Yoga and high blood pressure

Q. I have coronary artery disease and take medications for high blood pressure. I did yoga when I was younger and would like to resume the practice. Are there any poses I should avoid?

A. Restarting your yoga practice is a terrific idea. Yoga may help lower your blood pressure, especially if you practice often. A 2019 review and analysis of earlier data published in Mayo Clinic Proceedings found that people (most of whom were overweight, middle-aged adults with high blood pressure) who did yoga for an hour about five times a week for 13 weeks had significant reductions in their blood pressure. The improvements were even greater when the yoga practice included breathing techniques and meditation.

While you're doing yoga (as is true for any type of exercise), your blood pressure will naturally rise, especially if you move quickly or hold poses for longer periods of time. Play it safe by restarting with a beginner or gentle yoga class. To minimize possible spikes in blood pressure, move slowly from one pose to the next. If the teacher has you hold a pose longer than 10 seconds, you may want to take a break by moving briefly out of the pose and then back into it. If you feel the need, rest between moves in child's pose (kneeling with your knees apart, belly resting between your thighs, resting your forehead on the ground).

Holding your breath may also elevate blood pressure, so keep breathing — something a good instructor will remind you about periodically during class. Extending the length of your inhalations and exhalations can help calm your nervous system. But take care not to strain or force your chest or abdomen to expand as you inhale.

As for poses to avoid, most people (not just those with heart disease) should be cautious about inversions. These poses, which place the heart higher than the head, require the heart to pump blood against gravity and tend to be more challenging. Some of the more advanced inversions, such as shoulder stand, headstand, and handstand, probably aren't a good idea. However, one common inversion, downward-facing dog (see photo), is generally fine for people with well-controlled high blood pressure, says Dr. Darshan Mehta, assistant professor of medicine at Harvard Medical School and medical editor of the Harvard Special Health Report Intermediate Yoga (/iy). But it's always best to check with your doctor if you have concerns about specific poses.

Finally, always end your practice with meditation, which is sometimes done while lying on your back, in a pose called savasana. This ritual helps relax your body as your breathing rate and blood pressure gradually drop.

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