exercises to patients with arterial hypertension. J Bodyw Mov Ther 2013 Jan;17(1):35-41.
Jayasinghe SR. Yoga in cardiac health (a review). Eur J Cardiovasc Prev Rehabil 2004 Oct;11(5):369-375.
Hutchinson SC, Ernst E. Yoga therapy for coronary heart disease: a systematic review. Focus Altern Complement Ther 2003;8(1):144.
Sharma M, Haider T. Yoga as an alternative and complementary treatment for hypertensive patients: a systematic review. J Evid Based Complement Altern Med 2012;17(3):199-205.
Taylor AG, Goehler LE, Galper DI, Innes KE, Bourguignon C. Top-down and bottom-up mechanisms in mind-body medicine: development of an integrative framework for psychophysiological research. Explore (NY) 2010 Jan-Feb;6(1):29-41.
Shankardevananda S, Satyananda S. The effects of yoga on hypertension. Munger: Yoga Publications Trust; 1998.
Udupa KN, Prasad RC. Stress and its management by yoga. Delhi: Motilal Banarsidass; 1985.
Narkiewicz K, van de Borne P, Montano N, Hering D, Kara T, Somers VK. Sympathetic neural outflow and chemoreflex sensitivity are related to spontaneous breathing rate in normal men. Hypertension 2006;47(1):51-55.
Agte VV, Chiplonkar SA. Sudarshan kriya yoga for improving antioxidant status and reducing anxiety in adults. Altern Complement Ther 2008;14(2):96-100.
Jacobs GD. Clinical applications of the relaxation response and mind-body interventions. J Altern Complement Med 2001;7(Suppl 1):S93-S101.
Singh N, Telles S. Heart rate variability and state anxiety in hypertensives and diabetes after one week of yoga. J Indian Psychol 2009;27(1-2):13-20.
Williams B, Poulter NR, Brown MJ, Davis M, McInnes GT, Potter JF, Sever PS, McG Thom S; British Hypertension Society. Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004—BHS IV. J Hum Hypertens 2004 Mar;18(3):139-185.
Rabi DM, Daskalopoulou SS, Padwal RS, Khan NA, Grover SA, Hackam DG, Myers MG, McKay DW, Quinn RR, Hemmelgarn BR, et al. The 2011 Canadian Hypertension Education Program recommendations for the management of hypertension: blood pressure measurement, diagnosis, assessment of risk, and therapy. Can J Cardiol 2011 Jul-Aug;27(4):415-433.e1-2.
Wahlgren NG, MacMahon DG, De Keyser JF, Indredavik B, Ryman T. Intravenous Nimodipine West European Stroke Trial (INWEST) of nimodipine in the treatment of acute ischaemic stroke. Cerebrovasc Dis 1994 May;4(3):204-10.
Kaste M, Fogelholm R, Erilä T, Palomäki H, Murros K, Rissanen A, Sarna S. A randomized, double-blind, placebo-controlled trial of nimodipine in acute ischemic hemispheric stroke. Stroke 1994 Jul;25(7):1348-1353.
Schrader J, Lüders S, Kulschewski A, Berger J, Zidek W, Treib J, Einhaupl K, Diener HC, Dominiak P; Acute Candesartan Cilexetil Therapy in Stroke Survivors Study Group. The ACCESS study: evaluation of Acute Candesartan Cilexetil Therapy in Stroke Survivors. Stroke 2003 Jul;34(7):1699-1703.
Sandset EC, Bath PM, Boysen G, Jatuzis D, Kõrv J, Lüders S, Murray GD, Richter PS, Roine RO, Terént A, et al. The angiotensin-receptor blocker candesartan for treatment of acute stroke (SCAST): a randomised, placebo-controlled, double-blind trial. Lancet 2011 Feb;377(9767):741-750.
Potter JF, Robinson TG, Ford GA, Mistri A, James M, Chernova J, Jagger C. Controlling hypertension and hypotension immediately post-stroke (CHHIPS): a randomised, placebo-controlled, double-blind pilot trial. Lancet Neurol 2009 Jan;8(1):48-56.
Robinson TG, Potter JF, Ford GA, Bulpitt CJ, Chernova J, Jagger C, James MA, Knight J, Markus HS, Mistri AK, et al. Effects of antihypertensive treatment after acute stroke in the Continue or Stop Post-Stroke Antihypertensives Collaborative Study (COSSACS): a prospective, randomised, open, blinded-endpoint trial. Lancet Neurol 2010 Aug;9(8):767-775.
Jauch EC, Saver JL, Adams HP, Bruno A, Demaerschalk BM, Khatri P, McMullan PW, Qureshi AI, Rosenfield K, Scott PA, et al. Guidelines for the early management of patients with acute ischemic stroke. Stroke 2013 Mar;44(3):870-947.
Ahmed N, Wahlgren N, Brainin M, Castillo J, Ford GA, Kaste M, Lees KR, Toni D; SITS Investigators. Relationship of blood pressure, antihypertensive therapy, and outcome in ischemic stroke treated with intravenous thrombolysis. Stroke 2009 Jul;40(7):2442-2449.
Karachalios GN, Charalabopoulos A, Papalimneou V, Kiortsis D, Dimicco P, Kostoula OK, Charalabopoulos K. Withdrawal syndrome following cessation of antihypertensive drug therapy. Int J Clin Pract 2005 May;59(5):562-570.
PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet 2001 Sep;358(9287):1033-1041.
Schrader J, Lüders S, Kulschewski A, Hammersen F, Plate K, Berger J, Zidek W, Dominiak P, Diener HC; MOSES Study Group. Morbidity and mortality after stroke, eprosartan compared with nitrendipine for secondary prevention. Stroke 2005 Jun;36(6):1218-1226.
Yusuf S, Diener HC, Sacco RL, Cotton D, Ôunpuu S, Lawton WA, Palesch Y, Martin RH, Albers GW, Bath P, et al. Telmisartan to prevent recurrent stroke and cardiovascular events. N Engl J Med 2008 Sep;359(12):1225-1237.
Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, Fang MC, Fisher M, Furie KL, Heck DV, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke 2014 Jan:45(7):2160-2236.
Robb AO, Mills NL, Din JN, Smith IB, Paterson F, Newby DE, Denison FC. Influence of the menstrual cycle, pregnancy, and preeclampsia on arterial stiffness. Hypertension 2009 Jun;53(6):952-958.
Avni B, Frenkel G, Shahar L, Golik A, Sherman D, Dishy V. Aortic stiffness in normal and hypertensive pregnancy. Blood Press 2010 Feb;19(1):11-15.
Khalil A, Akolekar R, Syngelaki A, Elkhouli M, Nicolaides KH. Maternal hemodynamics at 11–13 weeks’ gestation and risk of pre-eclampsia. Ultrasound Obstet Gynecol 2012 Jul;40(1):28-34.
Medical Research Council trial of treatment of hypertension in older adults: principal results. MRC Working Party. BMJ 1992 Feb;304(6824):405-412.
Dahlof B, Devereux RB, Kjeldsen SE, Julius S, Beevers G, Faire U, Fyhrquist F, Ibsen H, Kristiansson K, Lederballe-Pedersen O, et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002 Mar;359(9311):995-1003.
Dahlof B, Sever PS, Poulter NR, Wedel H, Beevers DG, Caulfield M, Collins R, Kjeldsen SE, Kristinsson A, McInnes GT, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trials-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet 2005 Sep;366(9489):895-906.
