Journal of Yoga and Physical Therapy

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1 Joural of Yoga Physical Therapy ISSN: Joural of Yoga Physical Therapy Murray Wilso, J Yoga Phys Ther 2018, 8:2 DOI: / Research Ope Access Yoga Hypertesio: A Systematic Review Alexra Murray 1* Kisha Wilso 2 1 Bachelor of Sciece i Nursig, Labor Delivery, West Virgiia Uiversity, Uited States 2 Bachelor of Sciece i Nursig, Emergecy Services, Vidat Medical Cetre, North Carolia, Uited States * Correspodig author: Alexra Murray, Bachelor of Sciece i Nursig, Labor Delivery, West Virgiia Uiversity, RN, Morgatow, WV, Uited States, Tel: ; murra@simmos.edu Received Date: October 04, 2018, Accepted Date: December 06, 2018, Published Date: December 13, 2018 Copyright: 2018 Murray A, et al. This is a ope-access article distributed the terms of the Creative Commos Attributio Licese, which permits urestricted use, distributio reproductio i ay medium, provided the origial author source are credited. Abstract Itroductio: The objective of this systematic review is to study the effects of i reducig pressure i adult patiets with hypertesio. Yoga is uiversally accepted as aciet practice i which you use breathig techiques, exercise mediatio. Yoga is icreasig beig practiced i studios is widely beig accepted as part of a welless program i corporate compaies. The focus of this literature review is to provide a summary evaluatio of the existig research gai a ew body of kowledge o the use of to maage hypertesio. This systematic review used the Health Belief Model as the theoretical framework. Methods: CINAHL, PubMed, Directory of Ope Access Jourals, Academic OeFile, MEDLINE, Sciece Citatio Idex EBSCO Host. Search criteria romized cliical trials, peer-reviewed papers, systematic metaaalysis articles betwee Results: Eleve studies were reviewed with 957 total participats. There are six romized cliical trials, two matched cotrolled three itervetioal studies. Two types of were, i the studies, eight were ot. Two of the eleve studies showed o sigificat chage i systolic diastolic pressure. Coclusio: Through the studies aalysed, it ca be cocluded that practicig ca reduce systolic diastolic pressure. Keywords: Hypertesio, Yoga, Systolic diastolic hypertesio, Complemetary alterative medicie, Lifestyle, Essetial hypertesio, Adult Blood pressure Itroductio Hypertesio is a major health risk factor heart attack stroke is third leadig cause of death i the Uited States. High pressure is called the silet killer because it ofte has o warig sigs or symptoms. Accordig to the World Health Orgaizatio, hypertesio is cosidered a global health problem is oe of the major causes of death. There are 76.4 millio adult Americas with hypertesio, which costs the atio $48.6 billio each year. This total icludes the cost of healthcare services, medicatios to treat high pressure missed days of work [1]. The cost of medicatios o-adherece to medicatios has cotributed to the high rates of ucotrolled hypertesio. Yoga is a alterative practice cost-effective method to maage hypertesio. The purpose of this systematic review is to determie if practice is a effective itervetio to treat maage elevated pressure i adults age 18 to 65 years old diagosed with essetial hypertesio. Problem statemet Hypertesio is a multifactorial disease that affects 75 millio America adults [2]. Hypertesio is a major cardiovascular risk factor that ca result i serious cosequeces to orgas is cosidered a serious public health problem due to its chroicity high costs of hospitalizatio [3]. The mai risk factors hypertesio iclude: heredity, age, ethicity, obesity, stress, sedetary lifestyle, alcohol cosumptio, geder, use of cotraceptives high sodium itake. The treatmet of hypertesio has relied heavily upo pharmaceutical itervetios, icludig beta blockers, agiotesi-covertig ezyme ihibitors, thiazide, calcium chael blockers, diuretics, agiotesi II receptor blockers, rei ihibitors mieralocorticoids [4]. While pharmaceutical itervetio has bee show to lower pressure, little research is kow about how alterative therapies lifestyle chage ca alter or lower pressure whe used i combiatio with a medicatio or eve as a prevetative measure [5]. While medicatio has bee prove to lower pressure i some, may people still struggle with high pressure because they are ot chagig the lyig causes cotributig to their hypertesio. A large barrier of utilizig medicatio comprehesive treatmet of hypertesio icludes medicatio compliace [6]. Through a qualitative study, it was foud that the two largest factors related to ocompliace iclude; a lack of basic kowledge regardig hypertesio itself fear of takig atihypertesive medicatio [2]. With a misstig of medicatio at the ceter of hypertesio ocompliace, providers must look to aother treatmet method of this disease to promote patiet adherece. Complemetary Alterative Medicie (CAM) are a alterative healthcare treatmet that icludes mid-body therapies have bee prove to positively affect pressure [7]. Icluded i complemetary alterative medicatio therapies, is the practice of. Yoga was developed by the Idus-Sarasvati civilizatio i

