Pranayama for Hypertension in Pregnancy

No longer recruiting at 1 trial location

Overseen By Shilpa Babbar, MD

Age: 18+

Sex: Female

Trial Phase: Academic

Sponsor: Children's Mercy Hospital Kansas City

Disqualifiers: Unstable maternal condition, Severe pulmonary disease, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how specific deep breathing techniques might lower blood pressure in pregnant women. Researchers aim to determine if exercises like Alternate Nostril Breathing (Nadi Shodhana or Anuloma Viloma), Bhramari Breathing (Bhramari Pranayama or Bee Breath), and Sheetali Breathing (Sheetali Pranayama or Cooling Breath) can naturally reduce blood pressure and influence other body functions, such as heart rate and breathing. Women in their third trimester, particularly those with high blood pressure or related conditions, might be suitable candidates for this study. As an unphased trial, this study provides a unique opportunity to investigate natural methods for managing blood pressure during pregnancy.

Do I need to stop my current medications for this trial?

The trial does not specify if you need to stop taking your current medications. It mentions that participants can have hypertension with or without using antihypertensive medications, so it seems you may continue your current medications.

What prior data suggests that these breathing techniques are safe for pregnant women?

Research shows that alternate nostril breathing is generally safe. Studies have found it can help reduce anxiety and high blood pressure in women with hypertension. This breathing technique is well-tolerated and has been practiced without major side effects.

For Bhramari breathing, safety information is mixed. Some sources suggest avoiding it in the later stages of pregnancy. However, other studies indicate that yoga, including Bhramari, can lower risks like high blood pressure and improve outcomes for mothers and babies.

Past research considers Sheetali breathing safe. It has been shown to lower blood pressure and positively affect heart function. People who practice this technique usually find it well-tolerated, with no major negative effects.

In summary, these breathing exercises are generally safe, but Bhramari might be better used with caution during late pregnancy. Always consult a healthcare provider before starting any new practice, especially during pregnancy. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about using breathing techniques like Alternate Nostril Breathing, Bhramari Breathing, and Sheetali Breathing for managing hypertension in pregnancy because these methods offer a natural, drug-free approach. Unlike standard treatments, which often involve medications like beta-blockers or calcium channel blockers, these breathing exercises aim to reduce stress and lower blood pressure through relaxation and improved oxygen flow. The potential for fewer side effects and the ability to practice these techniques at home provide a significant advantage, particularly for pregnant women seeking non-pharmacological options. Additionally, these exercises could offer immediate relief, making them a promising adjunct to traditional therapies.

What evidence suggests that these breathing techniques could be effective for hypertension in pregnancy?

Research shows that alternate nostril breathing, one of the techniques studied in this trial, can lower blood pressure and improve heart rate variability (the time difference between heartbeats) in pregnant women. Studies have found that this technique reduces anxiety and helps prevent high blood pressure and related issues during pregnancy. Participants in this trial may also practice Bhramari breathing, which evidence suggests helps the heart and blood vessels handle stress better. Regular practice has been linked to better health outcomes for both mother and baby. Another technique under study is Sheetali breathing, which research suggests can lower blood pressure. Although not as well-studied as the other methods, early results are promising for managing blood pressure during pregnancy. These breathing exercises activate the vagal nerve, which naturally calms the body. ^{1 2 3 4 5}

Who Is on the Research Team?

Shilpa Babbar, MD

Principal Investigator

Children's Mercy Hospital Kansas City

Are You a Good Fit for This Trial?

This trial is for English-speaking pregnant women over 18 years old in their third trimester with high blood pressure, either gestational hypertension or chronic hypertension without severe features. It's not for those needing urgent delivery, with pre-eclampsia concerns, severe lung disease, deviated nasal septum, difficulty breathing through the nose, or very low blood pressure.

Inclusion Criteria

For Phase II only: You have had consistently high blood pressure before or during the early stages of pregnancy, and may or may not be taking medication for it.

I have high blood pressure during pregnancy without organ damage.

I have preeclampsia without severe symptoms.

Exclusion Criteria

I have trouble breathing through my nose.

I have a deviated septum.

I have an ongoing or recent lung condition.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Phase I

Normotensive pregnant women engage in a 15-minute deep breathing technique session with monitoring

1 visit

1 visit (in-person)

Phase II

Hypertensive pregnant women engage in a 15-minute deep breathing technique session with monitoring

1 visit

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after the intervention

1-2 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Alternate Nostril Breathing
• Bhramari Breathing
• Sheetali Breathing

Trial Overview The study tests how Alternate Nostril Breathing, Bhramari Breathing, and Sheetali Breathing affect blood pressure during pregnancy. It also looks at other physiological parameters like heart rate and respiratory rate to see if these yogic techniques can naturally reduce them.

