Author’s Note: The poses described in the following hypertension series are not intended to be a substitute for the personal advice of a health professional.
Everyone has seen the classic stereotype of one who suffers from hypertension (high blood pressure): an angry, sweating, red-faced man, mopping his head with a handkerchief, perhaps pacing and looking as if he is too tightly encased in his skin and about to pop out, the veins on his face or neck distended. But this picture is not quite accurate. While blood pressure does rise during times of stress, most of the millions of people with hypertension, both men and women (more likely after menopause), show no noticeable symptoms.
Individuals with consistently elevated blood pressure may even seem calm, not the agitated type at all, and because of this many people do not have their pressure checked, even as they age. But hypertension is potentially quite serious. It is closely associated with heart attacks and strokes, two of the leading causes of death and disability in our country.
What exactly is blood pressure? The numbers recorded when blood pressure is taken are actually a ratio of two measurements: the top number is the measurement (in equivalent millimeters of mercury) of the pressure generated when the heart beats and presses the blood against the arteries and arterioles. The lower of the two numbers is the pressure the circulatory system exerts between the beats of the heart, and it is one of the main measures of the health of the vascular system.
Both numbers are important indicators of cardiovascular health. Doctors say that a number of 120/80 is “normal,” but blood pressure can be lower and occasionally slightly higher with no risk to health.
Like all physiological measurements, blood pressure readings must be interpreted in context. Age, gender, level of physical activity, illness, physical position, prolonged stress, and other factors can affect the reading. However, a consistent diastolic (lower) reading of 90 points or above is cause to be concerned and a health professional should be consulted.
Hypertension can be caused by problems with the heart itself, or by the improper functioning of the kidneys or lungs. However, doctors call most hypertension “essential hypertension,” which means basically that they do not know the exact cause of the elevated pressure. Perhaps genetic predisposition plays a part.
People with hypertension are often told to restrict salt intake, but some studies have found this helpful for lowering blood pressure in only about 15 percent of the at-risk population. Weight reduction, if necessary, usually has a beneficial effect, as do the lifestyle changes we all hear so much about—exercise, stress reduction, and quitting smoking. Whether or not there is a family history of hypertension, it is a good idea for everyone over 35 to have their blood pressure checked occasionally by a health professional.
Current medical treatment for hypertension may include various classes of prescription drugs—calcium channel blockers, diuretics, ACE inhibitors and other vasodilators, as well as alpha and beta blockers.
The asanas which are the most effective are the supported bridge, the elevated feet-up-the-wall pose, and the ever-important savasana.
Yoga and High Blood Pressure
Yoga practices can help too. One study found that 10 minutes of relaxed deep breathing reduced blood pressure and kept it down for as long as 30 minutes. The asanas which are the most effective are the supported bridge, the elevated feet-up-the-wall pose, and the ever-important savasana, or corpse pose. In addition, spending some time each day in meditation has been shown by a number of studies to be beneficial.
The Supported Bridge Pose
An excellent pose that's used for reducing blood pressure is the supported bridge pose. You will need two yoga bolsters or two large couch cushions and some firm folded blankets. You may also need a washcloth.
Place your folded blankets in two stacks, end to end, on top of the bolsters or the couch cushions. Because each person’s body proportions are different, the height varies, but the props should be just high enough to let the shoulders touch the floor lightly. The height should be even for the entire length of the body.
Straddle the bolster and lie back so that your shoulders just lightly touch the floor. If the props feel too low or too high, roll to the side, use your arms to sit up, and adjust them by adding or taking away blankets.
Once you are in position, pay attention to your neck. If it feels as if your chin is forced downward too much, come out of the pose as indicated above. Fold the washcloth and place it under the large vertebrae at the base of your neck to lift the back of the neck up and create a more normal arch.
If your lower back is uncomfortable in this pose, try bending your knees, either placing your feet on the cushions or on the floor. Put your arms out to the sides in a comfortable position. Close your eyes and keep the breath easy and soft. Stay in the pose 5 to 15 minutes.
When you are finished, come out by rolling to the side or sliding off the end of the bolster. In either case, lie on your side and rest for a minute or two before proceeding to the next pose. Then use your arms to help you sit up.
Do not practice this pose if you are pregnant or have diagnosed disc disease in your lower back.
The next pose in this hypertension series is the elevated feet-up-the-wall pose, or viparita karani. You will need three firm blankets, or you can use one yoga bolster and one firm blanket.
Place the bolster or two firmly folded blankets about 8 to 10 inches from the wall. Place the third blanket at a 90-degree angle to the first. Sit on the end of the bolster so that your shoulder faces the wall and then roll your back onto the bolster and swing your legs up the wall.
Remember that this pose is not intended to be a stretch for the legs, so make sure that the bolster is far enough from the wall to allow you to relax. The tailbone drops slightly over the wall end of the blankets or bolster so that the belly is parallel to the floor. Make sure that the lower back is in a neutral position (which means slightly arched for this portion of the spinal column).
