Blood high pressure and inverted poses

Yoga Discussion General Yoga
#13

You have measured the blood pressure in your arm or wrist, ideally holding this limb at heart level. You have measured your BP before and after headstand. It would have been more relevant to measure your blood pressure (a) inside your head and (b) during headstand itself. In headstand, the head is below the heart and therefore there is a greater hydrostatic blood pressure inside the head due to the effect of gravity. The pressure at the bottom of a swimming pool is higher than the pressure at the surface.

The effect of headstand on blood pressure has been studied since Kuvalayananda (1926). In a study by Gilmore in 2002, testing men and women with normal blood pressure, cranial blood pressure recorded when performing a headstand averaged 150/110 mm Hg. Therefore, there is a potentially heightened risk of stroke. Baskaran (2009) found that intraocular pressure rises by 15 mm Hg immediately after assuming headstand. This may cause retinal detachment in people with eye disease.

However, many yoga teachers feel that that people with [B]controlled high blood pressure [/B]can practice headstand provided that they (a) move into the pose slowly, (b) limit the duration to a few minutes in the beginning, and © do not exceed 15 minutes in the pose. Controlled blood pressure means a pressure below 140/90 using medication. A better criterion is: if you feel strain, get out of the pose. It is wise to practice gentler inversions for several months before moving to headstand (e.g. downward facing dog, bridge, half-shoulderstand, shoulderstand, in this order).

The good news is that practicing yoga and meditation for a few months can lower both systolic and diastolic blood pressures (by values of 10 -15 mm Hg).

#14

[QUOTE=Willem;25624]You have measured the blood pressure in your arm or wrist, ideally holding this limb at heart level. You have measured your BP before and after headstand. It would have been more relevant to measure your blood pressure (a) inside your head and (b) during headstand itself. In headstand, the head is below the heart and therefore there is a greater hydrostatic blood pressure inside the head due to the effect of gravity. The pressure at the bottom of a swimming pool is higher than the pressure at the surface.

The effect of headstand on blood pressure has been studied since Kuvalayananda (1926). In a study by Gilmore in 2002, testing men and women with normal blood pressure, cranial blood pressure recorded when performing a headstand averaged 150/110 mm Hg. Therefore, there is a potentially heightened risk of stroke. Baskaran (2009) found that intraocular pressure rises by 15 mm Hg immediately after assuming headstand. This may cause retinal detachment in people with eye disease.

However, many yoga teachers feel that that people with [B]controlled high blood pressure [/B]can practice headstand provided that they (a) move into the pose slowly, (b) limit the duration to a few minutes in the beginning, and © do not exceed 15 minutes in the pose. Controlled blood pressure means a pressure below 140/90 using medication. A better criterion is: if you feel strain, get out of the pose. It is wise to practice gentler inversions for several months before moving to headstand (e.g. downward facing dog, bridge, half-shoulderstand, shoulderstand, in this order).

The good news is that practicing yoga and meditation for a few months can lower both systolic and diastolic blood pressures (by values of 10 -15 mm Hg).[/QUOTE]

Thanks Willem for your reply. So if I understand this correct, are you saying my tests showed me what it was supposed to show and there was nothing strange about it? I mean we always say headstand would increase blood pressure. So when we say this are we referring to the BP in ones head and not in ones arm or wrist? Honestly, I really find this strange.

By the way how does on measure the BP in the head?

#15

By definition, blood pressure is the pressure at the exit of the heart (aorta). It is close to the pressure that you measure in your arm or wrist, provided that you keep it at heart level when measuring BP. The blood pressure is different at different locations in the body, e.g. higher in the feet and lower in the head when standing up.

In inversions, there can be a surge of blood to the head and a corresponding increase in local blood pressure. This short increase in blood pressure in the head (not at the heart) is the one causing potential risks of stroke. Once you are in headstand, the body will attempt to lower blood pressure. For uncontrolled hypertensives this adjustment can be impaired, putting them at greater risk than the rest of the population.

I don’t know how the blood pressure measurements were done in the medical studies. Some of the earlier studies may have just calculated the hydrostatic pressure from the distance the head was below the heart. It would be interesting to get hold of the more recent studies, like Gilmore (2002) so see what they have done. Perhaps the doctors on this forum will comment.

