Exp Clin Endocrinol Diabetes 2016; 124(02): 65-70
DOI: 10.1055/s-0035-1565062
© Georg Thieme Verlag KG Stuttgart · New York

The Efficacy and Safety of Yoga in Managing Hypertension

H. Cramer
1   Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
› Author Affiliations
Further Information

Publication History

received 22 July 2015
first decision 22 July 2015

accepted 01 October 2015

Publication Date:
17 November 2015 (online)


Hypertension is a major public health problem and one of the most important causes of premature morbidity and mortality. Yoga is a traditional Indian practice that has been adapted for use in complementary and alternative medicine and mainly includes physical postures, breathing techniques, and meditation. The impact of yoga as a complementary intervention for hypertension has been investigated in a number of randomized controlled trials; with an overall effect of about 10 mmHg reduction in systolic and about 8 mmHg reduction in diastolic blood pressure. Yoga seems to be effective only for hypertension but not for prehypertension; and only as an adjunct to antihypertensive pharmacological treatment but not as an alternative therapy. Breathing and meditation rather than physical activity seem to be the active part of yoga interventions for hypertensive patients. These practices can increase parasympathic activity and decrease sympathetic activity, arguably mainly by increasing GABA activity; thus counteracting excess activity of the sympathetic nervous system which has been associated with hypertension. Although yoga has been associated with serious adverse events in single case reports, population-based surveys as well as clinical trials indicate that yoga is a relatively safe intervention that is not associated with more adverse events than other forms of physical activity. Yoga can thus be considered a safe and effective intervention for managing hypertension. Given the possibly better risk/benefit ratio, it may be advisable to focus on yogic meditation and/or breathing techniques.

