Because high blood pressure runs in Nicole Soteropoulos's family, she didn't flinch when, at 18 years old, her doctor told her that she too was affected. She faithfully took the prescribed medication, convinced this was about all she could do.
That belief changed 10 years later when she began practicing yoga. With the encouragement of a dedicated teacher who guided her through gentle poses and taught her visualization techniques, Soteropoulos learned that she had more control over her high blood pressure than she had thought. As the physical effects of her practice started to sink in, she began to feel more positive and more in control of her health. "Right away I felt less stressed," she says. She also lost weight.
Soteropoulos suspected that the poses were having a direct impact on her blood pressure. Out of curiosity, she devised an experiment with her yoga teacher. She performed poses recommended for high blood pressure in B.K.S. Iyengar's Light on Yoga, including Halasana (Plow Pose), Janu Sirsasana (Head-of-the-Knee Pose), and Paschimottanasana (Seated Forward Bend); then, she checked her blood pressure monitor. The results confirmed her hunch. "After every pose,my blood pressure reading went down a little more," she says.
Today, the 32-year-old from Louisville, Kentucky, practices yoga for about an hour a day. She adheres to no single style, instead doing what she calls a mélange of techniques that lean heavily on the principles of Iyengar Yoga. She also meditates and practices Pranayama (breathwork). Soteropoulos credits her practice with helping her to eat more healthfully and to stop smoking, both of which can lower high blood pressure. Now, four years after she discovered yoga, her blood pressure averages 100/70, down from a preyoga peak of 160/110 (a reading lower than 120/80 is considered healthy). Although she continues to take medication and probably will for the rest of her life, she believes her yoga practice is keeping her condition in check. "Nothing has helped as much as yoga," she says.
A National Epidemic
Approximately one in three Americans has high blood pressure, also known as hypertension. The term blood pressure refers to the pressure of the blood against artery walls as it circulates. It is measured with two numbers: The top number (systolic pressure) measures the pressure against the artery walls while the heart's left ventricle contracts, and the bottom number (diastolic pressure) marks the pressure when the ventricle rests. Ideally, the numbers stay below 120/80 mm Hg (millimeters of mercury). If, however, they start to inch up toward 139/89 mm Hg, lifestyle changes such as cutting back on salt consumption, getting more exercise, and losing weight can stop the progression. But for blood pressure that is consistently 140/90 mm Hg or higher, drugs are often prescribed.
Everyone's blood pressure changes during the day as the arteries expand and constrict in response to natural biorhythms, various habits, and tension. Anything that makes your pulse quicken—caffeine, rigorous exercise, nervousness—can cause your blood pressure to rise. When the caffeine wears off, your heartbeat slows or the excitement dies down, blood pressure normally decreases. But in a person with hypertension, the arteries are more likely to stay constricted.
Because high blood pressure often has no obvious symptoms, many people don't know they have a problem until it's too late. When left untreated for years, it puts an enormous strain on the body, especially the heart. "If you think of the heart as a pump and the arteries as something like inner tubes, the higher the pressure, the greater the strain on the pump and the greater the likelihood of getting a blowout," says Aadil Palkhivala, an Ayurvedic physician and Purna Yoga teacher in Bellevue, Washington. Over time, high blood pressure run amok can trigger a heart attack, strokes, or kidney failure.
The Stress Connection
According to the American Heart Association, the cause of high blood pressure is unknown up to 95 percent of the time. However, being overweight, consuming too much sodium or alcohol, getting little or no exercise, being African American, or having a family history of high blood pressure can increase your risk. Whether stress causes high blood pressure isn't known for sure, but many health practitioners believe not only that the two are related but also that reducing stress is a must for managing the condition. Mehmet Oz, who is a cardiac surgeon at New York-Presbyterian/Columbia University Medical Center and the co-author of You: Staying Young, encourages his patients with hypertension to practice yoga to relax. Yoga is ideal, he says, because it stimulates the parasympathetic nervous system, the body's natural switch for turning off the fight-or-flight response.