#16

[QUOTE=yalgaar;25630]
By the way how does on measure the BP in the head?[/QUOTE]

Your “head blood pressure” is exactly the same blood pressure you’ll find in your arm, in our leg, in your genitals, etc. The differences you find are due to the method used (i.e. sphyngomanometer), rather than having a diffeent blood pressure in your body. If you have for example, a considerable difference between an arm an a leg (in controlled conditions), we could have a diagnosis of an aorta’s dissection, if you find a considerable difference between left and right arm you it could be due to Portal Hyper Tension, etc.

Now, if you are talking about high intracraneal pressure, well, that is SOMETHING ELSE. Your cranium is a closed cavity composed of three main elements: brain, blood and cerebrospinal fluid. By measuring the changes in the third you can calculate intracraneal blood pressure. By doing a lumbar punction or inserting a catheter for continuous monitoring in your fifth ventricle (inside your brain, which sounds incredibly extreme but is a 10 minute procedure) you can calculate such.

Your brain has a regulatory system for the blood pressure which works this way: If your blood pressure rises over the normal rates your body takes cerebrospine fluid out of your head to compensate for pressure. If the BP rises over 150/100 approximately (changes between individuals, but this is the percentile 50 rate), the regulation is lost and your intracraneal pressure rises.

#17

[QUOTE=Willem;25635]By definition, blood pressure is the pressure at the exit of the heart (aorta). It is close to the pressure that you measure in your arm or wrist, provided that you keep it at heart level when measuring BP. The blood pressure is different at different locations in the body, e.g. higher in the feet and lower in the head when standing up.

In inversions, there can be a surge of blood to the head and a corresponding increase in local blood pressure. This short increase in blood pressure in the head (not at the heart) is the one causing potential risks of stroke. Once you are in headstand, the body will attempt to lower blood pressure. For uncontrolled hypertensives this adjustment can be impaired, putting them at greater risk than the rest of the population.

I don’t know how the blood pressure measurements were done in the medical studies. Some of the earlier studies may have just calculated the hydrostatic pressure from the distance the head was below the heart. It would be interesting to get hold of the more recent studies, like Gilmore (2002) so see what they have done. Perhaps the doctors on this forum will comment.[/QUOTE]

By definition, blood pressure is the force exerted by the blood to the arterial walls. It is measured in the aorta because its related to the peripheral vascular resistance which peak is found in the aorta.

The problem with a head stand is related to the fact it is much more difficult for return blood from your head to the heart due to simple gravity, and yes, it can cause blood stasis which increases the blood pressure inside your head.
[I]I agree [/I]when your pressure is not regulated a little increase might break the brain’s regulatory pressure system and cause intracraneal hypertension. [I] I don’t agree[/I] on the idea this is the cause of a stroke though. For a stroke you pressure would have to rise at least to numbers close to 200/100. Chronic hypertension though, causes arterial degeneration, including obviously, intracraneal arteries (Willy’s Polygon is how the main blood system is called), which can lead on pathologies including “head strokes” (sorry, it’s the only word I could think of not being a medical term to help everybody understand).

High Blood Pressure is called the “silent assassin”, because you never have a symptom until it is already too late.

#18

The potential risks of headstand continue to intrigue me. Headstand can increase arterial blood pressure in the head as a result of (a) the effort of holding the pose and (b) the position of the head below the heart.

Based on recent measurements, I estimate that arterial blood pressure at the top of the head will rise to 165/121 in headstand. This estimate is higher than the earlier calculation of 150/110 made by Coulter (2001). Note that this estimate is valid for experienced yoga practitioners with normal blood pressures.

The response of hypertensive, inexperienced yoga students is expected to be much higher. Not being a doctor, I don?t know how these blood pressures will affect intracranial pressure and the risk of stroke. However, in my opinion, headstand is contraindicated for people with uncontrolled hypertension.

Background:

Recent measurements show that average brachial blood pressure will rise from 122/83 to 151/107 during 5 min. of headstand (Blank, 2006). The 15 females in this study were intermediate/advanced Iyengar yoga practitioners who practiced 6 hours per week and had an average practice history of 9 years. Earlier studies (McArdle, 1996) measured the effects of a 3 min (unspecified) inversion on 50 normotensive men and women and found an increase from 114/76 to 140/91. Many yoga writers refer to Coulter (2001), but he merely presents calculations showing that arterial pressure at the top of the head changes from 100/60 (standing) to 150/110 (headstand). Gilmore (2002) has not performed any measurements but refers to McArdle and Coulter.

