Research Article

Effectiveness of Yoga for Hypertension: Systematic Review and Meta-Analysis

Table 1

Characteristics of studies ( ), randomized, nonrandomized controlled trials.

Author/date/
location
Sample size (yoga, control)% completed (yoga, controls)Study population (categorization)Yoga intervention description (categorization)Comparison group(s) (categorization)Yoga frequency/duration of session and total sessions Total time in minutesBP measureAdverse events

Randomized controlled trials

Cade et al. [19]
2010
USA
34, 2685.3, 80.8HIV infected adults with moderate CVD risk, 83% with hypertension, 18–70 yrs., 47% male, most on multiple medications related to HIV status and CVD risk including BP meds, unclear control of changes in BP meds during study P, M, B; Ashtanga Vinyasa; encouraged to practice at least one time per week at home/no homework compliance measures [1]usual care [1]2.5 wk/60 mins/20 wks3000NRNR

Cohen et al. [20]
2008
USA
14, 1285.7, 100Underactive, overweight adults, with metabolic syndrome, 30–65 yrs., 25% males, 59% on at least one BP med., no reported control for BP meds during studyP, M, B; “Restorative” warm up of stretches and breathing exercises followed by 10 poses. Home practice: 3x week for 30 minutes each/home diary for compliance [1]No treatment [1]Intro class 180 mins + 2x wk/90 mins/5 weeks + 1x wk/5 wks + reported mean 117 mins 10 wks2700SNone

Cohen et al. [21]
2011
USA
46, 3256.5, 96.8Hypertensive adults, 22–69 yrs., 50% males, none on BP meds by exclusion at recruitmentP, M, B; Iyengar yoga. Home practice during weeks 6–12 one time per day for 25 minutes/home diary for compliance [1]Enhanced usual care; motivational and behavioral components of life style modifications, for example, reduction of weight and ingestion of sodium and alcohol [3]2x wk/70 mins/6 wks + 1x wk/6 wks 1260Am3 (7%)

McCaffrey et al. [22]
2005
Thailand
32, 2984.4, 93Hypertensive adults, age range not reported/mean = 56 yrs., 35% male, none on BP meds by exclusion at recruitment, controlled for those who began BP meds by dropping from studyP, M, B; unspecified type of yoga it appears to be independent practice rather than classes using booklets based on yogic principles for guidance. No information about training in yoga practice. As appears that all practice was at home (no group classes)—no additional home practice [1]Usual care [1]3x wk/63 mins/8 wks1512NRNR

van Montfrans et al. [23]
1990
The Netherlands
19, 2394.7, 73.9Hypertensive adults, 24–60 yrs., 51% male, none on BP meds by exclusion at recruitment, no reported control for BP meds during studyP, M, B; multimodality program. Hatha yoga plus progressive relaxation and autogenic training for 8 weeks followed by 10 months of independent practice 2x day with cassette tape. All practice was at home except first 8 weeks so no additional home practice [3]Education about stress and hypertension. Relaxation in comfortable chair [3]1x wk/60 mins/8 wks plus home practice of 7x/wk/30 mins/40 wks480AmNR

Murugesan et al. [24]
2000
India
11, 11, 11100, 100, 100*Hypertensive adults, 35–65 yrs., gender not reported, none on BP meds by exclusion at recruitment, one comparison group used BP medsP, M, B; unspecified type of yoga. List of asanas provided plus Om recitation and meditation. No home practice [1]No treatment [1], medication [3]12x wk/60 mins/11 wks 7920SNR

Patel and North [25]
1975  
USA
18, 1894.4, 94.4Hypertensive adults, 34–75 yrs., 38% male, 94% on BP meds at enrollment, no reported control for BP meds during studyNot reported if P, M, B; multimodality, unspecified type of yoga. Yoga plus education regarding hypertension, “yoga relaxation methods,” “transcendental meditation,” and skin resistance biofeedback. “Instructed to practice relaxation and meditation twice per day.” No homework compliance measures [3]No treatment [1]2x wk/30 mins/6 wks360SNR

Saptharishi et al. [26]
2009  
India
27, 30, 28, 2877.8, 96.7, 96.4, 89.3Young pre- and hypertensive adults, age range not reported/mean of all groups 22 yrs., 67% male, BP meds status not a recruitment criterion and not reported P, B; unspecified type of yoga; postures and breath practices as per reference to previous paper. It appears that only practice is home practice “encouraged to practice yoga.” No compliance measures reported [2]No treatment [1] walking program [2], reduction of salt intake [3]5x wk/45 mins/8 wks1800SNR

