Yoga may help reduce blood pressure in people with hypertension, according to a review of 7 past studies involving 452 patients. The studies found yoga reduced systolic blood pressure by an average of 10 mm Hg and diastolic blood pressure by 7 mm Hg compared to usual care. However, more high-quality research is still needed to fully understand yoga's effects on blood pressure and safety, as the studies varied in methodology and some limitations were present. The review recommends yoga styles incorporating breathing techniques and relaxation along with postures, and cautions that patients should continue blood pressure medications and respect their limits while practicing yoga.

1. Yoga may help manage blood pressure, but more research
needed
Participants perform the tree pose as they take a yoga class taught by twelve-year-old certified yoga
instructor Jaysea DeVoe at the Bergamot Spa in Encinitas, California March 11, 2014.
Reuters/Mike Blake
NEW YORK (Reuters Health) - Doing yoga may
help reduce blood pressure among people with
hypertension, a new analysis of past studies
suggests.
"There is now a growing number of randomized
controlled trials on yoga for a variety of
medical conditions," Holger Cramer told
Reuters Health in an email.
But, he added, "the quality and expressiveness of these trials varies, thus, it is often difficult to
evaluate the real evidence for the usefulness of yoga in a specific condition based on single trials."
Cramer led the review at the Faculty of Medicine at University of Duisburg-Essen in Essen,
Germany.
Previous studies have suggested yoga may be beneficial for a number of health conditions, including
irregular heart rhythms and posttraumatic stress disorder (see Reuters Health stories of January 30,
2013 here: reut.rs/1jawFIW and April 18, 2014 here: reut.rs/1hYvQY9).
Cramer said he has published reviews on yoga for low back pain, breast cancer, schizophrenia,
depression, menopausal symptoms, cardiovascular risk factors, heart disease, asthma and rheumatic
diseases.
"The current review on yoga for hypertension is part of this ongoing project. In my opinion, since
yoga is widely used all over the world for a number of health issues, it is of crucial importance to
scientifically evaluate where it is useful - and where it is not," he said.
The findings were published in the American Journal of Hypertension.
Cramer and his colleagues combined the results of seven previous studies that included 452
patients. In each of those studies, people with high or borderline-high blood pressure were randomly
assigned to practice yoga for at least eight weeks or to get usual blood pressure care or another type
of treatment instead.
The researchers found that on average, yoga reduced systolic blood pressure (the top number in a
blood pressure reading) by about 10 mm Hg and diastolic blood pressure (the bottom number) by 7
mm Hg, compared to usual care.

2. When they looked only at patients with full-blown hypertension - leaving out those with only slightly
elevated blood pressure, or "prehypertension" - the reduction in blood pressure was even greater.
"We did, however, not find any effects in pre-hypertensive patients," Cramer said.
The National Institutes of Health defines high blood pressure as 140/90 mm Hg and above. Normal
blood pressure is below 120/80 mm Hg, and prehypertension is anything in the middle.
The review also found that yoga helped patients who were taking blood pressure medication at the
same time, but not those who used it as an alternative to drugs.
However, the studies included in the review varied in ways that made it difficult to evaluate the big
picture of yoga's effect on blood pressure, the researchers said.
Two studies looked at specific yoga styles. One exclusively examined the effect of yoga breathing
techniques, and the rest involved some combination of yoga postures and breathing techniques,
relaxation, meditation and lifestyle advice.
"While these findings are limited by the few available trials, we found that yoga breathing seems to
be more effective and safer in persons with hypertension than more physically-oriented yoga forms,"
Cramer said.
The researchers also looked at the safety of yoga and found three adverse reactions were reported in
one of the studies. But it did not specify what those involved.
Other studies have suggested that strains of the neck, shoulders, legs and knees are common yoga
injuries.
"An issue that is really important and generally underrepresented in yoga research is the evaluation
of the safety of the intervention - in order to be able to precisely balance potential benefits and
potential harms for each individual patient," Cramer said.
The lack of consistency between studies, and limitations in the research methods they employed,
means more research is needed, he said.
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"It is really important to have large, well-designed trials available that fulfill the standards of today's
biomedical research," he said. "It might be worthwhile to conduct some more trials that compare
yoga to other forms of physical activity."
Cramer recommends that people interested in yoga look for a style that incorporates breathing
techniques and relaxation with yoga postures and look for a yoga teacher who has experience
working with people who try yoga for medical reasons.
"A licensed yoga therapist would be the best choice if available," he said.
Cramer added that patients should not stop taking their blood pressure medication and should not to
be too aggressive with their yoga practice.
"Respect your limits; yoga is not about achievement and it should be practiced mindful," he said.

3. SOURCE: bit.ly/RxbMla American Journal of Hypertension, online May 2, 2014.