Therapeutic role of yoga in hypertension

Table 3 Yoga for hypertension: Precautions and contraindications

Yoga practice	Details of yoga practice	Precautions and contraindications
Shatkriya (Yoga cleansing practices)
Shatkriya (Yoga cleansing practices)	Shankhaprakshalana (Alimentary tract cleansing); Agnisara Kriya (Activating the digestive fire); Vaman dhauti (Regurgitative cleansing); Vastra dhauti (Cloth cleansing); Nauli kriya (Abdominal massaging); Basti kriya (Yogic enema); Kapalbhati (Skull shining breath)	Contraindicated in hypertension[9]; Kapalbhati increases diastolic BP suggesting sympathetic stimulation[41]; Laghu shankhaprakshalana, the simplified and shorter version of shankhaprakshalana is suggested in mild to moderate hypertension[42]
Asana (Yoga postures)
Inversions and head below the heart postures	Shirshasana (Headstand pose); Sarvangasana (Shoulderstand pose); Chakrasana (Wheel pose); Halasana (Plough pose); Adhomukh shvanasana (Downward facing dog pose); Prasarit Padottanasana (Wide-Legged standing forward bend)	Cause a significant rise in both the systolic and diastolic arterial pressures; Contraindicated in hypertension[9,38]; Increase intrathoracic pressure and strain the cardiovascular system; Pooling of the blood in the head and neck region resulting in the rise of BP
Other asanas	Mayurasana (peacock pose); Dhanurasana (bow pose)	Compress the front of the diaphragm, which can raise the BP
Pranayama (Regulated breathing practices)
Pranayama pace	Fast breathing	Rapid breath practices may be unsafe in patients with hypertension and cardiovascular disease
Pranayama type	Bhastrika pranayama (Bellows breath) with rapid forceful inhalation and exhalation	Increases HR and BP, producing vasoconstriction[39]
Pranayama type	Surya bhedan/surya nadi pranayama (Right nostril breathing)	Sympathetic stimulating effect[39]
Pranayama technique	Kumbhaka (breath retention)	Significant increase in systolic, diastolic BP, and mean arterial pressure[40] due to combined effect of increased level of HR and total peripheral resistance during kumbhaka
Bandha (lock)
Bandha (lock); Practiced with breath retention	Mula Bandha (Root lock, pulling the perineum inward); Uddiyan Bandha (Abdominal lock, lifting of the diaphragm); Jalandhar Bandha (Chin Lock, pressing the chin on the chest and contracting the throat)	Long retention of breath strains the heart and is not recommended for hypertension[9]; If the jalandhar bandha is not performed properly, the BP is raised

BP: Blood pressure; HR: Heart rate.