Lowering Your Blood Pressure

by Nina

If you have high blood pressure—or even high blood pressure that is being controlled with medication as Timothy wrote yesterday—there are certain anti-stress poses that you should not be doing. Although inverted poses can lower blood pressure due to the interaction between your baroreceptors and your nervous system (see Why You Should Love Your Baroreceptors), going upside down initially raises your blood pressure before feedback from the baroreceptors to the nervous system causes the Relaxation Response to kick in. This initial rise in blood pressure is why the poses are considered dangerous for those whose blood pressure is already high (and perhaps for those whose blood pressure is being controlled with medication as Timothy wrote in Keeping Yoga Safe for People with High Blood Pressure), because there is concern it could cause a stroke.

Timothy didn’t list exactly which inverted poses besides Headstand that people with high or even controlled high blood should be avoiding, so I decided to talk with Baxter about the topic in order to list them out for you. The good news is that Baxter considers three of the most effective stress-reducing inversions to be generally safe. I’ve divided the inverted poses into same three groups I used in my post All About Supported Inversions. So here goes:

Full Inversions: Poses to Avoid

• Handstand (Adho Mukha Vrksasana)
• Forearm Balance (Pincha Mayurasana)
• Scorpion (Vrschikasana)
• Headstand (Sirsasana)
• Shoulderstand (Sarvagasana), including the chair version
• Plow (Halasana), including the chair/bench version

Because you are fully inverted in these poses, the blood quickly rushes toward your head, initially raising your blood pressure. In addition, most of these poses are stressful to perform, especially for beginners, and the stress itself can raise your blood pressure.

Half Inversions: Poses to Evaluate

• Downward-Facing Dog pose (Adho Mukha Svanasana)
• Standing Forward Bend (Uttanasana), with or without support
• Wide-Legged Standing Forward Bend (Prasarita Padottanasana)

Poses where your head and torso are inverted but your legs not, such as Standing Forward Bend, are probably safe. But Baxter recommends that you ask your teacher to look at you while you are doing the poses. The same questions about how you look in the pose that Timothy listed yesterday would be helpful for assessing the suitability of these poses for you or, if you’re a teacher, for your student.

“Does the student appear to have the strength and flexibility to do the pose safely? How is their breathing in the pose? Do they look uncomfortable? Are they able to maintain a healthy curve in the neck? Are their neck veins bulging? How do they say they feel in the pose? It is even possible, if you've got a blood pressure device, to measure the pressure to make sure it isn't spiking in the pose or poses you're concerned about.”

If the pose is difficult or stressful for you, you may want to exclude it from your practice. If you decide to exclude these poses, you can practice Half Downward-Facing Dog pose at the Wall instead.

Gentle Inversions: Poses that are Generally Safe

• Legs Up the Wall pose (Viparita Karani)
• Easy Inverted pose (Viparita Karani with bent legs)
• Supported Straight Leg Bridge pose (Setubanda Sarvangasana)

According to Baxter, gentle inversions where your heart is only slightly higher than your head and your body slopes gradually down, such as Legs Up the Wall pose, do not seem to cause an initial rise in blood pressure (he has done some informal testing). Therefore, he feels comfortable in saying they are generally safe. One caveat might be that if your blood pressure is wildly out of control, it might make sense for you to do a different type of practice for stress reduction (see below).

Safe Ways to Lower Blood Pressure

Remember, there is no need for you to do any inverted poses! If you are at all concerned about going upside down, you can choose from several other very effective and safe techniques for lowering your blood pressure. Any yoga or meditation technique that triggers the Relaxation Response (see The Relaxation Response and Yoga) will lower your blood pressure (this was proven in the 70s by Dr. Herbert Bensen and described in his book The Relaxation Response, which I highly recommend). Probably the easiest thing to do is just to sit quietly and observe your breath or recite a mantra. But you can practice any form of mediation, practice Yoga Nidra, any guided Savasana, or any form of Relaxation pose (Savasana) with a mental focus. You could also practice your favorite restorative poses (see Mini Restorative Practice, also with a mental focus. Just be sure to take a non-judgmental attitude toward your practice, give yourself at least 10 to 20 minutes of practice, as it takes a while for the Relaxation Response to kick in, and don’t fall asleep (sleeping is different than conscious relaxation).

All of these options are wonderful for anyone who experiences “situational” high blood pressure (when getting stressed out or angry causes... well, you know!) And practicing conscious relaxation on a regular basis will also enhance your health in the short term (bolstering your immune system) and the long term (helping to prevent heart disease, strokes, and other diseases of aging).

Keeping Yoga Safe for People with High Blood Pressure

by Timothy

Monterey Cyprus by Melina Meza

I recently taught a course on Yoga for High Blood Pressure on Yoga U Online. During the program I suggested that doing certain inverted poses such as Headstand (Sirsasana) may not be a good idea, even for some people whose blood pressure (BP) is “well controlled” by medications. But one listener had heard during her teacher training that inversions were okay in this situation. Her instructors had consulted a local cardiologist and shown the doctor the poses in question, and he had said he didn't have a problem with them in people whose BP was under control.

The concern is that when you go upside down, the pressure in the head increases, which could at least theoretically increase the risk of a stroke. I say theoretically, because actually no one really knows how large the risk is, though it's likely very, very small. As I've written elsewhere, more than likely yoga greatly decreases the overall risk of a stroke. But that doesn't mean it's a good idea to push your luck.

Interestingly, blood pressure is one area where yoga teachers are sometimes more conservative than doctors. Aadil Pahkivala, the teacher I worked with on the high blood pressure chapter of my book Yoga as Medicine, has found that some people with well-controlled BP nonetheless demonstrate jitteriness when they do some inversions and strong backbends. This nervous system agitation, which can be visible to the teacher and palpable to the student  (at least the ones who have developed their internal awareness though their yoga practices), suggests a potential problem.

In medical school, we were taught to always weigh risks vs. benefits of any test, drug or medical procedure under consideration. In medicine, this comes under the category of “first do no harm.” In yoga, we've got the same idea with the notion of ahimsa, non-harming, which is considered the foundation of any yoga practice. Again, the risk of a stroke when inverting with “well-controlled” high blood pressure is likely very small, but even a tiny risk of something very bad should be factored in when deciding whether or not to do a particular yoga pose. In yoga, a crucial way to assess safety is to study your student—or yourself, if you're the student in question—as they do the practice in question.

So rather than simply saying, “The doctor says it's okay to do Headstand so let's do it,” a more prudent approach is to let that be the beginning of your evaluation. If you're a teacher, consider the following questions: Does the student appear to have the strength and flexibility to do the pose safely? How is their breathing in the pose? Do they look uncomfortable? Are they able to maintain a healthy curve in the neck? Are their neck veins bulging? How do they say they feel in the pose? It is even possible, if you've got a blood pressure device, to measure the pressure to make sure it isn't spiking in the pose or poses you're concerned about. And if you're a student concerned about high blood pressure, ask your teacher to help you do this evaluation.

Especially when the risks are uncertain, the more information you can get the better. And after you have all the information, it’s time to practice ahimsa.