Arterial blood pressure in the head is different from the pressure at heart level. There are hydrostatic pressure differences and slight viscous pressure losses to consider. According to Martin-Du Pan (2004), the pressure correction (in mm Hg) can be approximated by 0,76 h ? 5 with h being the distance in cm. I will use a distance of 45 cm from the heart (or upper arm) to the head and 25 cm from the upper arm to the top of the head in headstand. Resultant pressure corrections amount to 29 mm Hg and 14 mm Hg, respectively.

For the skilled yoga practitioner in Blank?s study (normal BP 122/83), I estimate that the blood pressure at the top of the head will change from standing (93/54) to headstand (165/121).

References:

Blank, S.E. ?Physiological responses to Iyengar yoga performed by trained practitioners?, JEPonline 9,1,February 2006.

Martin-Dup Pan, et.al., ?The role of body position and gravity in the symptoms and treatment of various medical diseases?, Swiss Med Wkly 2004.

McArdle, et.al. Exercise Physiology, William and Wilkins 1996

Coulter, Anatomy of Hatha Yoga, 2001.

Gilmore, R., ?The Effect of Yoga Asanas on Blood Pressure?, IJYT, 12 (2002).

#19

Arterial blood pressure obviously rises in inversions, but so must intracrainial pressure simply because of the weight of blood backing up in the venous system, this will cause increaed leakage into the interstitual spaces upping intracrainial pressure. If this is so then inversions would actually reduce risk of stroke as the difference between intracrainial and arterial pressure would be equalised, and it is the difference that is the problem. Also if you go through the medical literature there doesn’t seem to be any correlation between head down positions and risk of stroke, you do find a correlation for glaucoma for instance. I emailed the professor of neurology at Zurich (Ralf Baumgartner) university on this subject last year, he felt is was highly unlikely that that headbalance would increase risk of stroke; he also said auto regulation failure was 220 sys or 120 dia. Personally I’m happy to teach inverteds to students with hbp if they are confident and secure in their practice.

#20

[QUOTE=Peteblackaby;25836]Arterial blood pressure obviously rises in inversions, but so must intracrainial pressure simply because of the weight of blood backing up in the venous system, this will cause increaed leakage into the interstitual spaces upping intracrainial pressure. If this is so then inversions would actually reduce risk of stroke as the difference between intracrainial and arterial pressure would be equalised, and it is the difference that is the problem.
Also if you go through the medical literature there doesn’t seem to be any correlation between head down positions and risk of stroke, you do find a correlation for glaucoma for instance. I emailed the professor of neurology at Zurich (Ralf Baumgartner) university on this subject last year, he felt is was highly unlikely that that headbalance would increase risk of stroke; he also said auto regulation failure was 220 sys or 120 dia. Personally I’m happy to teach inverteds to students with hbp if they are confident and secure in their practice.[/QUOTE]

First and second assumptions contradict each other. If the arterial blood pressure increases, the blood wouldn’t “back up” in the venous system. On the contrary, it backs up in the arterial system. The head stands make the returning blood from the lower limbs to return to the heart with the help of gravity which increases the amount of blood in the arterial system, increasing blood pressure. As said before, the way to equalize intracranial pressure is by decreasing cebrebrospinal fluid in the cranial cavity, not due to “blood leakage”. The “leakage” you talk about is always returned to the system via the lymphatic system.

I agree I don’t see much of a relationship between a head stand and a stroke as stated before in this same thread, but here is no valid statistical study I can bring to prove such though :smiley:

#21

Thanks for clarifying that, I’m sorry I came to the thread late and hadn’t read it all. I imagine it is difficult to get accurate measurements for both intra crainial and cerebral arterial pressure, so I guess we are looking for correlation to assess risk. It also seems odd to think that evolution wouldn’t have sorted these kind of issues out; other animals like giraffes have sophisticated mechanisms for maintaining balances in blood and crainial pressure when they change the position of their head… and while we are obviously not giraffes bending forwards is something humans have had to do a lot…

#22

[QUOTE=Peteblackaby;25840]Thanks for clarifying that, I’m sorry I came to the thread late and hadn’t read it all. I imagine it is difficult to get accurate measurements for both intra crainial and cerebral arterial pressure, so I guess we are looking for correlation to assess risk. It also seems odd to think that evolution wouldn’t have sorted these kind of issues out; other animals like giraffes have sophisticated mechanisms for maintaining balances in blood and crainial pressure when they change the position of their head… and while we are obviously not giraffes bending forwards is something humans have had to do a lot…[/QUOTE]

Hehehehe
Evolution has been kind to us regarding neurological structures, nerve connections, etc, but it has been a “bitch” regarding other things. :smiley:

I started Yoga to help with my back pain. Why? Because our back is the antithesis of evolution. We can’t support the upper body weight because our spine is made for walking in four legs, not two. Neither are our knees. Our knees suck! hey are by far the worst structure you could fin in nature. Human decided to walk on two legs: our body decided not to, and we see the results everyday (back pain being the 25% of all General Practitioner consults).

