Impact of Yoga on Blood Pressure and Quality of Life in Patients with Hypertension

Abstract

Background: Medical treatment of hypertension is not always sufficient to achieve blood pressure control. Despite this, previous studies on supplementary therapies, such as yoga, are relatively few. The investigator evaluated the effects of yoga intervention on blood pressure and quality of life in patients in selected hospital diagnosed with hypertension. Methods: Adult patients (age 20–80 years) with diagnosed hypertension were identified at OPD of Meenakshi Medical College and Hospital. In total, 83 subjects with blood pressure values of 120–179/≤109 mmHg at baseline were enrolled. At baseline, the patients underwent standardized blood pressure measurement at the health care center and they completed a questionnaire on self-rated quality of life (WHOQOL). There were three groups: 1) Yoga class with investigator (n = 28); 2) Yoga at home (n = 28); and 3) a control group (n = 27). The participants were matched at the group level for systolic blood pressure. After 12 weeks of intervention, the assessments were performed again. At baseline a majority of the patients (92%) were on antihypertensive medication, and the patients were requested not to change their medication during the study. Results: The yoga class group showed improvement in blood pressure or self-rated quality of life, while in the yoga at home group there was a decline in diastolic blood pressure of 4.4 mmHg (p < 0.05) compared to the control group. Moreover, the yoga at home group showed significant improvement in self-rated quality of life compared to the control group (p < 0.05). Conclusions: A short yoga program for the patient to practice at hospital seems to have an antihypertensive effect, as well as a positive effect on self-rated quality of life compared to controls. This implies that simple yoga exercises may be useful as a supplementary blood pressure therapy in addition to medical treatment.

Full text

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International Journal of Pharmaceutical and Clinical Research 2017; 9(5): 413-416
ISSN- 0975 1556
Research Article
*Author for Correspondence:
Impact of Yoga on Blood Pressure and Quality of Life in Patients with
Hypertension
J Vasantha Priya1, C Kanniammal2, Jaideep Mahendra3, G Valli4
1Department of Medical Surgical Nursing, Arulmigu Meenakshi College of Nursing, Kanchipuram, Tamilnadu
2SRM College of Nursing, SRM University,Kancheepuram District, Tamil Nadu
3Department of Periodontology, Meenakshi Dental College, Maduravoyal, Chennai
4Department of Pharmacology, Meenakshi Dental College, Maduravoyal, Chennai
Available Online: 25th May, 2017
ABSTRACT
Background: Medical treatment of hypertension is not always sufficient to achieve blood pressure control. Despite this,
previous studies on supplementary therapies, such as yoga, are relatively few. The investigator evaluated the effects of
yoga intervention on blood pressure and quality of life in patients in selected hospital diagnosed with hypertension.
Methods: Adult patients (age 20–80 years) with diagnosed hypertension were identified at OPD of Meenakshi Medical
College and Hospital. In total, 83 subjects with blood pressure values of 120–179/≤109 mmHg at baseline were enrolled.
At baseline, the patients underwent standardized blood pressure measurement at the health care center and they
