Yoga for reduction, control and prevention of hypertension
The prevention and management of hypertension, also known as high blood pressure, represents one of the major public health challenges modern societies need to address.
It has been estimated that over 76 million US people and more than 1 billion people worldwide suffer from hypertension, and that blood pressure is well controlled in less than 50% of these individuals.
It is estimated that by the year 2025 approximately 1 every 3 adults aged over 20 years will be affected by this condition.
Uncontrolled hypertension generates many health and economic issues: it is responsible for cerebrovascular and ischaemic heart diseases, strokes, kidney failure and dementia and it was estimated to cost the United States $93.5 billion in health care services, medications and several missed days of work in 2010.  , 
Over the past decades many kinds of antihypertensive agents were developed. As a result, pharmacotherapy is the most common form of hypertension management in current western clinical practice. However, the long-term use of these medicines is associated with development of pharmacoresistance and a wide range of side effects, spanning from fatigue, depression, asthma, erectile dysfunctions, fever, arrhythmia, to pain and insomnia.
Alternative methods to reduce blood pressure are much needed. The ideal alternative would be one cheaper the current antihypertensive drugs, devoid of side effects and lower risk of drug interactions, capable of conveying therapeutic benefits that last long term.  , 
CAMs techniques, hypertension and yoga
- CAMs techniques (Complementary and Alternative Medicine) are a compendium of therapies used traditionally around the world, may be biologically active botanical extracts & foodstuff (phytoceutic & nutraceutic), or mind-body healing. They represent a holistic approach to health and cures which consider patients in their whole: body, mind and spirit.
- Hypertension is defined as a persistently high blood pressure (≥140 / ≥90). 
Generally we avail of 2 numbers to measure Blood Pressure (BP): the top number represents the systolic BP while the lower number represent the diastolic BP.
Many factors influence BP, including environmental conditions, diet, body weight, a variety of behavioural factors, stress, anxiety and genetic predisposition. (Check the article Indian Porridge to protect your cardiac function for a healthy and yummy recipe!)
Today, some doctors prescribe antihypertensive medicines as soon as high BP is discovered. However, most experts recommend first trying non-drug measures like modifications in diet, salt & alcohol restriction, physical exercise and weight loss. 
- Yoga is an ancient Indian holistic science that produces consistent physiological changes. It has been shown to be useful to individuals with a wide range of health conditions and to increase longevity, conveying therapeutic and rehabilitative effects. , 
A community-based randomized controlled trial of non-pharmacological interventions for prevention and control of hypertension among 113 young adults showed that physical exercise, salt intake reduction, and yoga are effective non-pharmacological interventions that can significantly reduce BP among young hypertensives and pre-hypertensives. 
We shouldn’t think of yoga as an activity reserved to contortionists, acrobats or young and athletic people. Yoga is for everybody.
Comprised of gentle physical activity, slowed regulated breathing and meditation, yoga can suit everybody’s needs. It can be used as a form of cure and prevention, and its nature makes it especially attractive to older patients and those with musculoskeletal conditions. , 
A 2003 study involving 100 subjects over 40 years old, showed the potential of yoga in reducing the morbidity and mortality from cardiovascular diseases.
In the long term, yoga affects hypothalamus (the part of the brain involved in most of the functions of the autonomic nervous system, like heart rate and blood pressure, body temperature, appetite and body weight, sleep cycles and glandular secretions). It brings about decrease in the systolic and diastolic BP through its influence on vasomotor centre, which leads to reduction in sympathetic tone and peripheral resistance. 
It has been postulated that yogic relaxation and breathing techniques (pranayama) may reduce blood pressure by inducing slow rhythmic proprioceptive and exteroceptive impulses, (decelerating responses to external stimuli, which often play as stressors), overall reducing peripheral adrenergic activity, which diminish blood flow resistance. This process allows to facilitate autonomic balance and reduce chemoreceptor responses and enhance baroreflex sensitivity. 
How yoga act against stress and hypertension
Today, most doctors agree that regular physical activity is a key element for a healthy lifestyle. Epidemiological research has demonstrated how physical activity can reduce the risk of several chronic diseases, including coronary heart disease, hypertension, non-insulin-dependent diabetes mellitus, osteoporosis, cancer, anxiety and depression. 
Hypertensive patients may benefit from yoga on many levels. To begin with, few repetitions of Sun Salutations (Surya Namaskara), one of the most common warm-up sequences of yoga, can be intense enough to become aerobic exercise, having therefore the potential to lower blood pressure.
But the benefits of yoga are far greater than that of pure physical activity:
1) It has been demonstrated how regular yoga practice can help reduce stress, which is a key factor of short-term elevations in BP.
In fact, stress can be involved in many of the lifestyle choices that raise our BP like: skipping physical exercise, indulging in unhealthy foods, drinking alcohol or smoking cigarettes.
2) Yoga aids reversing the above mentioned tendencies promoting a healthier lifestyle. Yoga connects people with themselves and with time practitioners become more kind and gentle with themselves and with others.
3) Yoga places great emphasis on the practice of self-study and self-observing. This is an important aspect, especially when we come to high blood pressure patients.
Checking your BP regularly trying to correlate the readings to what else is going on in your life, can help you better understand what is generating what.
It is suggested to keep track of your readings, noting the time when you took them, your mood, when and what you’ve eaten, how much sleep you’ve had, any alcohol or caffeine, and how stressed you felt.
Once a certain amount of data have been collected, look back over your notes. You may notice trends that will help you to make more informed decisions. 
Yoga and hypertension: the scientific evidence
In a 2011 study, 57 subjects were selected and divided in 2 groups, in order to verify the efficacy of Iyengar yoga alone versus improved diet as hypertensive treatments. Despite noticing equal improvements in both groups after six weeks, only the group practising Iyengar yoga showed consistent improvement.