How Is the Trial Designed?

Group I: Sheetali Breathing Phase II Active Control 1 Intervention

Sheetali breathing for hypertensive women in 3rd trimester of pregnancy

Group II: Sheetali Breathing Phase I Active Control 1 Intervention

Sheetali breathing for normotensive women in 3rd trimester of pregnancy

Group III: Alternate Nostril Breathing Phase II Active Control 1 Intervention

Alternate nostril breathing for hypertensive women in 3rd trimester of pregnancy

Group IV: Alternate Nostril Breathing Phase I Active Control 1 Intervention

Alternate nostril breathing for normotensive women in 3rd trimester of pregnancy

Group V: Bhramari Breathing Phase I Active Control 1 Intervention

Bhramari breathing for normotensive women in 3rd trimester of pregnancy

Group VI: Bhramari Breathing Phase II Active Control 1 Intervention

Bhramari breathing for hypertensive women in 3rd trimester of pregnancy

Who Is Running the Clinical Trial?

Children's Mercy Hospital Kansas City

Lead Sponsor

Trials

261

Recruited

941,000+

Published Research Related to This Trial

A study involving 72 pregnant women at risk for gestational hypertension showed that a walking program (20-30 minutes, four times a week) significantly reduced the incidence of gestational hypertension and preeclampsia compared to a control group.

The experimental group had notably lower mean systolic and diastolic blood pressures, indicating that moderate walking is an effective and safe intervention for managing hypertension during pregnancy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of walking on pregnancy blood pressure disorders in women susceptible to pregnancy hypertension: A randomized clinical trial. Khoram, S., Loripoor, M., Pirhadi, M., et al.[2020]

In a clinical trial involving 60 pregnant women with high blood pressure, progressive muscular relaxation and breathing control techniques significantly reduced both systolic and diastolic blood pressure after 4 weeks of intervention.

The most notable decrease was in systolic blood pressure, which dropped from an average of 131.3 mmHg to 117.2 mmHg, indicating that these non-pharmacological interventions can be effective in managing hypertension during pregnancy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of progressive muscular relaxation and breathing control technique on blood pressure during pregnancy. Aalami, M., Jafarnejad, F., ModarresGharavi, M.[2020]

In a study of 100 patients with hypertension, practicing Sheetali pranayama for 3 months led to a significant reduction in blood pressure compared to a control group, indicating its efficacy as a complementary intervention.

The intervention also improved heart rate variability, suggesting enhanced parasympathetic activity, which is beneficial for cardiovascular health in hypertensive patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Sheetali pranayama on cardiac autonomic function among patients with primary hypertension - A randomized controlled trial. Thanalakshmi, J., Maheshkumar, K., Kannan, R., et al.[2020]

A 5-minute session of Bhramari pranayama, a slow breathing exercise, significantly reduced both systolic and diastolic blood pressure in volunteers, indicating its potential as a cardiovascular health intervention.

The practice also led to a slight decrease in heart rate, suggesting that Bhramari pranayama promotes parasympathetic dominance, which is beneficial for relaxation and heart health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Immediate effect of a slow pace breathing exercise Bhramari pranayama on blood pressure and heart rate. Pramanik, T., Pudasaini, B., Prajapati, R.[2022]

In a study of 90 participants with essential hypertension, practicing alternate nostril yoga breathing significantly reduced both systolic and diastolic blood pressure and improved performance on the Purdue pegboard task, indicating enhanced manual dexterity and coordination.

The findings suggest that alternate nostril breathing not only lowers blood pressure but also positively impacts tasks requiring attention and coordination, making it a beneficial practice for individuals with hypertension.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Blood pressure and Purdue pegboard scores in individuals with hypertension after alternate nostril breathing, breath awareness, and no intervention. Telles, S., Yadav, A., Kumar, N., et al.[2021]

In a study of 29 hypertensive patients, performing pranava pranayama for just five minutes led to significant reductions in heart rate and systolic blood pressure, indicating its immediate effectiveness in managing hypertension.

The observed cardiovascular improvements may be linked to enhanced vagal modulation and reduced sympathetic activity, suggesting that pranava pranayama could be a beneficial complementary therapy alongside standard medical treatments for hypertension.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Immediate cardiovascular effects of pranava pranayama in hypertensive patients. Bhavanani, AB., Madanmohan, ., Sanjay, Z., et al.[2022]

In a study of 16 pregnant women with hypertension, those using nasal CPAP alongside standard prenatal care experienced significantly better blood pressure control and required lower doses of antihypertensive medication compared to those receiving standard care alone.

The treatment group also had improved pregnancy outcomes, with all patients delivering healthy infants who had higher APGAR scores at one minute post-delivery, indicating better overall health at birth.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pre-eclampsia and nasal CPAP: part 2. Hypertension during pregnancy, chronic snoring, and early nasal CPAP intervention. Poyares, D., Guilleminault, C., Hachul, H., et al.[2022]

In a study of 118 pregnant women, stretching exercises significantly reduced both systolic and diastolic blood pressure compared to a control group, while walking showed no significant effect on blood pressure.

The findings suggest that incorporating stretching exercises during the second trimester can help manage hypertension in pregnancy, whereas walking does not provide the same benefits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of stretching exercise and walking on changes of blood pressure in nulliparous women. Bahadoran, P., Pouya, F., Zolaktaf, V., et al.[2020]

In a study involving 22 patients with essential hypertension, 27 rounds of exclusive left nostril breathing (chandra nadi pranayama) led to significant immediate reductions in heart rate and systolic blood pressure, indicating its potential as an effective intervention for hypertension.

The study suggests that the benefits of this breathing technique may stem from improved autonomic regulation of the cardiovascular system, highlighting its value as a simple and cost-effective addition to standard hypertension management protocols.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Immediate effect of chandra nadi pranayama (left unilateral forced nostril breathing) on cardiovascular parameters in hypertensive patients. Bhavanani, AB., Madanmohan, ., Sanjay, Z.[2022]

Pranayama, or yoga breathing exercises, can lead to significant reductions in blood pressure, with acute studies showing a mean systolic blood pressure (SBP) reduction of 2-10 mmHg and chronic studies showing reductions of 4-21 mmHg, based on a review of 13 trials.

The most effective pranayama techniques for lowering blood pressure involve slower breathing rhythms and left nostril breathing, suggesting these methods should be prioritized for hypertensive patients, despite the overall low quality of the studies reviewed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The hypotensive effect of Yoga's breathing exercises: A systematic review. Brandani, JZ., Mizuno, J., Ciolac, EG., et al.[2018]

Both right nostril breathing (RNB) and left nostril breathing (LNB) pranayama significantly increased heart rate variability (HRV) parameters, indicating enhanced parasympathetic activity and relaxation in 20 healthy yoga practitioners after just 5 minutes of practice.

There was no significant difference in the immediate effects of RNB and LNB on HRV, suggesting that both techniques are equally effective for promoting relaxation and calming the mind.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Immediate autonomic changes during right nostril breathing and left nostril breathing in regular yoga practitioners. Malhotra, V., Srivastava, R., Parasuraman, P., et al.[2022]

In a study of 423 women, including 70 nonpregnant and 353 pregnant women, it was found that normotensive pregnant women had significantly higher plasma concentrations of nitric oxide metabolites compared to nonpregnant women, suggesting that nitric oxide plays a role in maintaining healthy blood pressure during pregnancy.

Pregnant women with preeclampsia had even higher levels of nitric oxide metabolites, which correlated with increased systolic blood pressure, indicating that nitric oxide may be involved in the development of hypertensive disorders in pregnancy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Plasma nitric oxide levels in pregnant patients with preeclampsia and essential hypertension. Nobunaga, T., Tokugawa, Y., Hashimoto, K., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11996816/

An Exploratory Randomised Trial to Assess the Effect of Nadi ... The practice of nadi shodhan pranayama, preceded by two minutes of yogic deep abdominal breathing, reduced the systolic and diastolic BP and improved HRV- ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9276689/

Effects of yoga on cardiometabolic risks and fetomaternal ... Twenty weeks of practice of yoga during pregnancy decreases the incidence of hypertension, improves fetomaternal outcomes, and reduces cardiometabolic risks

3. researchgate.net researchgate.net/publication/338262637_Practice_of_Alternate-nostril_Breathing_Anuloma-Viloma_Pranayama_Attenuates_the_Development_of_Hypertension_and_Cardiometabolic_Dysfunctions_During_Pregnancy_in_Women_Having_Risk_Factors_for_Pregnancy

Practice of Alternate-nostril Breathing (Anuloma-Viloma ... Conclusion: Practice of anuloma-viloma pranayama from 1st trimester improves sympathovagal balance, reduces cardiometabolic risks and prevents ...

4. ijcep.org ijcep.org/index.php/ijcep/article/download/338/468/

Practice of Alternate-nostril Breathing (Anuloma-Viloma ... including pranayamic breathing in pregnancy decreases the incidence of pregnancy related complications and improves pregnancy outcomes.[20]. Further, there ...

5. ejhc.journals.ekb.eg ejhc.journals.ekb.eg/article_350651_ef4b5fcb43bcee2ebb9f81564e16f05d.pdf

Effect of Alternate Nostril Breathing Exercise on Reducing ... Abstract. The current study aimed to explore the effect of alternate nostril breathing exercise on reducing anxiety and blood pressure among pre-eclamptic ...