Lie on the props so that the last rib at the back of your waist is well-supported, and your shoulders are lightly resting on the blanket. Close your eyes, covering them if you wish, breathe naturally, and rest from 3 to 10 minutes.
To come out of the pose, bend your knees and roll to the side and off the bolster/blankets carefully. Remain lying on your side for a minute or two before using your arms to help you sit up. Take some time before you move to the next pose or on with your daily activities.
Do not practice this pose if you are more than three months pregnant, suffer from hiatal hernia, or from diagnosed disc disease in the lumbar spine.
Baroreceptors and Blood Pressure
Informal testing by yoga teachers who are also health professionals shows that students practicing viparita karani have lowered their diastolic (the lower number) pressure by as much as eight points.
Both this and the supported bridge pose help to reduce blood pressure in a similar way—because both involve the movement of the chin toward the chest, both have a similar effect upon structures called baroreceptors in the carotid arteries on either side of the neck. The word “baro” means pressure; the baroreceptors are arterial sites which are sensitive to changes in blood pressure in the neck. Their function is to keep pressure from getting too high as blood enters the brain so that virtually the same amount of blood (and therefore oxygen) is maintained in the brain at all times.
The brain, like all nervous tissue, is exquisitely sensitive to oxygen deprivation, and if the blood pressure drops too much in the brain while you are sitting or standing, you are likely to faint. This is an adaptive mechanism which quickly puts you into a horizontal position and brings blood to the brain, restoring normal blood pressure and oxygen there.
The neck position in these two poses stimulates the baroreceptors which therefore register too much pressure in the carotid arteries. The nervous system responds to this information by reflexly lowering systemic blood pressure. What this means in practical terms is that the poses in effect “fool” the baroreceptors into “thinking” that the blood pressure is too high, and this causes the reflex reduction of blood pressure.
Finally, this practice session and in fact all practice sessions of yoga asanas are wonderfully ended by savasana, the basic relaxation pose. You will need two blankets and something to cover your eyes.
To begin, sit on a floor which has a comfortable surface such as a rug or another blanket. Roll one of the blankets into a thick roll and place it under your knees. Fold another blanket into a rectangle and then fold it again so that one edge is about six inches from the other. Place the thinner of the two folded edges under your shoulder blades and curl the thicker end slightly to support the natural curve of the cervical spine (neck).
Cover your eyes with a yoga eyebag or a soft towel, and spend a few minutes making sure that you are comfortable with your props.
The arms and legs should be equidistant from your midline. Drop the chin just slightly, swallow, and release the jaw, letting the lips part.
Suggest to yourself that your abdominal organs drop toward the floor, thus relaxing the belly. Imagine that your brain is shrinking and dropping to the back of the skull. Experience the vast space within your body. Take a series of slow and even breaths through the nose.
Then let the breathing return to normal. Lie in relaxation for 15 to 20 minutes.
When you are ready to come out, slowly bend one knee and roll to the side. Lie on that side for a minute or two and then, using the arms, sit up. Take your time about commencing the normal activities of your day.
There are two major benefits of savasana: the first is that it provides systemic relaxation; the second is the mental benefit one can gain from a daily 20-minute practice.
The relaxation component is critical in modern life. Most people have two speeds: pushing to accomplish the myriad tasks we all have, or dead asleep. Sometimes we have another speed—vegging out in front of the mind-numbing TV. There are very few activities which teach the art of relaxation. But with the regular practice of savasana, we can learn another way of being.
The posture not only offers us a chance to lower blood pressure, but also gives the parasympathetic nervous system a chance to dominate. And during deep relaxation all our physiologic parameters show signs of rest: the breathing rhythm slows, digestion as well as the repair and growth of tissues occurs, and the pH of the blood changes.
If you are more than three months pregnant, practice this pose lying on your side.
Be Creative You may want to take a savasana break in the mid-afternoon or when you return home from work, before beginning to prepare dinner. But whenever it fits into your day, practice this pose. Be creative; you can practice “sitting” savasana while waiting in your car for someone to come out of the store, or while taking off or landing in an airplane. Perhaps you can practice relaxation on the couch in your office after lunch. (If you choose this option, try lying on your left side to facilitate digestion as you rest.)
I believe this pose is the most important of all the yoga asanas. Not only does it lower blood pressure (and afford other benefits), but it is the gateway to meditation. What better thing could we do with 15 minutes a day? What better and more healthy skill could we teach our students?
For help in preparing this article, thanks to Catherine McDonough, yoga teacher, family nurse practitioner, and co-director with her husband, Tom Lambert, M.D., of the new Wellness Center in Billings, MT.
Photos by Fred Stimson from Relax and Renew © 1995 by Judith Lasater, PhD., P.T. Reprinted by arrangement with Rodmell Press, Berkeley, CA. model (figures 1 & 2): Carol Nelsonmodel (figure 3): Richard Rosen model (figure 4): Carol Wong