Iyengar Yoga versus Enhanced Usual Care on Blood Pressure in Patients with Prehypertension to Stage I Hypertension: a Randomized Controlled Trial

Debbie L Cohen, Leanne T Bloedon, Rand L Rothman, John T Farrar, Mary Lou Galantino, Sheri Volger, Christine Mayor, Phillipe O Szapary, Raymond R Townsend, Debbie L Cohen, Leanne T Bloedon, Rand L Rothman, John T Farrar, Mary Lou Galantino, Sheri Volger, Christine Mayor, Phillipe O Szapary, Raymond R Townsend

Abstract

The prevalence of prehypertension and Stage 1 hypertension continues to increase despite being amenable to non-pharmacologic interventions. Iyengar yoga (IY) has been purported to reduce blood pressure (BP) though evidence from randomized trials is lacking. We conducted a randomized controlled trial to assess the effects of 12 weeks of IY versus enhanced usual care (EUC) (based on individual dietary adjustment) on 24-h ambulatory BP in yoga-naïve adults with untreated prehypertension or Stage 1 hypertension. In total, 26 and 31 subjects in the IY and EUC arms, respectively, completed the study. There were no differences in BP between the groups at 6 and 12 weeks. In the EUC group, 24-h systolic BP (SBP), diastolic BP (DBP) and mean arterial pressure (MAP) significantly decreased by 5, 3 and 3 mmHg, respectively, from baseline at 6 weeks (P < .05), but were no longer significant at 12 weeks. In the IY group, 24 h SBP was reduced by 6 mmHg at 12 weeks compared to baseline (P = .05). 24 h DBP (P < .01) and MAP (P < .05) decreased significantly each by 5 mmHg. No differences were observed in catecholamine or cortisol metabolism to explain the decrease in BP in the IY group at 12 weeks. Twelve weeks of IY produces clinically meaningful improvements in 24 h SBP and DBP. Larger studies are needed to establish the long term efficacy, acceptability, utility and potential mechanisms of IY to control BP.

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Changes in mean 24 h SBP and DBP in the IY and EUC groups at randomization, 6 and 12 weeks.

References

    1. Fields LE, Burt VL, Cutler JA, Hughes J, Roccella EJ, Sorlie P. The burden of adult hypertension in the United States 1999 to 2000: a rising tide. Hypertension. 2004;44(4):398–404.
    1. Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. Journal of the American Medical Association. 2003;290(2):199–206.
    1. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206–1252.
    1. Vasan RS, Larson MG, Leip EP, et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. The New England Journal of Medicine. 2001;345(18):1291–1297.
    1. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. Journal of the American Medical Association. 2003;289(19):2560–2572.
    1. Stevens VJ, Obarzanek E, Cook NR, et al. Long-term weight loss and changes in blood pressure: results of the trials of hypertension prevention, phase II. Annals of Internal Medicine. 2001;134(1):1–11.
    1. Cohen D, Townsend RR. Yoga and hypertension. The Journal of Clinical Hypertension. 2007;9:800–801.
    1. Damodaran A, Malathi A, Patil N, Shah N, Marathe S. Therapeutic potential of yoga practices in modifying cardiovascular risk profile in middle aged men and women. Journal of Association of Physicians of India. 2002;50(5):633–640.
    1. Murugesan R, Govindarajulu N, Bera TK. Effect of selected yogic practices on the management of hypertension. Indian Journal of Physiology and Pharmacology. 2000;44(2):207–210.
    1. Patel C. 12-month follow up of yoga and bio feedback in the management of hypertension. The Lancet. 1975;I(7898):62–64.
    1. Lakshmikanthan C, Alagesan R, Thanikachalam S, et al. Long term effects of yoga on hypertension and/or coronary artery disease. The Journal of the Association of Physicians of India. 1979;27(12):1055–1058.
    1. Tulpule TH, Shah HM, Shah SJ, Haveliwala HK. Yogic exercises in the management of ischaemic heart disease. Indian Heart Journal. 1971;23(4):259–264.
    1. Datey KK, Deshmukh SN, Dalvi CP, Vinekar SL. “Shavasan”: a yogic exercise in the management of hypertension. Angiology. 1969;20(6):325–333.
    1. Granath J, Ingvarsson S, von Thiele U, Lundberg U. Stress management: a randomized study of cognitive behavioural therapy and yoga. Cognitive Behaviour Therapy. 2006;35(1):3–10.
    1. Carlson LE, Speca M, Faris P, Patel KD. One year pre-post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients. Brain, Behavior, and Immunity. 2007;21(8):1038–1049.
    1. Sivasankaran S, Pollard-Quintner S, Sachdeva R, Pugeda J, Hoq SM, Zarich SW. The effect of a six-week program of yoga and meditation on brachial artery reactivity: do psychosocial interventions affect vascular tone? Clinical Cardiology. 2006;29(9):393–398.
    1. O’Brien E, Mee F, Atkins N, O’Malley K. Accuracy of the SpaceLabs 90207 determined by the British Hypertension Society Protocol. Journal of Hypertension. 1991;9(6):573–574.
    1. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. The Lancet. 2002;360(9349):1903–1913.
    1. Levenstein S, Smith MW, Kaplan GA. Psychosocial predictors of hypertension in men and women. Archives of Internal Medicine. 2001;161(10):1341–1346.
    1. Markovitz JH, Matthews KA, Kannel WB, Cobb JL, D’Agostino RB. Psychological predictors of hypertension in the Framingham study: is there tension in hypertension? Journal of the American Medical Association. 1993;270(20):2439–2443.
    1. Rutledge T, Hogan BE. A quantitative review of prospective evidence linking psychological factors with hypertension development. Psychosomatic Medicine. 2002;64(5):758–766.
    1. Spence JD, Barnett PA, Linden W, Ramsden V, Taenzer P. Lifestyle modifications to prevent and control hypertension. 7. Recommendations on stress management. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada. Canadian Medical Association Journal. 1999;160(9):S46–50.
    1. Khan NA, Hemmelgarn B, Padwal R, et al. The 2007 Canadian Hypertension Education Program recommendations for the management of hypertension: part 2: therapy. Canadian Journal of Cardiology. 2007;23(7):539–550.
    1. Schneider RH, Staggers F, Alexander CN, et al. A randomized controlled trial of stress reduction for hypertension in older African Americans. Hypertension. 1995;26(5):820–827.
    1. Schneider RH, Alexander CN, Staggers F, et al. A randomized controlled trial of stress reduction in African Americans treated for hypertension for over one year. American Journal of Hypertension. 2005;18(1):88–98.
    1. McCaffrey R, Ruknui P, Hatthakit U, Kasetsomboon P. The effects of yoga on hypertensive persons in Thailand. Holistic Nursing Practice. 2005;19(4):173–180.
    1. Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. The New England Journal of Medicine. 1997;336(16):1117–1124.
    1. Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet. The New England Journal of Medicine. 2001;344(1):3–10.
    1. Appel LJ, Champagne CM, Harsha DW, Cooper LS, Obarzanek E, Elmer PJ, et al. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. Journal of the American Medical Association. 2003;289:2083–2093.
    1. Yadav RK, Ray RB, Vempati R, Bijlani RL. Effect of a comprehensive yoga-based lifestyle modification program on lipid peroxidation. Indian Journal of Physiology and Pharmacology. 2005;49(3):358–362.

Source: PubMed

3
Subscribe