Yoga and hypertension: a systematic review

Lifestyle modification is a cornerstone of hypertension (HPT) treatment, yet most recommendations currently focus on diet and exercise and do not consider stress reduction strategies. Yoga is a spiritual path that may reduce blood pressure (BP) through reducing stress, increasing parasympathetic activation, and altering baroreceptor sensitivity; however, despite reviews on yoga and cardiovascular disease, diabetes, metabolic syndrome, and anxiety that suggest yoga may reduce BP, no comprehensive review has yet focused on yoga and HPT. A systematic review of all published studies on yoga and HPT was performed revealing 39 cohort studies, 30 nonrandomized, controlled trials (NRCTs), 48 randomized, controlled trials (RCTs), and 3 case reports with durations ranging from 1 wk to 4 y and involving a total of 6693 subjects. Most studies reported that yoga effectively reduced BP in both normotensive and hypertensive populations. These studies suggest that yoga is an effective adjunct therapy for HPT and worthy of inclusion in clinical guidelines, yet the great heterogeneity of yoga practices and the variable quality of the research makes it difficult to recommend any specific yoga practice for HPT. Future research needs to focus on high quality clinical trials along with studies on the mechanisms of action of different yoga practices.