Yoga as a non pharmacological alternative or complementary therapy for hypertension

1. Yoga as a non pharmacological alternative or complementary therapy for hypertension Manoj Sharma, MBBS, Ph.D. Session 3083; Board 1; Monday, October 31, 2011; 10:30 am

2. Introduction • Hypertension is an important risk factor for heart disease and stroke. Treatment of hypertension reduces this risk. • The Healthy People 2020 objective is to increase the proportion of adults with high blood pressure whose blood pressure is under control.

3. Prevalence of Hypertension • Prevalence of hypertension in the United States based on the data from NHANES 2007-2008 indicate 29% people have hypertension (95% CI: 27.6% - 30.5%) defined as systolic blood pressure ≥ 140 mm Hg or diastolic blood pressure ≥ 90 mm Hg. • Blood pressure was controlled in approximately 50.1% (95% CI 46.8% - 53.5%) of all patients with hypertension based on NHANES 2007-2008 data. • Not all patients accept pharmacological therapy.

4. Characteristics of yoga users • 2002 National Health Interview Survey (NHIS) found about 5.1% of US population or over 14 million people were yoga users • 85% Caucasians • 76% females • Means age of 39.5 years • Hypertension was associated with lower use (OR 0.78; 95% CI: 0.64-0.95)

5. Stages of Ashtangayoga • Yama: Techniques for successful living in society • Niyama: Techniques for managing and purifying self • Asaana: Postures for physical homeostasis & mental balance • Pranayama: Breathing techniques for physical homeostasis & mental balance • Pratihara: Techniques for developing dispassion toward senses for mental balance and equanimity • Dharana: Concentration techniques for mental balance and equanimity • Dhyana: Meditation techniques for mental balance and equanimity • Samadhi: Universal consciousness

6. Purpose • The purpose of this study was to examine whether yoga is beneficial as a non pharmacological alternative or complementary therapy for hypertension.

7. Methods • The method used in this study was a systematic qualitative review of interventions obtained from MEDLINE, CINAHL, & ERIC databases. • The criteria for including studies were: publication in English language, publication between 1975 and 2010, studies that measured blood pressure as an outcome, and studies that used yoga (from any school) as an intervention.

8. Results • A total of 16 articles met the criteria with one study reporting two interventions. • Eight interventions were from India, five from United Kingdom, three from United States, and one from Thailand. • Only five interventions used randomized controlled trials. • All the interventions demonstrated statistically significant beneficial effects of yoga on hypertension.

9. Studies 1, 2 (with 2 studies): 1975

10. Studies 3, 4, 5: 1975, 1976, 1979

11. Studies 6, 7, 8: 1984, 1988, 1989

12. Studies 9, 10: 1998, 2000

13. Studies 11, 12, 13: 2002, 2005, 2007

14. Studies 14, 15, 16: all 2009

15. Discussion…1 • Almost all studies used shava asana (relaxation) which can be considered as the common denominator for effectiveness of yoga interventions for hypertension. • Only five studies used randomized controlled trial (RCT) as the design. Future studies must use the robust RCT or group randomized controlled designs.

16. Discussion…2 • Most studies had small sample sizes (< 50). Such small sizes limit generalizability and do not allow for subgroup analyses. Future studies need to use larger sample sizes. • The duration of interventions ranged from 7 days to 12 months. This implies that duration is not associated with effectiveness. However, most interventions were between 6-8 weeks long and that seems to be most practical.

17. Discussion…3 • It can be concluded that yoga is beneficial for management of hypertension and must be used more as a non pharmacological complimentary and alternative treatment of hypertension