Oh! But don’t think “yes to all, but we got a bigger brain”, because Mother Nature likes to play tricks. With additional development of the neocortex and pre-frontal lob come a lot of new diseases. Have you even seen a Schizophrenic Duck? A Suicidal Cow? Snake with multiple personality disorder? Oh, she played it well, didn’t her? Hehehehehe

Take care…

#23

yeah, I take you’re point it’s one of the best arguements against intelligent design :slight_smile:
I don’t know if you’ve come across the work of serge gracovetsky; he wrote a book called the spinal engine, arguing that its actually a sophisticated locomotor system, and very compelling he his… but then again if you’ve got back pain …!
all the best

#24

I finally got a hold of Yoga-Mimansa 1926 (editor Kuvalayananda). Kuvalayananda is one of the earliest researchers into the medical effects of yoga. This issue studies the effect of headstand (sirshasana) on blood pressure.

The subjects were 11 young adults of average health. Their average age was 22 ? 2 years and they had a normal body weight (body mass index 20 ? 2). They had normal blood pressures of 122/85 [FONT=Calibri](? 12/9). Brachial blood pressures were recorded with a sphygmomanometer (in mm Hg) using the auscultation method .[/FONT]

Blood pressures were recorded before, during and after headstand. Headstand was performed while the subjects? heels lightly touched a wall. This was done to decrease the muscular effort in the arms. Without the wall, the muscular contraction at the elbow decreased the blood flow and inconvenienced the measurements. Blood pressure was recorded just after getting into headstand (initial) and after every minute, the maximum duration being 5 minutes. Blood pressures were also recorded in a sitting position, just after headstand.

Averaged results are shown in the graph. Note that blood pressure rises from 122/85 while sitting to 140/111 after 2 minutes of headstand. Blood pressures then decrease to 131/108 at the end of the fifth minute of headstand. The increase in systolic blood pressure is only 18 mm Hg at the end of the second minute (diastolic 26 mm Hg). Blood pressures decreased after two minutes of headstand.

The effect of headstand on blood pressure is mild compared to other forms of exercise, like running (200/80), very strenuous exercise 245/160 (McArdle Exercise Physiology 1996, p 276) or a maximum of 320/250 attained by body builders in a dead weight double leg press (J. Appl. Phys 58:785-790, 1985).

#25

The same study (yoga Mimansa 1926) contains blood pressure data on other asanas as well. I’m sharing it with you all here. Note that, for these subjects, headstand does not produce markedly different blood pressures from other asana.

#26

Thanks very much Willem, this is very useful data, and gives us more basis for assessing risk. I did a bit more research following your last posting. As you pointed out intra crainial pressure is regulated by the csf, but it does seem that intra crainial pressure changes in response to postural changes and is higher in the supine postion than the upright. Although I can’t find any measurements for inversions Iit would seem reasonable to think it might increase a little further there too. If this is the case risk of stroke would be further reduced during inversion. best wishes Pete

#27

Hi gurus,

I am having high blood pressure and low HDL cholestorel problem.
I am taking medicines since last 8-9 months and started yoga also. Can you please let me know what will best suite me to cure my Blood pressure problem completely. Will I be ever able to remove my all medicines.

I visited taking baba ramdev clinic and they gave following medicine which I am taking since last 1 month:
divya mukta vati
medohar vati
chandraprabha vati

Please help…I’m feeling unhappy while taking medicine daily at this small age.

Thank you all

Niraj
Age: 26
Male
60kg
5’5"

#28

any info plz

#29

6 years and high blood pressure? It is something to be very careful about mate…

The non-medical advice I could give you (although with my background I would definitely recommend you to follow a medical prescription :D) would be:

First of all, about 40-50% young people who have high blood pressure with a reason different from a reaction to a secondary pathology will end up without medication if changing their life styles.

