Hypertension prevalence continues to increase in the United States. Yoga, a form of mind body therapy has become increasingly popular in the United States and represents an alternative to drug therapy. In our previous pilot study we assessed the effects of yoga vs. enhanced lifestyle modification in lowering blood pressure in subjects with prehypertension and stage 1 hypertension. Our results showed that yoga practice did result in clinically meaningful decreases in 24 hour ambulatory blood pressure readings. In this proposed study we plan to determine the effects of yoga therapy vs. enhanced lifestyle modification vs. the combined intervention of yoga therapy and lifestyle modification on lowering blood pressure in subjects with prehypertension and stage 1 hypertension. We believe that the combined intervention will result in significant clinically meaningful decreases in blood pressure. If this study shows significant decreases in blood pressure, this combined intervention can be incorporated into patients lifestyles as an intervention to avoid drug therapy.
Specific aims to be addressed are: 1. To determine the effect of a structured 24-week yoga program on reducing blood pressure in adults with high-normal to stage I hypertension. 2. To determine if the combined effects of yoga and lifestyle modification are more effective at reducing 24 ambulatory blood pressure than either group alone. 3. To test if the effects of yoga on changes in blood pressure are reflected in changes in cerebral blood flow (CBF) as measured by arterial spin labeling (ASL) functional magnetic resonance imaging (fMRI). This will be accomplished by performing fMRI during a resting and stimulated state and observing changes in regional CBF in the prefrontal cortex and cingulate gyrus before and after 24 weeks of yoga, lifestyle modification or the combined intervention. 4. To compare changes in mean scores of both psychological and physiological measures of mood, perceived stress and health competence with changes in blood pressure within the intervention groups.

Public Health Relevance

This proposed study will determine if yoga therapy combined with enhanced lifestyle modification will result in clinically meaningful decreases in blood pressure and can be used as an alternative to drug therapy in subjects with prehypertension and stage 1 hypertension.

National Institute of Health (NIH)
National Center for Complementary & Alternative Medicine (NCCAM)
Research Project (R01)
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Clinical and Integrative Cardiovascular Sciences Study Section (CICS)
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Weber, Wendy J
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University of Pennsylvania
Internal Medicine/Medicine
Schools of Medicine
United States
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Shulman, Rachel; Cohen, Debbie L; Grandner, Michael A et al. (2018) Sleep duration and 24-hour ambulatory blood pressure in adults not on antihypertensive medications. J Clin Hypertens (Greenwich) 20:1712-1720
Cohen, Debbie L (2013) Yoga and Hypertension. J Yoga Phys Ther 3:
Cohen, Debbie L; Bowler, Anne; Fisher, Stephen A et al. (2013) Lifestyle Modification in Blood Pressure Study II (LIMBS): study protocol of a randomized controlled trial assessing the efficacy of a 24 week structured yoga program versus lifestyle modification on blood pressure reduction. Contemp Clin Trials 36:32-40
Newberg, Andrew B; Amsterdam, Jay D; Wintering, Nancy et al. (2012) Low brain serotonin transporter binding in major depressive disorder. Psychiatry Res 202:161-7