  • References

  • 1 American Heart Association . High Blood Pressure – 2013 Statistical Fact Sheet. 2013 https://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_319587.pdf
  • 2 Bertschinger DR, Mendrinos E, Dosso A. Yoga can be dangerous – glaucomatous visual field defect worsening due to postural yoga. Br J Ophthalmol 2007; 91: 1413-1414
  • 3 Bhende AM, Zade SB, Sitre SR et al. Effect of yogic practices on the management of hypertension in working women. International J Biomedical and Healthcare Sci 2011; 1: 1-7
  • 4 Brook RD, Julius S. Autonomic imbalance, hypertension, and cardiovascular risk. Am J Hypertens 2000; 13: 112S-122S
  • 5 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. JAMA 2003; 289: 2560-2572
  • 6 Chusid J. Yoga foot drop. JAMA 1971; 217: 827-828
  • 7 Cohen DL, Bloedon LT, Rothman RL et al. Iyengar Yoga versus Enhanced Usual Care on Blood Pressure in Patients with Prehypertension to Stage I Hypertension: a Randomized Controlled Trial. Evid Based Complement Alternat Med 2011; 2011: 546428
  • 8 Cramer H. Yoga in Deutschland – Ergebnisse einer national repräsentativen Umfrage [Yoga in Germany: results of a nationally-representative survey]. Forsch Komplementmed 2015; in press
  • 9 Cramer H, Haller H, Lauche R et al. A systematic review and meta-analysis of yoga for hypertension. Am J Hypertens 2014; 27: 1146-1151
  • 10 Cramer H, Krucoff C, Dobos G. Adverse events associated with yoga: a systematic review of published case reports and case series. PLoS One 2013; 8: e75515
  • 11 Cramer H, Lauche R, Dobos G. Characteristics of randomized controlled trials of yoga: a bibliometric analysis. BMC Complement Altern Med 2014; 14: 328
  • 12 Cramer H, Lauche R, Haller H et al. A systematic review of yoga for heart disease. Eur J Prev Cardiol 2015; 22: 284-295
  • 13 Cramer H, Lauche R, Langhorst J et al. Are Indian yoga trials more likely to be positive than those from other countries? A systematic review of randomized controlled trials. Contemp Clin Trials 2015; 41: 269-272
  • 14 Cramer H, Ward L, Saper R et al. The safety of yoga: A systematic review and meta-analysis of randomized controlled trials. Am J Epidemiol 2015;
  • 15 Cramer H, Ward L, Steel A et al. Prevalence, patterns, and predictors of yoga use: Results of a US nationally representative survey. Am J Prev Med 2015; in revision
  • 16 Dacci P, Amadio S, Gerevini S et al. Practice of yoga may cause damage of both sciatic nerves: a case report. Neurol Sci 2013; 34: 393-396
  • 17 De Michelis E. A history of modern yoga: Patanjali and western esotericism. London, UK: Continuum International Publishing Group; 2005
  • 18 Esler M. The sympathetic system and hypertension. Am J Hypertens 2000; 13: 99S-105S
  • 19 Fahmy JA, Fledelius H. Yoga-induced attacks of acute glaucoma. A case report. Acta Ophthalmol 1973; 51: 80-84
  • 20 Feuerstein G. The yoga tradition. Prescott: Hohm Press; 1998
  • 21 Gallardo MJ, Aggarwal N, Cavanagh HD et al. Progression of glaucoma associated with the Sirsasana (headstand) yoga posture. Adv Ther 2006; 23: 921-925
  • 22 Hagins M, Rundle A, Consedine NS et al. A randomized controlled trial comparing the effects of yoga with an active control on ambulatory blood pressure in individuals with prehypertension and stage 1 hypertension. J Clin Hypertens 2014; 16: 54-62
  • 23 Hanus SH, Homer TD, Harter DH. Vertebral artery occlusion complicating yoga exercises. Arch Neurol 1977; 34: 574-575
  • 24 Iyengar BKS. Light on yoga. New York: Schocken Books; 1966
  • 25 Lloyd-Jones D, Adams RJ, Brown TM et al. Executive summary: heart disease and stroke statistics – 2010 update: a report from the American Heart Association. Circulation 2010; 121: 948-954
  • 26 Macy D. Yoga journal releases 2008 Yoga in America market study. Yoga Journal 2008; http://www.yogajournal.com/advertise/press_releases/10
  • 27 Mahajan AS, Reddy KS, Sachdeva U. Lipid profile of coronary risk subjects following yogic lifestyle intervention. Indian Heart J 1999; 51: 37-40
  • 28 Manchanda SC, Narang R, Reddy KS et al. Retardation of coronary atherosclerosis with yoga lifestyle intervention. J Assoc Physicians India 2000; 48: 687-694
  • 29 Mark AL. The sympathetic nervous system in hypertension: a potential long-term regulator of arterial pressure. J Hypertens Suppl 1996; 14: S159-S165
  • 30 Markil N, Whitehurst M, Jacobs PL et al. Yoga Nidra relaxation increases heart rate variability and is unaffected by a prior bout of Hatha yoga. J Altern Complement Med 2012; 18: 953-958
  • 31 McCaffrey R, Ruknui P, Hatthakit U et al. The effects of yoga on hypertensive persons in Thailand. Holist Nurs Pract 2005; 19: 173-180
  • 32 Mourya M, Mahajan AS, Singh NP et al. Effect of slow- and fast-breathing exercises on autonomic functions in patients with essential hypertension. J Altern Complement Med 2009; 15: 711-717
  • 33 Murugesan R, Govindarajulu N, Bera TK. Effect of selected yogic practices on the management of hypertension. Indian J Physiol Pharmacol 2000; 44: 207-210
  • 34 Nagler W. Vertebral artery obstruction by hyperextension of the neck: report of three cases. Arch Phys Med Rehabil 1973; 54: 237-240
  • 35 Oparil S, Zaman MA, Calhoun DA. Pathogenesis of hypertension. Ann Intern Med 2003; 139: 761-776
  • 36 Pal A, Srivastava N, Narain VS et al. Effect of yogic intervention on the autonomic nervous system in the patients with coronary artery disease: a randomized controlled trial. East Mediterr Health J 2013; 19: 452-458
  • 37 Pal A, Srivastava N, Tiwari S et al. Effect of yogic practices on lipid profile and body fat composition in patients of coronary artery disease. Complement Ther Med 2011; 19: 122-127
  • 38 Patel C, North WR. Randomised controlled trial of yoga and bio-feedback in management of hypertension. Lancet 1975; 2: 93-95
  • 39 Patil SG, Dhanakshirur GB, Aithala MR et al. Effect of yoga on oxidative stress in elderly with grade-I hypertension: a randomized controlled study. J Clin Diagn Res 2014; 8: BC04-BC07
  • 40 Posadzki P, Cramer H, Kuzdzal A et al. Yoga for hypertension: a systematic review of randomized clinical trials. Complement Ther Med 2014; 22: 511-522
  • 41 Pullen PR, Nagamia SH, Mehta PK et al. Effects of yoga on inflammation and exercise capacity in patients with chronic heart failure. J Card Fail 2008; 14: 407-413
  • 42 Pullen PR, Thompson WR, Benardot D et al. Benefits of yoga for African American heart failure patients. Med Sci Sports Exerc 2010; 42: 651-657
  • 43 Rice R, Allen RC. Yoga in glaucoma. Am J Ophthalmol 1985; 100: 738-739
  • 44 Saptharishi L, Soudarssanane M, Thiruselvakumar D et al. Community-based Randomized Controlled Trial of Non-pharmacological Interventions in Prevention and Control of Hypertension among Young Adults. Indian J Community Med 2009; 34: 329-334
  • 45 Streeter CC, Gerbarg PL, Saper RB et al. Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Med Hypotheses 2012; 78: 571-579
  • 46 Telles S, Raghavendra BR, Naveen KV et al. Changes in autonomic variables following two meditative states described in yoga texts. J Altern Complement Med 2013; 19: 35-42
  • 47 Toise SC, Sears SF, Schoenfeld MH et al. Psychosocial and cardiac outcomes of yoga for ICD patients: a randomized clinical control trial. Pacing Clin Electrophysiol 2014; 37: 48-62
  • 48 Vogel CM, Albin R, Alberts JW. Lotus footdrop: sciatic neuropathy in the thigh. Neurology 1991; 41: 605-606
  • 49 Walker M, Meekins G, Hu SC. Yoga neuropathy. A snoozer. Neurologist 2005; 11: 176-178
  • 50 Woolf KJ, Bisognano JD. Nondrug interventions for treatment of hypertension. J Clin Hypertens 2011; 13: 829-835
  • 51 World Health Organization . World health statistics. 2012 http://apps.who.int/iris/bitstream/10665/44844/1/9789241564441