[U]
DIET:[/U]

  1. Try to eat lots of water. even though water intake could increase blood pressure, it makes your kidneys to work faster decreasing the final intravascular volume helping blood pressure levels.

  2. Remember to include in your diet Avocado, Olive Oil, Macadamias (or Macadamia Oil), Cold water fish like Salmon or Trout (full of Omega 3.6.9) which will increase your HDL levels

  3. Eat as LOW in salt as you possibly can. This includes not only table salt additions, but keeping away from smoked products, salted peanuts or nuts, or animal dried meat.

  4. Include antioxidant and diuretic food like Green Tea (my all around favorite.), Ginger, or Pineapple. it will help with the intravascular water depletion

[U]
EXERCISE:[/U]

  1. Yoga should work fine for you since meditation and relaxation produce dilatation of blood vessels lowering blood pressure.

  2. In case you do none, try to add some other cardiovascular exercise to your routine at least for 35 minutes / 3 times a week. Exercise in the long term is the main way to lower your blood pressure due to a decrease in oxygen demand and uptake by muscle tissue leaving more oxygen in the form of nitrous oxide which is the main body’s vasodilatator…

Take care…

#30

Greetings to all!

Recently I started taking medication to treat my ADHD. One of the negative side effects of that medication is increase in blood pressure. I’ve always been physically healthy, but as result of this medication my BP increased to “pre-hypertension” levels (119/89). In order to reverse this or at least prevent further deterioration I started searching for remedies. In addition to other lifestyle adjustments (diet, exercise) I thought I’d look into yoga. In my 20s and 30s I dabbled a bit in yoga and I remember liking inverted asanas, and shirshasana in particular. (I remember reading some where that if you could do only one asana, and one asana only -shirshasana would be best choice).

In my search for asanas suitable for people with high BP I came across this thread. General consensus here seems that inverted asanas should be approached cautiously (at the very least) if one has high BP. While reading an article on another yoga website I came across following statement:
[I][B]
“The inverted poses in yoga are designed to lower blood pressure.”[/B][/I]

I found that statement on a New Zeland based yoga web site. As I am a new poster, forum software does not allow me to post links to other sites, but if you paste above statement into Google, the first result will be the site and article I got that statement from.

Can any one explain/comment on this dichotomy?

One additional question: The “Yoga Mimasa” graphs presented by Willem previously in this thread clearly demonstrate that BP increases while in shirshasana. But could it be that even though BP temporarily (?) increases while performing the actual asana, the long term effect of this practice is decreased BP?

Thanks in advance for any replies. :slight_smile:

#31

As an MD with a PhD in a field of neuroscience, I’m going to put my two cents in here.

Xamilo and Willem make a lot of sense, thanks guys for such great input.

1.) The concern with inverted postures for those with high blood pressure is NOT that being inverted will raise their blood pressure over the short term - meaning while actually in the posture. As Willem’s Mimasa study points out, we ENCOURAGE patients with high blood pressure to get aerobic exercise, and aerobic exercise raises blood pressure in the short term.
2.) The concern is in people with high blood pressure that have continuously high readings over the long term - those high pressures have resulted in damage to the blood vessels within their brains. The damaged vessels are more likely to rupture when there is increased pressure inside the head = a stroke. Standing on your head pools the blood inside a fixed cavity that cannot expand (the skull) and that increased blood inside the head increases the blood pressure within the arteries of the brain. Increased pressure inside a damaged blood vessel can make it blow.
3[B].) People that have a history of high blood pressure that is adequately controlled (less than 140/90 on most days and at most times of the day) may safely assume inverted postures.[/B]
4.) Lots of theory here - and some common sense. There are no medical studies of which I am aware that have actually DOCUMENTED stroke in a person with out of control blood pressure performing sirsasana or sarvangasana. In the absence of evidence one way or the other, it is prudent to be safe. IF your blood pressure is [I]uncontrolled[/I], hold off on sirsasana until your medical condition is better managed.

Having a blood pressure cuff at the Yoga studio is a GREAT idea. High blood pressure is the silent killer. Bringing awareness to blood pressure control and helping students to monitor theirs is a wonderful way to promote holistic health and to care for each other within the Yoga community.

#32

This is pretty interesting thread. I do Sirsasana and Sarvangasana for 15 minutes. I do not know if I have BP or not, but I have family history of hypertension :frowning: