SAN FRANCISCO, CA — Hatha yoga introduced to individuals with mild to moderate hypertension appears to lower blood pressure, and while the reductions in systolic and diastolic blood pressure aren't earth-shattering, they might just be enough to avoid starting antihypertensive medications, say researchers.

"We know with prehypertension it is a risk factor for cardiovascular events, so in these people yoga would definitely have a benefit," lead investigator Dr Debbie Cohen (University of Pennsylvania, Philadelphia) told heartwire . "With a reduction of 4 to 5 mm Hg, you could really have an impact on their cardiovascular-disease risk. I think you should obviously use yoga as an adjunct to other lifestyle modifications, such as weight loss. But with yoga, you could, perhaps, avoid the need for medication."

The results of the study were presented last week here at the American Society of Hypertension (ASH) 2013 Scientific Sessions .

Excited by the Results

To heartwire , Cohen explained that there are a number of studies that have addressed the benefits of yoga therapy on blood pressure. In fact, one of the first studies was published as far back as 1975 in the Lancet , but the medical community hasn't really embraced yoga to date. As a result, many other trials are of poor design and of limited use given the quality issues.

With our lifestyle studies, what we're looking to do is lower blood pressure in the range of 3 to 6 mm Hg.

In an attempt to address the benefits of yoga a little more scientifically, the researchers conducted a randomized clinical trial, with 120 subjects randomized to one of three treatment groups. The three arms included hatha yoga two to three times per week for 24 weeks, a supervised diet/weight-reduction program that included walking, and a combination program that included yoga and the dietary intervention. The patients were 50 years of age, on average, and had a baseline systolic blood pressure of 134 mm Hg.

Presenting the results of 58 subjects who have completed the study to date, the researchers report that the yoga program significantly reduced systolic blood pressure to 129 mm Hg at 12 weeks and 130 mm Hg at 24 weeks. Diastolic blood pressure was also significantly reduced 2 to 3 mm Hg, as well. In the diet/walking and yoga/dietary intervention groups, there was no significant reduction in blood pressure from baseline.

"We're really excited about the results," said Cohen. "It's not a huge decrease in blood pressure, it's not a drug effect, but it is significant. With our lifestyle studies, what we're looking to do is lower blood pressure in the range of 3 to 6 mm Hg. So potentially, it's exciting, because yoga is really popular in the US and all over the world. People really like it, so if it has additional health benefits and people can avoid going on medication, that would be great."

Medical Advice from Dr Oz

In a separate ASH session, Dr Robert Brook (University of Michigan, Ann Arbor) addressed various breathing techniques to lower blood pressure. Yoga, relaxation therapy, and devices that assist patients to control respiration are some of the techniques employed by physicians to achieve small reductions in blood pressure.

In fact, the US Food and Drug Administration has approved one device (RESPeRATE, InterCure) as an adjunctive to lower blood pressure. The device is designed to help train patients to slow their respiration and ultimately, lower their blood pressure. The mechanisms underlying the reduction in blood pressure are complex, said Brook, and to date there are no long-term data supporting its use. The evidence to support device-guided breathing is classified IIa, level of evidence B.

Brook said there is concern that patients get their medical advice from television, specifically Dr Mehmet Oz, and stop their use of medication. Breathing techniques to lower blood pressure are considered appropriate in prehypertensive patients, untreated stage 1 hypertension patients with no indication for drug therapy, and as a possible adjuvant to step-down drug therapy, said Brook.


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