Oz thinks yoga is especially helpful for women because they are better equipped than men to respond to the nerve impulses from the brain that could contribute to high blood pressure. Men's arteries are thick, "like linguine," Oz says, but women's arteries are thinner and more delicate, "like capellini." That's both good and bad. When a woman gets stressed, her arteries quickly clamp down, Oz explains. That tightening makes it harder for blood to flow through them, and the pressure inside them increases. Likewise, when she relaxes, her arteries open, allowing the blood to flow more easily. And that's where yoga comes in.
In 2007, researchers at Yale University reviewed studies conducted on the impact of mind-body therapies—including yoga, meditation alone, and guided imagery—on high blood pressure. They found that of the three, a yoga practice had the most soothing effect. The other modalities also showed a benefit, but yoga's was far greater. "The magnitude of improvement we saw in this review was generally higher than some of the most commonly used drugs," says Ather Ali, the assistant director of integrative medicine at Yale-Griffin Prevention Research Center, who was the study's lead author.
Debbie Cohen, a kidney specialist at the University of Pennsylvania School of Medicine, says that she's cautiously optimistic that many people may be able to use yoga instead of medication. With a grant from the National Institutes of Health, Cohen compared the results of dietary changes to those of doing yoga for people in the early stages of hypertension. In the study, one group of volunteers attended four one-hour weight-loss classes and received dietary coaching for 12 weeks. A second group participated in two one-hour yoga classes per week for the first six weeks, and then attended one class per week and did a daily DVD-guided yoga session the remaining days, for six weeks. Iyengar Yoga was chosen because it is less aerobic than some other forms of yoga, Cohen says.
The class included a range of poses chosen for their ability to calm the nervous system, including Paschimottanasana, Adho Mukha Virasana (Forward Bending Hero Pose) and Apanasana (Knees-to-Chest Pose). After 12 weeks, the yoga group saw a significant drop in blood pressure, while the diet group didn't. "We were happy with the results," says Cohen, who is already planning a longer, more involved study of yoga and high blood pressure.
After four years of tuning in to her body through yoga, Soteropoulos knows that her blood pressure is climbing when she starts feeling flushed or shaky. "It feels like my blood is boiling," she says. In those moments, she relies on pranayama to restore balance. Her favorite tool is to do a guided visualization she learned from her teacher: She thinks of the breath as a wave that, as she inhales, splashes over her face and body. On the exhalation, the water moves down her back body and then back out to the ocean. If she doesn't have time for a full visualization, simply making her exhalations longer than her inhalations goes a long way toward restoring a feeling of balance and calm.
"Yoga made me aware of every choice I make," Soteropoulos says. "I have totally transformed my body and my life."
Easy Does It
Seated twists and gentle backbends can help stabilize blood pressure.
For people with hypertension, Ayurvedic physician and yoga teacher Aadil Palkhivala recommends a gentle, nonaerobic style of yoga. He also advises finding an experienced teacher who is familiar with the condition.
In addition to straining the heart, Palkhivala says that hypertension also stresses the kidneys. Therefore, he doesn't recommend arm balances, which can contract the belly and push the kidneys toward the back. Instead he suggests seated twists and gentle backbends, such as Bharadvajasana I (Bharadvaja's Twist), Marichyasana III (Marichi's Twist), and Supta Baddha Konasana (Reclining Bound Angle Pose) with props, which, he says, draw the kidney energy back into the body. Palkhivala also recommends avoiding most inversions, because they can cause blood to pool in the head, putting pressure on the head and eyes, which, he says, is risky if the blood vessels are already strained.
During your yoga practice, check in frequently to ask yourself whether your breath is smooth and even and whether you feel at ease. "If you can say 'yes' to both, your blood pressure is most likely stable," Palkhivala says.
Most of all, Palkhivala recommends meditation, a suggestion supported by research. A meta-analysis of studies published last year in the American Journal of Hypertension found that a regular Transcendental Meditation practice may significantly lower both systolic and diastolic blood pressure.
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Catherine Guthrie is a freelance writer and yoga instructor in Bloomington, Indiana.