2 Murray A, Wilso K (2018) Yoga Hypertesio: A Systematic Review. J Yoga Phys Ther 8: 289. doi: / Page 2 of 10 Norther Idia over 5,000 years ago [8]. Yoga provides a mid body practice that ca advace muscle stregth toe, reduce weight, improve cardio circulatory health offer a wide variety of metal as well as physical beefits. Yoga modulates the physiological system of the body ca lower a idividual s heart rate icrease flow to extremities [7]. Yoga provides beefits without drug iteractios or harmful side effects. O a idividual patiet basis, research must be cosidered to determie whether or pharmaceutical itervetios are more effective i treatig maitaiig hypertesio patiets. Literature Review Hypertesio is defied as a systolic pressure of greater tha 140 over a diastolic pressure of over 90 [1]. May Americas live with chroic hypertesio a sigificat portio of those are uaware they have high pressure. High pressure has sigificat detrimetal effects o health wellbeig, so it is imperative that all treatmet optios are explored. Curretly, there are strict guidelies treatig hypertesio set th by the Joit Natioal Committee (JNC III); these recommedatios iclude lifestyle modificatios pharmacological itervetios. The most commo pharmacological itervetios iclude thiazide diuretics, Agiotesi-Covertig Ezyme ihibitors (ACE), Agiotesireceptor blockers (ARB) Calcium-Chael Blockers (CCB) [9]. Though there are strict guidelies the treatmet of high pressure, a large portio of America adults remai hypertesive suggestig a area improvemet i hypertesio maagemet. A study from aalysed data from determied that approximately 30.4% of adult Americas are livig with hypertesio; of those idividuals with hypertesio, 53.5% did ot have their hypertesio cotrolled. Sigificat portios of idividuals with ucotrolled hypertesio were uaware of their elevated pressure [1]. May of the participats were takig pharmacological itervetios their pressure, yet still remaied hypertesive. These umbers suggest that while there are curret solutios to maage high pressure, there is still a large percetage of the populatio strugglig with hypertesio. It has log bee kow that ucotrolled hypertesio ca lead to myocardial ifarctio, heart failure stroke, but more recetly, studies have bee fidig further complicatios of hypertesio [10]. Atrial fibrillatio is a irregular heart rhythm characterized by quiverig of the atria that is ot sychroous with the vetricles [11]. While may people chroically live i atrial fibrillatio, it ca be a serious life threateig disease. The America Heart Associatio estimates that atrial fibrillatio doubles the risk of heart cardiac related deaths icreases the likelihood of stroke by five times. A study examiig the relatioship betwee hypertesio atrial fibrillatio was doe at a hospital i Pakista. This prospective study aalysed the rates of atrial fibrillatio i hospitalized patiets with log-stig hypertesio. Researchers foud that the group who suffered from hypertesio over 15 years had a 70% rate of atrial fibrillatio. More specifically, the mea systolic pressure of those with atrial fibrillatio was the mea of patiets without atrial fibrillatio was [12]. This study shows a sigificat relatioship betwee rates of atrial fibrillatio hypertesio further demostrates the dagers of hypertesio cardiac related illess. Stressig lifestyle modificatios bee prescribig medicatio is the recommeded iitial treatmet hypertesio. A study from Europe highlights the importace of lifestyle cousellig while attemptig to maage Cardio-Vascular Disease risk (CVD) i middle-aged me. I this study cardiovascular risk was determied by BMI, smokig status, physical activity pressure. Broke ito 3 groups, the me were reassessed 5 years later CVD risk was measured agai. The 3 groups were me havig bee see regularly by a primary care provider, occupatioal health provider, or o visits to a health care provider. The researchers foud that after 5 years, groups with the greatest reductio i CVD risk were those me that saw a primary care provider regularly egaged i cousellig related to their CVD status [13]. Lifestyle cousellig ope dialogue by primary care providers about their patiet s cardiovascular risk compoets, such as pressure, ca be a importat beeficial approach i reductio of CVD risk cardiovascular adverse evets. While it has bee well studied that hypertesio ca lead to stroke, myocardial ifarctio heart failure, more curret studies shows further complicatios [11-13]. Both Sire Ahmed s studies reveal that eve with all the imatio research we have today, there cotiues to be ew imatio emergig that illustrates ew problems associated with hypertesio. I additio to cardiac issues, hypertesio ca affect may other aspects of health welless. I a large study of 590 participats, rates of hypertesio depressio were examied. Ulike Sire or Ahmed s