Yoga as a treatment for hypertension in primary care. A quantitative and qualitative analysis conducted in Sweden

Sammanfattning: Introduction: Persistent hypertension is a key risk factor for coronary heart disease, stroke and other cardiovascular diseases, such as heart failure. For primary care physicians, hypertension is the number one diagnosis for office visits and for our communities, the treatment of high blood pressure (BP) and its consequences constitutes a substantial economic burden. Aim: To evaluate yoga as a treatment for hypertension in primary care. Methods: The thesis is based on two quantitative studies and one qualitative study: •A prospective three-arm single-centre study of two types of yoga (83 adult primary care patients diagnosed with hypertension). BP measurement, blood sampling and a questionnaire on self-rated quality of life (QOL) were carried out at baseline and after 12 weeks of intervention. There were two intervention groups and one control group. The groups were matched based on baseline systolic BP (SBP). (Papers I and II) •A three-centre parallel group randomized controlled trial (RCT) with follow-up after 12-week intervention completion (191 adult primary care patients diagnosed with hypertension). At baseline and follow-up, the participants underwent standardized BP measurements and completed questionnaires on QOL, stress, anxiety and depression. (Paper III) •A qualitative study based on individual semi-structured interviews with 13 participants from the intervention group of the RCT. We used a semi-structured interview guide according to Kvale. Qualitative analysis was conducted by systematic text condensation inspired by Malterud. (Paper IV) Results: Paper I: The patients who performed a short home-based yoga programme 15 minutes daily had a decline in diastolic BP (DBP) of 4.4 mmHg (p <0.05) and a significant improvement in self-rated QOL compared to the control group (p <0.05). Paper II: We recorded no evidence that yoga altered inflammatory biomarkers or metabolic risk factors in our study population. Paper III: There was a significant reduction in SBP and DBP for both groups (−3.8/ − 1.7 mmHg for yoga and − 4.5/ − 3.0 mmHg for control groups, respectively). However, the BP reduction for the yoga group was not significantly different from control. There were small but significant improvements for the yoga group in some of the QOL and depression measures compared with control. Paper IV: Most patients expressed a wish to find alternative ways to treat their high blood pressure. The positive experiences of doing yoga were described in terms of tranquility and increased agility. The drawbacks were mainly linked to the time required to perform the exercises. Conclusions: The patients in our qualitative study described several benefits from doing yoga but they also pointed out difficulties in implementing yoga as a regular and permanent lifestyle change. The RCT, which is the largest study from an OECD country (Organization for Economic Co-operation and evelopment) to date, does not show that the yoga intervention (MediYoga) lowers BP compared to control. However, it is of great importance that we continue to evaluate the effects as well as the experiences of “new” alternative and complementary therapies.