Yoga as Antihypertensive Lifestyle Therapy: A Systematic Review and Meta-analysis

Objective: To investigate the efficacy of yoga as antihypertensive lifestyle therapy and identify moderators that account for variability in the blood pressure (BP) response to yoga. Methods: We systematically searched 6 electronic databases from inception through June 4, 2018, for articles published in English language journals on trials of yoga interventions that involved adult participants, reported preintervention and postintervention BP, and had a nonexercise/nondiet control group. Our search yielded 49 qualifying controlled trials (56 interventions). We (1) evaluated the risk of bias and methodological study quality, (2) performed meta-regression analysis following random-effects assumptions, and (3) generated additive models that represented the largest possible clinically relevant BP reductions. Results: On average, the 3517 trial participants were middle-aged (49.2 +/- 19.5 years), overweight (27.9 +/- 3.6 kg/m(2)) adults with high BP (systolic BP, 129.3 +/- 13.3 mm Hg; diastolic BP, 80.7 +/- 8.4 mm Hg). Yoga was practiced 4.8 +/- 3.4 sessions per week for 59.2 +/- 25.0 minutes per session for 13.2 +/- 7.5 weeks. On average, yoga elicited moderate reductions in systolic BP (weighted mean effect size, +/- 0.47; 95% CI, +/- 0.62-0.32, +/- 5.0 mm Hg) and diastolic BP (weighted mean effect size, +/- 0.47; 95% CI, +/- 0.61 to +/- 0.32; +/- 3.9 mm Hg) compared with controls (P<.001 for both systolic BP and diastolic BP). Controlling for publication bias and methodological study quality, when yoga was practiced 3 sessions per week among samples with hypertension, yoga interventions that included breathing techniques and meditation/mental relaxation elicited BP reductions of 11/6 mm Hg compared with those that did not (ie, 6/3 mm Hg). Conclusion: Our results indicate that yoga is a viable antihypertensive lifestyle therapy that produces the greatest BP benefits when breathing techniques and meditation/mental relaxation are included. (C) 2018 Mayo Foundation for Medical Education and Research