Hypertension, also known as high blood pressure, is a global health problem associated with an increased risk of cardiovascular diseases and related consequences. Current modern lifestyle habits and dietary patterns lead to several consequences in which body homeostasis is challenged. Alterations in homeostasis result in increased blood pressure (BP) and associated disorders such as hypertension and cardiovascular diseases. (Heidari et al., 2022; Mariano et al., 2023) According to the International Society of Hypertension and the American Society of Hypertension, hypertension is characterized by a consistent increase in systolic BP (SBP) and diastolic BP (DBP). Hypertension was classified as prehypertension (SBP: 120–139 mmHg, DBP: 80–89 mmHg), stage 1 hypertension (SBP: 140–159 mmHg, DBP: 90–99 mmHg) or stage 2 hypertension (SBP ≥ 160, DBP ≥ 100 mmHg).(Nalbant et al., 2022)
Current estimates suggest that approximately 1.4 billion people worldwide have high blood pressure, but only 14% have this condition under control.(World Health Organization, 2021) The prevalence of hypertension is increasing worldwide in low- and middle-income countries. The epidemic of hypertension is spreading alarmingly in India across rural as well as urban populations.(Koya et al., 2023; Nalbant et al., 2022; World Health Organization, 2021) According to WHO India Hypertension Profiles – 2023, approximately 188.3 million adults aged 30–79 years in India suffer from hypertension.(World Health Organization – Hypertension Profiles, 2023, 2023)
The cause of primary hypertension, which accounts for approximately 90–95% of cases, is unknown but is influenced by genetic, environmental, and lifestyle factors, including unhealthy diet and insufficient physical activity. (Aljuraiban et al., 2024) The American College of Cardiology, American Heart Association, and European Society of Hypertension (BP) guidelines recommend lifestyle interventions for the prevention and treatment of hypertension.(Whelton et al., 2022) Among various modifiable direct and indirect risk factors, a sedentary lifestyle resulting from emerging globalization and modernization has been identified as one of the primary causes of chronic diseases.(Koya et al., 2023; Patil et al., 2023) Evidence has also shown the association of psychological factors, such as negative affect, suppressed hostility, and emotional defensiveness, with elevated blood pressure and increased risk of hypertension.(Charchar et al., 2024; Schaare et al., 2023) At present, hypertension management strategies aim to reduce BP and include lifestyle modifications such as dietary patterns, physical activity, and stress reduction, along with pharmacological treatment.(Nalbant et al., 2022)
Nonpharmacological interventions play a significant role in the prevention and management of hypertension, as demonstrated by a plethora of research studies on lifestyle interventions, including single-component interventions such as exercise, diet, breathing exercises, and yoga, as well as multicomponent lifestyle interventions. These lifestyle modifications have been shown to effectively control BP and reduce cardiovascular morbidity and mortality.(Dhungana et al., 2021; Emma Bray Lucy Hives Valerio Benedetto Joseph Spencer Catherine Harris Andrew Clegg Paul Rutter Caroline Watkins, 2024; Koya et al., 2023)
Currently, there is growing evidence to support the use of several complementary and alternative medicine activities to control high BP, including yoga, certain relaxation techniques, and meditation.(Emma Bray Lucy Hives Valerio Benedetto Joseph Spencer Catherine Harris Andrew Clegg Paul Rutter Caroline Watkins, 2024; Koncz et al., 2024; Santaella et al., 2014; Shao et al., 2024) Yoga and meditation are ancient techniques used as nonpharmacological mind-body interventions and have been studied for their potential benefits in individuals with hypertension and effectiveness in improving cardiovascular functions. (Koncz et al., 2024; Santaella et al., 2014) Deep breathing exercises, including yogic techniques, have been found to reduce stress and manage hypertension.(Emma Bray Lucy Hives Valerio Benedetto Joseph Spencer Catherine Harris Andrew Clegg Paul Rutter Caroline Watkins, 2024; Koncz et al., 2024; Shao et al., 2024) These techniques have been used for thousands of years as practical, safe, and effective tools for stress reduction and health management strategies. [15]
Based on Patanjali’s Ashtanga principles, many different yogic systems have been developed, with each discipline having methods for enhancing physical and mental health, such as ethical standards (yama), self-discipline (niyama), yogic poses (asana), breathing practices (pranayama), withdrawal of the senses (pratyahara), concentration (dharana), meditation (dhyana) and relaxation practices, and transcendence (samadhi).(Dhungana et al., 2021; Nalbant et al., 2022) Studies show that the regular practice of integrated yogic systems alters physiological mechanisms to increase parasympathetic activity through vagal stimulation, suppressing the hypothalamic‒pituitary‒adrenal axis, and reducing the activity and reactivity of the sympathetic nervous system, thereby decreasing elevated BP.(Nalbant et al., 2022; Svatmarama, 1994)
One such meditation technique is heartfulness meditation, which is rooted in the Raja yoga tradition and referenced from the Yoga Sutras.(Pollock, 2018; Svatmarama, 1994; van’t Westeinde & Patel, 2022) This technique is based on centering focus on the heart as a source of inner guidance and spiritual growth. The core of heartfulness practice is the uniqueness of yogial transmission, which has benefits such as stress reduction, improved emotional well-being, increased self-awareness, and enhanced spiritual development. This technique of meditation aims at attaining a balanced state of mind that eventually improves physical health, psychological health, burnout, sleep quality and stress.(Thakur et al., 2023; Thimmapuram et al., 2017) The beneficial effects of heartfulness meditation may also contribute to improving health status in individuals suffering from hypertension and related diseases. (Koncz et al., 2024; Santaella et al., 2014; Shao et al., 2024)
Today, there is a need for developing and testing the feasibility, acceptability, and efficacy of an integrated approach that involves interventions involving both yoga and meditation practices, which would aid in the prevention and control of hypertension by controlling considerable risk factors and prove vital in combatting the high-risk burden of hypertension globally.(Alinaitwe et al., 2024; World Health Organization, 2021) To date, very few studies have focused on the development of feasible and effective yoga and meditation protocols for hypertension treatment. However, the development and efficacy of an Integrated Approach of Heartfulness Meditation and Yoga Practice for hypertension treatment are unresolved. Combined therapy involving Yoga and heartfulness meditation techniques, depicting the transition between asanas and meditation, would enable simultaneous upswing of physical, mental, and spiritual well-being. In this study, we aimed to design and validate a feasible, cost-effective tool for meditation and Yoga intervention, i.e., an “Integrated Approach of Heartfulness Meditation & Yoga Practice” (IAHFNM & YP), for efficiently improving the lifestyles of individuals with mild and moderate hypertension.