work, Almas study focused more o the psychological effects of pressure rather tha the physiological aspects [14]. This study foud that there is a sigificat correlatio betwee hypertesio depressio that is idepedet of other factors such as demographics comorbidities. It was foud that while there is a associatio betwee the two, they are still usure of the causatio. Some possible theories the authors suggest is that the costat physiological stress that hypertesio puts o the body could lead to psychological stress, or that the patiet might develop hopelessess about their chroic illess of ucotrolled hypertesio leadig to depressio. It was cocluded that more research eeds to be doe i order to clearly explai this pheomeo, demostratig that there are still ew dagerous aspects of hypertesio that are cotiuig emerge[14]. Medicatio compliace is a costat issue i healthcare ay type of pharmaceutical itervetio. A study coducted by Richardso looked at perceived ati-hypertesive medicatio compliace. The study foud that 47% of the participats were o-compliat with their pressure medicatio [15]. Medicatio compliace is a big topic i healthcare will likely always be problematic uless there are alterative optios to pharmacological itervetios. More curret literature shows that compliace is still a issue today. For example, a recet cross-sectioal study revealed the biggest predictors of ocompliace with pressure medicatios i hospitalized patiets. Poor medicatio adherece was associated with uawareess about hypertesio its dagers, side effects of pressure medicatios lack of kowledge about pressure goals [16]. Richardso s research demostrated that medicatio compliace was a problem over 20 years ago Macedo s research similarly shows that it cotiues to be a issue. With hypertesio s cotiued compliace problems, it is importat to cosider other ways to treat hypertesio besides pharmacological itervetios. A importat aspect to cosider whe lookig at alteratives to pressure medicatio is the shift i the way people view holistic health today. I recet years, a larger portio of the Uited States populatio is covertig their lifestyle to a more atural, pharmaceutical-free life tha i the past. I a research study by, the

3 Murray A, Wilso K (2018) Yoga Hypertesio: A Systematic Review. J Yoga Phys Ther 8: 289. doi: / author highlighted the recet paradigm shift holistic health practices, examied views o holistic health through participat surveys. Nursig studets who participated i a holistic health class were surveyed roughly 1-7 years after the course rated their feeligs towards the class. The study foud that 52% of the studets use the leared imatio frequetly i their persoal lives 42% i their professioal lives [17]. While the geeral Uited States populatio switches to a more aturalistic approach to healthcare, the medical field has begu to follow suit. The shift to holistic methods was explored withi the medical fields foud that cost quality cocers were the drivig ce behid the chage of practice [18]. Holistic medicies practices are more ofte cheaper the patiet as well as the medical facility prove to have fewer side effects tha their medicie couterparts. Attributig to the high cost of medicie is medical product waste. I 2012, it was estimated that 30 cets of every dollar spet o medical care i the Uited States was wasted, amoutig to $750 billio wasted aually [19]. With diet exercise reicemet beig pushed as the iitial physicia respose to deterrig chroic illesses, the practice is movig away from pharmacological approaches. While may studies researched the effects of medicatio o hypertesio, some researchers examied alterative treatmets to the disease. I a cross-sectioal study carried out through primary care cliics i Sigapore, 488 patiets with chroic disease diagoses were iterviewed regardig the use of Complemetary Alterative Medicie (CAM). Complemetary alterative medicatio is a category of medicie that icludes a variety of treatmet approaches that fall outside of the realm of covetioal medicie [20]. Withi the Asia culture, CAM use is stard with practices ofte passed dow throughout the family. Lee et al. [20] foud that 22.7% of the participats cosistetly utilized complemetary alterative medicatios as the sole treatmet their chroic disease. CAM use was foud to have a higher prevalece i idividuals with factors icludig: middle age, arthritis, musculoskeletal disorders stroke, multiple coditios, poor perceived health, family use of CAM, recommedatio by close social cotacts, strog adherece to traditioal health beliefs perceived satisfactio with care. Patiets who were dissatisfied or very dissatisfied with the cost of treatmets the waitig time were more likely to use CAM, while patiets who were satisfied from the beefits of treatmets were less likely to use CAM. Satisfactio with the physicia carig the idividual was foud to ot have ay effect o CAM use [20]. Complemetary alterative therapy is a broad headig, icludig may beeficial practices to geeral health wellbeig. Oe of these therapies icludes, which is a exercise that has bee steadily icreasig i popularity withi the US over the past few decades. Accordig to a study i the America Joural of Prevetative Medicie, the use of has icreased by 6% atiowide sice This study also showed that 78.4% of people practicig regularly self-reported a overall improvemet i their geeral well-beig. Other fidigs of the study say that the majority of the participats practicig reported a icreased sese of cotrol over their health alog with may other physiologic health improvemets [7]. Probably oe of the most importat aspects of this study is that oe third of those who have tried had told their primary care provider about it. This demostrates the importace of primary care providers stig the health beefits associated with alog with Page 3 of 10 optios alteratives to discuss with patiets about their health cocers. Lookig further ito the practice of, [21] med a crosssectioal desig with aoymous olie surveys, aimed to describe practice health characteristics of idividuals who practice, as well as explore their health beliefs regardig the effects of their practice o their health. Participat raged from 19 years old to 81 years old, with 82.4% female, 89.2% Caucasia 87.4% well educated with a bachelor s degree or higher. 4.9% of participats were obese 2% were smokers. 84.6% of participats agreed that improved eergy, 84.5% happiess, 68.5% sleep, 53.7% weight 67% social relatioships [21]. Yoga has may perceived beefits, such as icreased happiess social relatioships, as well as umerous health related avails. Yag coducted a systematic review that observed differet health compoets of practice. The study suggests that participats who regularly adhered to a program had a decrease i body weight, lowered their glucose level lowered their cholesterol levels [22]. Sui looked at health beefits i idividuals diagosed with metabolic sydrome foud favourable results the additio of to oe's exercise regime [23]. A 1-year program was started those i the study foud that waist circumferece was sigificatly improved, a decrease i systolic pressure was observed. These studies had positive implicatios metabolic cardiovascular health related to practice [23]. Historically, i commo medical practice, physicias made a diagosis, cosidered the maagemet alteratives imed patiets what could be doe to help them. Decisio-makig rested exclusively i the physicia's domai. Liddy et al. [24] coducted a itegrative review to examie the challeges of self-maaged care i multiple chroic coditios withi a family healthcare cliic. The researchers foud three key challeges to self-maaged care amog the 354 participats; cotradictory kowledge, the complexity of social support lack of fiacial resources. The physicias did ot seem to be educatig their patiets as adequately as the patiets would like some eve described itimidatig doctor-patiet relatioships with cotradictory kowledge, miscommuicatios lack of overall iterest by the physicias [24]. I order patiet cetered care to be effective, patiets must be well-imed comtable with their healthcare providers. I order to provide patiet cetered care, the medical care provider has to commuicate well with the patiet. Tailorig itervetios medicatio to patiet s idividualized situatios are extremely importat. Aother key theme withi the research was the sharig of power resposibility i healthcare. Healthcare practice has always relied primarily o the physicia s expertise, but whe the patiet is aidig i the process the resposibility of carryig out medicatio previously decided upo itervetios become shared. There is sigificat research that idicates hypertesio is still will cotiue to be oe of the leadig chroic coditios i the U.S. [11]. This presets the issue of how such a well-studied researched disease cotiues to be a problem, eve while there are pharmacological treatmet optios available. Cramer [7] discovered that curret hypertesio maagemet techiques are ot sufficiet eough to maage the problem a multidimesioal approach to treatig high pressure is ecessary. This problem opes up a opportuity to explore o-pharmacological itervetios to treatig hypertesio. Primary care providers, such as urse practitioers, are

4 Murray A, Wilso K (2018) Yoga Hypertesio: A Systematic Review. J Yoga Phys Ther 8: 289. doi: / Page 4 of 10 ofte oe of the first people that patiets ask about exercise, medical other health related choices theree should be up to date o all curret methods of hypertesio maagemet. With its popularity growig its health beefits well studied, is a reasoable complemetary alterative medical therapy to cosider ivestigate the effects it has o pressure. Despite its may potetial health beefits, is ot a widely accepted treatmet optio hypertesio warratig further research of this alterative medical therapy pressure maagemet. Withi healthcare practice, there are may approaches to idividualized as well as effective care. I patiets with hypertesio, may ot always be the first suggestio i maagemet. However, there is research to support its effectiveess i maagig pressure as prevetative measure, a adequate maagemet techique mild hypertesio i cocurret use with medicatio. Emotioally physically this practice provides umerous beefits should be cosidered whe adaptig a patiet s persoalized care. Search methods The literature review strategy this study was executed by CINAHL, PubMed, Directory of Ope Access Jourals, Academic OeFile, MEDLINE, Sciece Citatio Idex EBSCO Host. Search criteria icluded cliical trials, peer-reviewed papers, systematic meta-aalysis articles betwee The data search icluded the followig key words: hypertesio,, systolic diastolic hypertesio, complemetary alterative medicie, lifestyle, adult pressure. Iclusio criteria cosisted of ages geder, ay m legth of those with essetial hypertesio. Exclusio criteria cosisted of other ms of hypertesio beig studied such as pulmoary hypertesio or gestatioal hypertesio, paediatric studies, use of therapy other comorbidities such as cacer or diabetes mellitus with a pressure compoet studies that were focused o meditatio breathig rather tha. The icluded studies were from various regios of the world; Idia, Uited States, Australia, Swede, etc. I the selected studies there were a total of 957 participats with ages ragig from early 20 s to 80 s. Depedig o the study, participats were recruited from a variety of settigs, icludig cetres, cardiology cliics o-specific healthcare offices. A majority of authors specifically stated that imed coset was obtaied, as well as goig through their coutry s ethical clearace, while oly oe study did ot metio ethical cosideratio at all. Theoretical framework The Health Belief Model helps idetify why certai people are more iclied to reject or accept prevetive health services or implemet healthy behaviours. This theory was origially developed to better st the motivatio decisio makig process health behaviours choices. There are 4 mai compoets of the theory: severity of a potetial illess, the perso susceptibility to that illess, beefits of takig a prevetative actio the barriers to takig that actio [25]. This theory relates to the problem of hypertesio i a few ways. Hypertesio is a commo severe illess, but there are may prevetative actios people ca take to avoid treat high pressure. There are may curret treatmet optios high pressure, yet it still remais a large issue idicatig that there are barriers to compliace other health related factors ivolved. The Health Belief framework may help explai health-seekig behaviours whe it comes to the treatmet of hypertesio. A related study examied weight maagemet barriers i youg adults usig the Health Belief Model. I this qualitative study, first-year college studets were iterviewed to help idetify perceived challeges to weight maagemet durig their time i college. It was based o the framework idea that weight gai is a prevetative problem with a decisio-makig compoet. This study foud that me typically felt their barriers to weight loss were exteral factors, such as lack of resources imatio. Wome felt their barriers were based more o iteral factors, such as poor time maagemet [26]. This study further illustrates the importace of patiet perceptios o barriers to compliace their motivatio that determies prevetative health measures. This is similar to hypertesio maagemet because patiets must determie whether they perceive the severity of the issue as a potetial problem themselves, what the beefits would be if they decreased their pressure what barriers challeges there are them to take actio o it. Methodology A systematic review is a structured, comprehesive meticulous summary of fidigs. It is a overview of primary studies with the goal of idetifyig ew kowledge o a particular topic. Oe advatage of a systematic review is the ability to limit bias to draw reliable coclusios leadig to a defiitive aswer to a questio. A disadvatage to a systematic review is bias i the selectio of articles coflict with ew experimetal data [27]. A systematic review of published studies was permed. Of the eleve studies aalysed, oe study accompaied practice with medicatio, while the other studies utilized participats ot curretly takig pressure medicatios. Amogst participats i the trials, systolic pressure raged from to 158 bee begiig the itervetio of. Two studies applied the specific type Kudalii, while oe used Bikram. The eight other studies did ot specify their precise practice. After the itervetio, systolic rates lowered to a rage of to Diastolic pressure prior to practice raged from 74.7 to 100.3, compared to the after rage of 73.5 to Two of the eleve studies showed o sigificat chage i systolic diastolic pressure. The collected data from the articles icluded: study desig tools, sample size, descriptio of the study populatio pressure outcomes. Systolic diastolic pressure i adults was aalysed that utilized. The chart below describes the research desig framework coducted each study reviewed. I additio, a detailed explaatio of data collectio method is preseted. Citatio APA Purpose Sample umber Sample type Cliical Measures Research Desig Yoga itervetio Blood Results Pressure Sigifica ce Limitatios Data base Agarwal et al. [28] "to observe =40, 20-65, Age Coveie ce BP, headache, palpitatios, RCT 90miutes/ day, 7days/ Cotrol group BP bee: both Sciece Citatio Idex