In fact, at week 12, the blood pressure of these patients kept bettering over time, compared to the diet-only group, which showed no further improvements after week 6.
The study showed how, on long-term, Iyengar yoga conveys greater benefits to reduce hypertension compared to a simple change of diet. 
However, nobody would deny the great influence diet has over blood pressure. Thus, it might be assumed that combining Iyengar yoga with a more conscious diet could be the most effective approach to manage hypertension.
People usually identify yoga with asanas (postures), considering it a purely physical practice. However the reality cannot be further from that.
The physical practice is influenced by a process of breathing, of withdrawal of the senses, of concentration and meditation. In addition, the yoga practice should come along with the study of the philosophy that lies behind it, following the lifestyle and ethics encouraged by this.
Using only asanas and not other yogic aspects is like using only drug therapy without diet, exercise and stress reductions practices to try to lower your blood pressure. It may work, but, in order to make it more effectively lasting, a 360 degrees approach should be implemented. 
The effectiveness of a full yoga approach has been confirmed by a study carried out at the Integral Health Clinic (IHC) at All India Institute of Medical Sciences, involving 175 subjects between January 2002 and July 2003.
The subjects had history of hypertension, coronary artery disease, diabetes mellitus, obesity, psychiatric disorders (depression, anxiety, ‘stress’), gastrointestinal problems (non ulcer dyspepsia, duodenal ulcers, irritable bowel disease, Crohn’s disease, chronic constipation) and thyroid disorders (hyperthyroidism and hypothyroidism).
The yoga intervention consisted of asanas, pranayama (breath control), relaxation techniques, group support, individualised advice and lectures and films on philosophy of yoga, the place of yoga in daily life, meditation, stress management, nutrition, and knowledge about the illness.
The outcomes of the study showed that there was a significant reduction in the anxiety scores within just 10 days of the beginning of the intervention.
Each of these measures adopted can also individually influence the anxiety levels favourably; but, by putting them together, the objective manifestations of anxiety (a racing heart, palpitations, tremors, sweating, increased blood pressure, dry mouth, avoidance behaviour, signs of restlessness, and heightened responsiveness) decrease and slowly disappear. 
Yoga has proven to be effective also in managing secondary cardiac complications due to chronic hypertension. In fact, cardiovascular response to head-down-body-up postural exercise (like Sarvangasana or shoulderstand) has been shown to be particularly beneficial in preventing and treating hypertension-associated left ventricular hypertrophy and diastolic dysfunction.
Practicing Sarvangasana for two weeks can cause a resting heart rate and left ventricular end diastolic volume to reduce significantly with a mild regression of left ventricular mass.
In addition, 4 months of yoga practice can produce a significant improvement in the subjective well-being of post-infarct patients.
The life quality improvements of yoga have been associated with triggering of neurohormonal mechanisms, which bring about health benefits thanks to the suppression of sympathetic activity (fight or flight response). 
Savasana, a resting pose generally practiced at the end of a yoga class, has been deeply investigated in more than one study.
40 subjects were asked to practice Savasana for 3 months for 30 mins 3 times per week. Compared to the control group that rested on the sofa for the same amount of time, the Savasana group saw an average reduction of 26 points in systolic BP and 15 points in diastolic BP versus a drop of just 9 points in systolic BP and 2 points in the diastolic BP for the sofa group. 
Another study compared the effects of yoga, drug therapy and no treatment (placebo) among 33 patients with hypertension. The yoga intervention consisted of Savasana and other active asanas, pranayama and meditation 1 hour per day.
The results after 11 weeks were clear:
- yoga group: BP dropped from an average of 156/109 to 123/82.
- drug therapy group: BP drop from 159/106 to 135/92.
- control group: BP drop from 155/109 to 151/107. 
Be conscious, be yogic and be safe
Yoga is for everybody. Millions of people safely practice it everyday, including kids, elders, patients and healthy young people. It can be a great opportunity to improve your well-being, develop new friendships and meet new people. Yoga centres and yoga people are generally very friendly, positive and modest.
Yoga can be defined as a holistic approach to health but this doesn’t mean it cannot be a fun and life-changing experience. 
However, the practice of yoga should be taken seriously and with the due respect. Simple precautions must be taken and followed in order to avoid possible injuries and absorb all the benefits of the practice.
If it’s the first time you practice yoga or if you begin yoga right after learning that it can help you dealing with your blood pressure, you definitely want to err on the side of caution. Any form of exercise tends to lower BP over the long run, but BP can increase while practicing the exercise acutely.
Asanas such as backbends, inversions and arm balances are particularly likely to increase BP. Any yoga practice, even something as theoretically relaxing as a seated forward bend, can raise your blood pressure if you are uncomfortable or struggling with the pose.
Carefully monitoring yourself as you practice is the best way to detect problems. If your breath is smooth and even, and you feel at ease, your BP is likely to be stable.
Though inversion tend to raise BP while being performed, a regular practice of inversions may actually lower it over time. However, if your BP is not well controlled you should avoid inversions, even mild one like simple standing forward bends or downward facing dog.
If you’re in doubt, not sure about what you’re doing or if you feel unsafe, reach out for an experienced yoga teacher or therapist. He/she will be able to assist you and introduce you to the most useful and safe asanas and exercises for your specific condition. 
Getting to yoga may change your life. Stay positive and remember: yoga is for everybody.
General tips to control your blood pressure
|Check your body weight. Losing even a few pounds/kilos can make a significant difference|
|Practice regularly some physical exercise like walking, cycling or practising yoga|
|Eat food high in phytoestrogens like soy products and lots of fruit and vegetables|
|Avoid smoking and second hand smoke|
|Limit the amount of alcohol and caffeine|
|Reduce the amount of salt|
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