completed a questionnaire on self-rated quality of life (WHOQOL). There were three groups: 1) Yoga class with
investigator (n = 28); 2) Yoga at home (n = 28); and 3) a control group (n = 27). The participants were matched at the
group level for systolic blood pressure. After 12 weeks of intervention, the assessments were performed again. At
baseline a majority of the patients (92%) were on antihypertensive medication, and the patients were requested not to
change their medication during the study. Results: The yoga class group showed improvement in blood pressure or self-
rated quality of life, while in the yoga at home group there was a decline in diastolic blood pressure of 4.4 mmHg (p <
0.05) compared to the control group. Moreover, the yoga at home group showed significant improvement in self-rated
quality of life compared to the control group (p < 0.05). Conclusions: A short yoga program for the patient to practice at
hospital seems to have an antihypertensive effect, as well as a positive effect on self-rated quality of life compared to
controls. This implies that simple yoga exercises may be useful as a supplementary blood pressure therapy in addition to
medical treatment.
Keywords: Hypertension, Yoga, Quality of Hospital, Complementary therapies.
INTRODUCTION
Hypertension is one of the most common diseases in the
world, affecting approximately 26% of the adult
population1. Persistent hypertension increases the risk of
developing coronary heart disease, stroke and other
cardiovascular diseases, such as heart failure2,3.
Hypertension is a common diagnosis in hospitals and its
consequences are considerable4. Although many
antihypertensive drugs are available, less than one third
of individuals in India who receive treatment reach their
target blood pressure (BP) (140/90)5. Previous studies
have also shown that yoga may reduce BP6-9. These
studies showed significant reduction of systolic BP (SBP)
of up to 6 mmHg and a significant reduction of diastolic
BP (DBP) of up to 5 mmHg compared to baseline6,8,9.
Whether these results are clinically significant remains an
unanswered question. If yoga has a BP lowering effect it
may be useful as a supplementary therapy in addition to
medical treatment. Since some studies have shown that
yoga positively impacts quality of life and subjective
well-being10-12, patients who regularly practice yoga may
also experience better quality of life. The novelty of the
present study is that it was performed in hospitals where
most patients with hypertension are treated. The purpose
of this matched controlled study was to determine the
effects of yoga on BP and quality of life in patients in
hospitals diagnosed with hypertension. Another aim was
to investigate whether there is a difference in effect on BP
and quality of life if yoga is practiced on a regular basis
in a group led by a investigator or if the patient practices
a shorter yoga program individually at home.
MATERIALS AND METHODS
This study was a prospective two-arm single-center study.
This was carried out in the medicine OPD of Meenakshi
College and Hospitals (MMCH & RI) during the month
of January 2016. Adult patients (age 20–80 years) at
Meenakshi Medical college and Hospital, Enathure,
Kanchipuram, diagnosed with hypertension, with BP
120–160/80–100 mmHg when last measured by previous
visit (e.g. normal, normal high and grade 1 hypertension
levels), were eligible for inclusion in the study. The

J Vasantha et al. / Impact of Yoga…
IJPCR, Volume 9, Issue 5: May 2017 Page 414
patients with BP values of 120–179/≤109 mmHg at
baseline were eligible for enrollment. The hypertensive
patients with extreme BP values, since these would
probably be under medical adjustments, expected
inability to understand instructions about the yoga
exercises, physical or mental incapacity to carry out yoga
exercises and language difficulties/interpreter needs.
Patients with systolic BP (SBP) ≥180mmHg and/or
diastolic BP (DBP) ≥110 mmHg or SBP <120 mmHg at
baseline were also excluded. They were informed about
the study and asked to provide written informed consent.
BP was measured using automated devices. The
participants completed a questionnaire on quality of life
(WHOQOL13) and a health status and lifestyle survey
designed for this study. The participants were sorted
numerically based on their SBP. There were no
statistically significant differences in BP at baseline
between the three groups.
Interventions
The yoga practiced in the present study is a form of
Kundalini yoga developed at the Institute for Medical
Yoga (IMY)14. A typical Kundalini yoga class
incorporates the following six elements: 1) tune-in with
mantra, 2) warm-up or breathing exercises, 3) physical
exercises or postures and breathing exercises, 4) deep
relaxation, 5) meditation, and 6) tune-out with mantra. In
the beginning yoga session both intervention group got
same yoga demo classes separately. The participants
received one detailed yoga instruction module and yoga
calendar. The participants were instructed to mark with a
cross the dates and also submit after their yoga training.
The intervention group 1 (28 persons) were practiced
yoga for 30 minutes every day at hospital with
investigator, intervention group 2 (28 persons) were
practiced at home and it was monitored by one of their
family member and recorded. There were no changes
made for control group 3 (27 persons). BP measurement
was standardized in a sitting position, right arm, two
readings (three readings when the first and second
readings differed by >5 mmHg)15, and was carried out by
investigator using a validated BP monitor (Omron i-C10).
BP was measured after 5–10 minutes of rest. After 12
weeks of intervention, the assessments were performed
again.
Table 1: Baseline characteristics.
SNO
Baseline characteristics
Intervention group 1
Yoga class Group
n = 28
Mean (SD)
Intervention group 2
Yoga class Group
n = 28
Mean (SD)
Control group group 3
n = 28
Mean (SD)
1.
Age in years
66.2 (7.7)
64.0 (10.3)
60.8 (11.0)
2.
% female
67.9
71.4
59.3
3.
BMI (Kg/ m2)
29.7 (7.0)
28.5(7.3)
28.8 (4.0)
4.
SBP (mmHg)
143.8 (14.9)
143.6(14.2)
144.3 (14.5)
5.
DBP (mmHg)
89.0 (7.6)
88.4(6.2)
89.8 (7.3)
6.
Well controlled (%)
39.3
92.9
37.0
7.
On medication (%)
96.4
92.9
85.2
8.
WHO 1
3.59 (0.8)
4.07(0.7)
3.96 (0.7)
9.
WHO 2
3.04 (0.9)
3.61(0.9)
3.31 (0.7)
Table 2: BP after intervention and adjusted mean change in BP.
S.
No
Category
Intervention group1,
Yogaclass group
Intervention group 2
Yoga at home group
group 2 Control group
OC
(N=28)
Mean(SE)
PPS (N=21)
Mean(SE)
OC (N=26)
Mean(SE)
PPS(N=20)
Mean(SE)
OC
(N=26)
Mean(SE)
PPS (N=23)
Mean(SE)
1.
SBP (mmHg)
144.1 (2.6)
144.3 (3.1)
137(2.7)
138(3.2)
141.5 (2.7)
142.6 (3.0)
2.
Change from
baseline
0.3 (2.6)
-0.2(3.1)
-6.8(2.7)
-6.1(3.2)
−2.3 (2.7)
−1.9 (3.0)
3.
P-value
0.917
0.954
.013**
.o61
0.381
0.527
4.
Difference vs.
control
2.6(3.7)
1.7 (4.3)
-4.4(3.8)
-4.2(4.4)
3.1(2.5)
3.0(2.8)
5.
P-value
0.482
0.693
.241
.341
0.329
0.454
6.
DBP (mmHg)
89.4(1.6)
89.5 (1.9)
84.7(1.6)
85.3(1.9)
89.9 (1.6)
90.2 (1.8)
7.
Change from
baseline
02(1.6)
0.3 (1.9)
-4.4(1.6)
-3.9(1.9)
0.8 (1.6)
1.01 (1.8)
8.
P-value
0.889
0.890
.008**
.045**
0.612
0.571
9.
Difference vs.
control
-0.6(2.5)
−0.8 (2.6)
-5.2(2.3)
-4.9(2.6)
-
-
10.
P-value
0.794
0.771
.025*
.064
11.
Yoga sessions during
intervention
47.2
52.7
63.9
72.6

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IJPCR, Volume 9, Issue 5: May 2017 Page 415
RESULTS
The baseline characteristics of the patients in the three
groups are presented in Table 1. There was a
predominance of women in all three groups. The majority
of the patients were overweight (BMI >25 kg/m2) and
92% were on antihypertensive medication (Table 1). At
baseline, 37% of the patients were well controlled
(≤140/90 mmHg). The most common single treatment
was beta blockers (BB, 13%). The study was not powered
to detect difference or change in morbidity, but there
were no significant differences between the groups
regarding prevalence of cardiovascular disease at
baseline. This was also the case for the results regarding
physical activity from the lifestyle survey. Table 2 shows
changes in SBP and DBP in the two groups. No
significant differences in change in SBP from baseline
between the yoga groups and the control group were
detected. However, the improvement in DBP for the yoga
at home group was significantly greater than that for the
control group (−4.4 ± 1.6 vs. 0.8 ± 1.6 mmHg; OC, p <
0.05). The yoga at home group also showed significant
improvements in self-rated quality of life compared to the
control group (0.29 ± 0.13 vs. 0.06 ± 0.13 for WHOQOL,
Item 1; OC, p < 0.05) (Table 3). There were no
significant differences in change in DBP or self-rated
quality of life between the yoga class and the control
groups. Further analyses of the WHOQOL domains did
not demonstrate any significant changes in any group.
The yoga group showed significant improvements in self-
rated quality of life compared to the control group (0.29 ±
0.13 vs. 0.06 ± 0.13 for WHOQOL, Item 1; OC, p < 0.05)
(Table 3). There were no significant differences in change
in DBP or self-rated quality of life between the yoga class
and the control group. Further analyses of the WHOQOL
domains did not demonstrate any significant changes in
any group. For questions (WHOQOL, Items 1–2), refer to
Table 1. Significant difference compared to the other
groups (p < 0.05) (ANOVA). OC, observed cases; SE,
standard error of the mean.
DISCUSSION
The present study was conducted to determine the effects
of yoga on BP and quality of life in patients in hospital.
Our results demonstrated a significant reduction in DBP
in the patients who practiced yoga compared to the
control group (p < 0.05). The yoga at home group also
showed a greater improvement in quality of life than the
control group (p < 0.05). Patients who practiced yoga in a
group with an instructor, however, did not experience
significant improvements in BP or self-rated quality of
life compared to the control group.
As reported, the yoga at home patients rated their quality
of life at baseline higher than the other groups. This fact
could indicate a higher motivation among these patients
to try something new to further improve their quality of
life. On the other hand, one could argue that it is more
difficult to improve quality of life when starting from a
higher level. It is unclear why the yoga class group did
not have any reduction in BP. One possible explanation
lies in the yoga exercises the two groups performed at
home. The number of sessions may have influenced the
result, but the yoga class group patients spent on average
about 50% more time doing yoga than the yoga at home
group patients. Being in a class environment with other
patients could also make some people feel insecure and
uncomfortable. The results imply that simple yoga
exercises may be useful as a supplementary BP therapy in
addition to medical treatment. It is well known that
physical activity has a BP lowering effect. For those
patients who are not able or willing to do demanding
exercise, an easy yoga program could be an alternative.
According to a Swedish literature review, the mean
reduction of BP from an antihypertensive drug is 10/ 5
mmHg, when used alone2. The effect of an additional
drug is mostly lower. In view of this fact, the mean
reduction of DBP of 4.4 mmHg, shows that the effect of
the short yoga program could be of clinical relevance and
interest when used as a supplement to other treatment.
CONCLUSION
A short yoga program for patients to practice at home
seems to have an antihypertensive effect, as well as a
positive effect on self-rated quality of life. This implies
that simple yoga exercises may be useful as a
supplementary BP therapy in addition to medical
treatment. One could also speculate as to whether this in
the long run could influence medicine intake, side effects
and drug costs. However, larger, randomized controlled
studies are needed to confirm the antihypertensive effect
Table 3: Self-rated quality of life and self-rated health after intervention.
S.NO
self-rated health
Intervention
group 1 OC, n = 40
Mean (SE)
Intervention
group 1 OC, n=40
Mean (SE)
Control group
OC, n = 26,
Mean (SE)
WHO1
1.
Average score
3.98(0.09)
4.21(.09)
3.92(0.09)
2.
Change from baseline
0.12 (0.09)
.35(.09)
0.06 (0.09)
3.
Difference vs. control
0.29 (0.13)
.29(.13)
0.06 (0.13)
4.
P-value
0.027
.027*
0.640
WHO2
5.
Average score
3.44 (0.11)
3.68(.12)
3.41 (0.12)
6.
Change from Baseline
0.15 (0.11
.39(1.12)
0.11 (0.12)
7.
Difference vs.control
0.28 (0.16)
.28(.16)
0.04 (0.16)
8.
P-value
0.099
.099
0.826

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IJPCR, Volume 9, Issue 5: May 2017 Page 416
of yoga and to identify the groups of patients that will
benefit most from yoga-based treatment. We also need to
study the long-term effects of yogic treatment on
hypertension.
ABBREVIATIONS
BMI: Body mass index; BP: Blood pressure; SBP:
Systolic blood pressure, DBP: Diastolic blood pressure;
FP: Fasting plasma;OC: Observed cases; PPS: Per
protocol set;
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