Subramanian et al. [27]
2011
India
25, 25, 23, 25100, 100, 100, 84Young pre- and hypertensive adults, age range not reported/mean of all groups 23 yrs., 65% male, BP meds status not a recruitment criterion and not reportedP, B; unspecified type of yoga; postures and breath practices as per reference to previous paper. It appears that only practice is home practice “encouraged to practice yoga.” No compliance measures reported [2]No treatment [1] walking program [2], reduction of salt intake [3]5x wk/45 mins/8 wks1800SNR

Non randomized controlled trials

Deepa et al. [28]
2012
India
15, 15100,
100*
Hypertensive adults, 45–65 yrs., 53% male, 100% on BP medication P, M, B; Yoga Nidra: it begins with single sitting pose and single breath exercise followed by 45 mins of corpse pose meditation led by instructor. No home practice as this occurred 2x/day [1]Usual care, in this case, continued medication [1]10x wk/60 mins/12 wks7200SNR

Hegde et al. [29]
2011
India
60, 6395, 100Adults with Type 2 diabetes, 40–75 yrs., gender not reported, BP meds status and recruitment criterion not reportedP; unspecified type of yoga—19 asanas described only. No home practice described [2]Usual care [1]Class length and frequency not reported: class sessions occurred over 3 monthsNRNRNone

Jain et al. [30]
2010
India
57, 30100,
100
Adults, hypertension status not described (although mean BP values suggest pre-hypertension of both groups), yoga group 30–60 yrs., age of control group not reported, 60% male in yoga group, gender not reported in control group, BP meds status and recruitment criterion not reported P, M; unspecified type of yoga, Surya Namaskar + “Sharir Sanchalan”, and “Bhajan Cassette”
No home practice as this occurred daily [2]
No description of any kind for control group [1]7x wk/90 mins/18 weeks11340SNR

Lakkireddy et al. [31]
2013
USA
52, 4994,
100
Adults with paroxysmal atrial fibrillation, 39% with known hypertension, (mean BP values across groups suggest pre-hypertension) 18–80 yrs., 47% male, BP meds not a recruitment criteria but reported and controlled for during the interventionsP, M, B: iyengar: home practice encouraged with DVD provided but no compliance measures for homework [1]Wait list control, same participants for yoga and control group [1]3x wk (median value)/60 mins/12 wks.2160NRNone

Mizuno and Monteiro
[32]
2013
Brazil
17, 16100,
100
Hypertensive adults, age range not reported/mean(SD) yoga group = 67 (7) and control group = 62 (12) yrs., 15% male, majority of participants on blood pressure medication, meds controlled for in studyP, M, B; Unspecified type of yoga, although reference for asanas is Iyengar text; Pranayama, then asana, end with breathing meditation [1]Usual care [1]3x wk/90 mins/16 wks4320NRNone (PC)

Niranjan et al.
[33]
2009
India
16, 16100,
100
Hypertensive adults, age not reported, gender not reported; BP meds status and recruitment criterion not reportedP, M, B: Unspecificed type of yoga, chanting, prayer, asana, breathing exercises, ending with Savasana. No home practice described [1]Standard exercise, warm up, stationary bike 30 mins, cool down total = 45 mins; intensity not described [2]4x wk/60 mins/36 wks8640NRNR

Patel [34]
1975  
USA
20, 20100*Hypertensive adults, age range not reported/mean = 57 yrs., 31% male, 64% on BP meds at enrollment, no reported control for BP meds during studyNot reported if P, M, B; Multimodality, unspecified type of yoga. Yoga plus “psychophysical relaxation exercise based on yogic principles and reinforced by bio-feedback instruments.” No home practice [3]No treatment [1]3  wk/30 mins/12 wks1080NRNR

Selvamurthy et al. [35]
1998
India
10, 10100, 100Hypertensive adults, 100% male, age range not reported/groups divided by age with mean of yoga 50 yrs. and mean of control group 34 yrs., BP meds gradually withdrawn on all participants prior to study onsetP; Unspecified type of yoga; described several specific asanas. No homework practice [1]Tilt table [3]Frequency/time in class not reported. Class sessions occurred over 3 weeksNRSNR

Yoga intervention categorization: P: postures; B: breathing; M: meditation; 1 = P + M + B, 2 = any 2 of these or less; 3 = (±P ±M ±B) ± other interventions.
Comparison group categorization: 1 = no intervention or usual care, 2 = exercise or exercise + additional intervention, 3 = nonexercise intervention.
BP:blood pressure: measurement methods: S: sphygmomanometer; M: machine; Am: ambulatory blood pressure, and NR: not reported.
Males within study based on enrollment data, if not available, data of participants that completed study was used.
Adverse event: NR: not reported; PC: per personal communication with corresponding author.
Number of participants at completion not reported/estimate assumes 100% completion.