5 Murray A, Wilso K (2018) Yoga Hypertesio: A Systematic Review. J Yoga Phys Ther 8: 289. doi: / Page 5 of 10 the effect of alog with medicies o hypertesi o, better maagem et" geder ot Participa ts chose from OPD Cardiolog y Ceter. fatigability, irritability, edema, vertigo, isomia week, 6 weeks **both groups iitiated drug therapy prior to study with recommede d doses of either Ateolol or Amlodipie. Cotrol group: medicatio oly, Yoga itervetio group: medicatio practice /97.6, cotrol group BP after: 143.5, group BP bee: 158/97.6, group BP after: 125/82.2 cotrol groups, also differece betwee groups selectio bias, Chauha al. [29] et "to evaluate the effect of 1 moth practice o body mass =26, idex pressure" =90, experimetal =64 (25males 39 females), cotrol group avg age 53.6 (rage 22-69) Coveie ce Participa ts chose from free camps orgaized by uiversity. BMI, BP RCT 60 miutes, 7 days a week 1 moth Experimetal bee : 136.9/84.7, experimetal after : 133/ Cotrol bee : /84, cotrol after time: /83.9 selectio bias, Directory of Ope Access Jourals Das et al. [30] "to fid out the effects of Itegrated Approach of Yoga (IAY) o Essetial Hypertes io" =120, Age 21-65, geder ot Coveie ce Participa ts chose from subjects attedig the Cardiolog y OPD of AIIMS.,, BMI, HR, RR, HAR (Hamilto axiety ratig scale) RCT 75 miutes/day every morig x 3 weeks. Cotrol group: advised to walk 30 miutes/day 5 days a week 3 weeks. Cotrol group bee: /94.87, cotrol group after: /92.5, Yoga group bee: /93.73, group after: /87.73 selectio bias, Directory of Ope Access Jourals Devi et al. [31] "to assess the effect of o heart rate pressure i mild hypertesi ve patiets who are ot o ay m of medicatio " =50 (28 males 22 females) Age Coveie ce Participa ts chose from those who came to practise at YTRC. restig HR, restig BP, HR respose to tig, BP respose to stig, valsalva ratio, BP respose to sustaied hgrip Itervetioal study 60 miutes/ day, 6 days/ week 3 moths Bee : /89.08, After : /84.64 No cotrol group, selectio bias, Academi c OeFile Divya et al. [32] "to evaluate the effect of short term practice by heatlthy voluteers o cardiovas cular =50, ages 22-55, geder ot Volutary Participa ts at a studio voluteere d to be i study. serum cholesterol, serum triglycerides, HDL, LDL, TSH, T3, T4, ECG, PFT's (FVC, FEV, PEFR), heart rate, systolic BP, diastolic BP, Fastig Itervetioal study 75 miute/ day, 6 days/ week 41 days Bee mea: /80.44 After mea: 117.6/79.24 Lack of cotrol group, usee lab errors, voluteer bias, caot be geeralized due to sample Academi c OeFile

6 Murray A, Wilso K (2018) Yoga Hypertesio: A Systematic Review. J Yoga Phys Ther 8: 289. doi: / Page 6 of 10 fuctio, pulmoary fuctio, body mass idex, glucose, lipid profile thyroid fuctio" BMI sugar, Hewett et al. [33] "to ivestigat e the effect of a bikram itervetio o the high frequecy power compoe t of heart rate variability associate d cardiovas cular disease risk factors i stressed sedetary adults." =63, (14 male, 49 female), cotrol =34, =experime tal 29, Age Coveie ce Sowball Participa ts were recruited by usig flyers by word of mouth referral. HR,,, augmetatio idex, total cholesterol, HDL, LdL, triglycerides, FBG, Body weight, BMI, weist circumferece, fat mass, lea mass, fat free mass, body fat RCT 90 miutes, 3-5 classes/ week, 16 weeks Bee : 120.3/74.7, After : 119.1/73.5 No sig. but "sigifica t associatio s" i Low attedece with participats attedig oly avg. 1.7 classes/week. Cohort may have bee too low risk to see adaptatio i certai measures such as BP, selectio bias, MEDLIN E Nejati et al. [34] "to assess the effect of group MBSRP coscious o lifestyle, copig strategies systolic diastolic pressures =30 (12 i patiets wome, 18 with me) mea hypertesi age 43.66, o" ages Coveie ce All patiet who referred to the hospital with a diagosis of ht were BP, recruited the study. Lifestyle questioaire, copig strategies RCT 90 miutes/ day, 1 day a week 2 moths. Bee cotrol: /90.34, After cotrol: /92.31, Bee experimetal: /90.58, After experimetal: /86.14 Short follow up period, iability to perm a comprehesiv e samplig of all urba areas limitig the scope to oly oe hospital, selectio bias, Directory of Ope Access Jourals Satya et al. [35] "aimed to evaluate the effective ess of i the treatmet of high pressure" =100, Age>18, geder ot Coveie ce Patiet recruited from outpatiet Cardiolog y departme t. BP Matched cotrolled trial 60 miutes/ day, 7 days/ week, 12 weeks alog with weekly doctors visits both groups Cotrol group BP bee: 155.3/100.2, Cotrol group BP after: 127.5/84.4, Yoga group BP bee: 154.2/100.3, Yoga group BP after: 122.3/81.7 both cotrol groups selectio bias, Academi c Search Complet e

7 Murray A, Wilso K (2018) Yoga Hypertesio: A Systematic Review. J Yoga Phys Ther 8: 289. doi: / Page 7 of 10 Sowae al. [36] et "to show the effects of praayam o auditory visual RT o certai physiologi cal parameter s such as weight, BMI, pulse rate, respirator y rate, systolic pressure diastolic pressure i ormal hypertesi ve subjects." =140 (70 ormal, 70 hypertesive), ages 30-60, geder ot Volutary For cotrol group, ot itervetio group. weight, BMI, HR, RR,,, ART, VRT Comparative itervetioal study 90 miutes/ day, 7 days/ week, 3 moths Bee ormotesive: /76.02, Bee hypertesive: /88.0, After ormotesive: /71.73, after hypertesive: 130.0/82.25 i both hypertesi ve ormote sive groups bias due to samplig, caot be geeralized to larger populatio, Academi c OeFile Wolff et al. [37] "to assess the beefit of two itervetio s o iflammat ory biomarker s metabolic risk factors i a high risk populatio i primary care" =83 (55 female, 28 males), avg age Simple rom Adult patiet with ht were selected by electroic charts at a health care cliic Swede. BMI, waist circumferece, BP, health status quality of life, other tests, Matched cotrolled trial split ito 3 groups (cotrol, at home, class) cotrol groupo itervetio, group 1 met oce a week did 60 mis of with istructor, the asked to practice 30 miutes a day at home i additio, the 2 group were each give a doctors appoitmet durig which they recieved istructios 2 exercises to perm at home a combied totatal of 15 mis a day, all groups a total of 12 weeks Yoga group 1 bee: 143.8/ 89 Yoga group 1 after: 143.6/89.3 Yoga group 2 bee: 143.6/88.4 Yoga group 2 after: 136.8/84 No sig. group 1 but i group 2 Some patiets (92%) already o atihypertesi ves so difficult to determie whether that was why the lack of sigificat BP results, sigle m of stuidied, participats were matched at a group level ot romized, some self reported data with how much patiets were actually doig Sciece Citatio Idex Wolff et al. [38] "to evaluate 's impact o =191, 99 wome, 92 me, mea Simple rom Adult BMI, waist circumferece,,, perceived RCT 15 miutes, 2 times/day, 12 weeks Cotrol group BP bee: 150.0/88.1, cotrol group BP after: 145.2/84.9, No sig. i either group oly oe type of itervetio tried, self Sciece Citatio Idex

8 Murray A, Wilso K (2018) Yoga Hypertesio: A Systematic Review. J Yoga Phys Ther 8: 289. doi: / Page 8 of 10 pressure quality of life o stress, depressio axiety i patiets with hypertesi o i a primary care settig" age 64.7years patiet with ht were selected by electroic stress scale, charts at a health care cliic WHO (quality of life), HAD (hospital axiety Swede. depressio) Yoga group BP bee: 148.8/88.3, Yoga group BP after: 145.4/86.3 reported data o axiety/ depressioalways room ucertaity i reportig Table 1: Aalysig the articles. Results Total Studies 11 Total Participats 957 Study Type Sample Type Yoga Type Legth of Yoga Practice Rage Average legth of Yoga practice 6 RCT, 2 Matched Cotrol, 3 Itervetioal 7 Coveiece sample, 2 volutary sample, 2 simple rom sample. 2 Kudalii, 1 Bikram, 8 ot days. mea=69.63 days, media=90 days, mode=90 days BEFORE Systolic BP Rage BEFORE Diastolic BP Rage BEFORE Average BP /88.71 AFTER Systolic BP Rage AFTER Diastolic BP Rage AFTER Average BP /82.73 Sigificat studies 9 studies, 2 o studies Table 2: Total study summary. Eleve studies were reviewed with 957 total participats. A total of six romized cliical trials, two matched cotrolled three itervetioal studies met the iclusio criteria. Two types of were i the studies, eight were ot. Studies had participats practice from 21 to 120 total days of duratio. Two of the eleve studies showed o sigificat chage i systolic diastolic pressure. These studies show that is a effective complemetary therapy hypertesio. The reviewed studies are preseted i Table 1, which compares the 11 research studies through purpose, sample size, sample type, cliical measures, research desig, itervetio, pressure results, sigificace limitatios. Discussio Researchig as a method to reduce hypertesio is importat due to the limited umber of studies that focus specifically o. Whe the results of all 11 studies were reviewed, as show i Table 2, the research recogizes that those with hypertesio ca beefit greatly from adaptig as a practice to decrease pressure. Our review attempted to provide ew isight ito the therapeutic beefits of o hypertesio. The major fidig of the study foud the had a positive effect i lowerig pressure i adults with hypertesio. Yoga demostrates a effect o pressure by modulatig the physiological system of the body, specifically o the heart rate. Systolic diastolic pressure was reduced, reflectig meaigful improvemets, as represeted i Figure 1. Yoga as opharmacological method has a positive effect o physical as well as emotioal wellbeig. May participats who were i adheret to a strict schedule reduced their BMI waist circumferece.

9 Murray A, Wilso K (2018) Yoga Hypertesio: A Systematic Review. J Yoga Phys Ther 8: 289. doi: / Page 9 of 10 Varyig baselie health amogst study participats ca cause the results to ot be geeralizable. Data collected was ofte directly from self-reported questioaires. While self-reported measures are ofte easier to implemet cost effective, they are ot always reliable. The legth of the trials i each study varied from 21 to 120 days i legth (Figure 2). Cocludig that, the members of each study were ot exposed to the same amout of as others. Figure 1: Diastolic BP i Yoga Itervetio Groups. Figure 2: Yoga Practice Legth per Study. Limitatios Geder has to be cosidered as a limitatio withi these studies. The perceptio of as a complemetary alterative medicie practice differs betwee me wome. The majority of the participats were wome i the studies. Typically, me thik of as somethig wome do may ot feel as comtable with the practice. Geder ca have a effect o the adaptatio of as a CAM, resultig i skewed efficacy. Aother limitatio is the variability i the differet ms of practice, diet experiece amogst the participats. Eight of the icluded studies did ot specifically state the type of practice that was implemeted. Results foud that a majority of the studies were from select small populatios age rages. This ca lead to fidigs that are uable to be geeralized. Ethicity of the participats was ot disclosed i ay of the studies, while six of the eleve studies listed this as a limitatio. Hypertesio varies substatially across ethic backgroud is valuable imatio to icorporate i order to coclude more accurate results [39]. Oe study icluded patiets that were already prescribed atihypertesive medicatios four studies did ot specifically state the baselie geeral health of their participats. Implicatios FNP practice The fidigs of this systematic review support the use of as a complemetary alterative medicatio i prevetig cotrollig hypertesio. Firstly, educatig patiets about the hypertesio. Secod, stress the importace of beig screeed hypertesio. Lastly, adherig to a proper diet, medicatio exercise regime. I 2014, the Eighth Joit Natioal Committee (JNC-8) released guidelies healthcare providers to follow i order to adequately maage a patiet s hypertesio based upo their idividual eeds [40]. These guidelies recommed iitiatig lifestyle modificatios i patiets over eightee years old, with hypertesio. Throughout the algorithm, lifestyle modificatios are reiced adherece is stressed, eve whe pharmacologic therapy is ot lowerig pressure. Family Nurse Practitioers (FNPs) ca recommed patiets with a history of hypertesio, or that are exhibitig sigs of prehypertesio, to begi practicig as log as they are physically able. This exercise is cost effective ca be practiced aywhere. There are umerous olie resources dedicated to teachig the practice of from begiers to expert levels. As log as the patiet shows adequate evidece of efficacy of practice, this is a beeficial CAM to implemet i a patiet s everyday life. Coclusio Through the studies aalysed, it ca be cocluded that practicig ca reduce systolic diastolic pressure. With eleve total studies reviewed, two differet types of were, i the studies, eight were ot. Two of the eleve studies showed o sigificat chage i systolic diastolic pressure. I the trials, systolic pressure raged betwee bee the practice of was implemeted. After this itervetio was admiistered, rates lowered to amogst participats. Diastolic pressure prior to practice raged from 74.7 to 100.3, compared to the after rage of 73.5 to A majority of trials foud that there are umerous beefits of, both metally physically. Study participat s weight, waist circumferece /or body mass idexes was decreased as a result of implemetatio i over half of the studies icluded. There is still a geuie eed more romized cotrolled trials to assess the effect of o persos with a family history of hypertesio, prehypertesio a diagosis of hypertesio. Utilizig the studies available, it ca be cocluded that is a adequate lifestyle modificatio that a Family Nurse Practitioer ca recommed to a patiet, i order to treat prehypertesio or accompay pharmacological therapy i essetial hypertesio. Refereces 1. Ceters Disease Cotrol Prevetio (2011) Vital sigs: Prevalece, treatmet cotrol of hypertesio-uited States. MMWR Morb Mortal Wkly Rep 60:

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