Stretching for Success Against Hypertension

By Maya Breuer

For the past 20 years I have been practicing and teaching yoga with the knowledge that it was helping individuals manage their response to stress, building their flexibility and strength, and teaching them to still the chatter of the mind. By teaching them to connect to this synergy of body, mind and spirit, I was – unwittingly – helping them control blood pressure levels.

High blood pressure – also known as hypertension – is one of the risk factors for strokes, heart attacks, heart failure, aneurysms and kidney failure. I am African American; my family has been ravaged by high blood pressure. My father died at age 37 from alcohol-related hypertension and heart failure. My grandfather died of a heart attack. My grandmother and her sister both had diabetes, hypertension, and heart disease. A maternal uncle died of a massive stroke at 45. And last year, my 48-year-old first cousin, while awaiting a kidney transplant, lost his battle with kidney disease.

As a group, African Americans experience the greatest levels of high blood pressure in the United States. Today 41% of African Americans have hypertension. Not only is hypertension more prevalent among African Americans, it also develops earlier in life. Those with hypertension are more likely to develop life threatening and disabling complications at a significantly greater rate than their white counterparts.

Dr. Elijah Saunders, a cardiologist at the University of Maryland, elaborated on the statistics in a recent interview published by that school's medical center:

"One African American dies as a result of high blood pressure every hour in this country, nearly twice as often as their white counterparts. Blacks suffer from heart and kidney disease at alarmingly high rates, both of which are adversely affected by high blood pressure. Blacks make up 30 % of those on dialysis due to kidney failure."

What is Hypertension?

Dr. Robert B. Saper, director of Integrative Medicine for Boston Medical Center's Department of Family Medicine, explains hypertension in lay terms:

"An easy way to understand what is happening to the body when one has hypertension is to first imagine a system of pipes carrying water. If the water pressure continually stays at the top pressure level, over time the sheer force or surge of the water pressure will erode the inside of the pipes. Similarly, when blood pressure levels remain high or elevated for extended periods of time, the heart works harder to pump against that pressure leading to abnormal thickening of the heart muscle, and ultimately heart failure. Also the high pressure of the blood flow causes damage to the inside of the artery wall. In response to this damage, cholesterol deposits on the artery wall over time grow to form blockages. These blockages can suddenly rupture and block the artery, causing a heart attack in the case of heart arteries or a stroke in the case of brain arteries."

Persons with hypertension, commonly called the "silent killer," often exhibit no physical symptoms until major damage has been done to vital organs. The causes of hypertension are often unknown. However, recent findings have established a link between hypertension and specific social determinants regarding health, including behavior and lifestyle.

Although ethnicity or genetics has recently been cited as one of the main causes of hypertension in African Americans, it is difficult to tease apart the role that social determinants of health – income, social status, environment and education among them – play in these findings. What is clear is that African Americans suffer disproportionately from hypertension due to a combination of behavior and lifestyle choices, genetics and stress stemming from factors such as racism, poverty, and violent environments.

Stress is a risk factor for developing hypertension because it causes arousal in the sympathetic nervous system, increasing heart rate, constricting blood vessels, and causing blood pressure to rise. If this continues over time, it leads to the development of hypertension.

As for behavorial factors, I found that the following precursors present in my family mirrored those of the general African American population. They include:

• Cigarette Smoking
• Excessive alcohol consumption – more than three drinks per day for women and more than four daily for men
• Lack of exercise
• Excess weight
• Consuming a diet rich in saturated fat
• High salt intake

Diabetes and kidney diseases were also present in my family members. Both are secondary health conditions that predispose one to hypertension.

Yoga and Stress

Yoga is a simple, doable practice with techniques for helping one create a healthy response to daily stress and for eliciting the relaxation response. In addition, the practice of yoga naturally promotes positive choices in behavior and lifestyle. As one student of mine said, "After I started practicing yoga, my bad habits just seemed to fall away."

Yoga was developed 5,000 years ago to teach human beings how to connect with their innermost selves, still the mind, and achieve health and balance. Yoga offers a unique conceptual approach to renewing self-awareness, increasing and maintaining flexibility, and teaches integration of body, mind and spirit. Everyone can do yoga no matter what his or her age, level of strength or flexibility.

My experience as a teacher of yoga has taught me that people who practice yoga are more likely to change their lifestyles and to adopt a more holistic approach to living. Many report improved diet and weight loss, reduction in smoking and alcohol intake, and willingness to incorporate daily exercise into their lives. They also report increased relaxation and calm which helps manage their daily stress.

In his book "Kripalu Yoga On and Off the Mat," Shobhan Richard Faulds, a senior yoga teacher at the Kripalu Center for Yoga and Health in Lennox, Mass., offered his perspective on African Americans, yoga and stress:

"For many African Americans, life is simply a battleground…Yoga provides a mild cardiovascular workout. More important, yoga stimulates the relaxation response known to dilate blood vessels and lower blood pressure."

Yoga changes lives. One of my goals as a teacher of yoga has been to bring yoga to the African American community. When I started teaching more than 20 years ago, all of my students were white. Certainly I wanted to attract African Americans but there was little interest in this practice. I was guided to create a healing yoga retreat for women of color. This small step felt doable, and I needed to start reaching out to other women. I knew that my life had been changed by yoga.

The first yoga retreat for women of color was held at the Kripalu center in 1999. Today the Kripalu Center for Yoga and Health does outreach to increase the interest of minorities in yoga and other holistic lifestyle programs. Last year they created their first diversity committee consisting of professional minorities from across the US. Their goal is to support Kripalu's efforts to reach minority communities. To this end the committee hosted a weekend for blacks in the media introducing them to Kripalu and beginning a dialogue about yoga and health.

In New England where I live and teach, I offer Yoga Life™ lifestyle coaching. It incorporates yoga practices and philosophy for daily living. The emphasis, when working with African Americans, is to manage and cope with stress.

There have been success stories. For example, Berry Jean Murray, one of my students for more than a year, is a successful director in the software program development industry. She came to me because she had suffered a heart attack and feared that her highly stressful lifestyle, lack of regular exercise, and poor diet, might lead to another heart attack.

Berry's initial practice was just 10 minutes per day. Overtime, we co-created a half-hour lifestyle program for her that included daily yoga postures, focused breathing, and relaxation. We meet weekly and our discussions explore the day-to-day utility of yoga philosophy, to promote self-awareness and self-love.

This has led to changes in her life. She has begun aerobic walking to lose weight. Also, she used to eat out regularly but now shops and cooks healthy meals.

Says Berry Jean, "I find my daily routine has really has made a difference in my stress levels. Today, I feel better than I ever. When I miss yoga I get back into that running and stressed-out mode."

Yoga has not replaced Berry's relationship with her doctor or her medical treatment for her condition. However, she says yoga has changed her health prospects.

"My health is better and I do not feel at risk for another heart attack," she says.

Or, consider the experience of Len Cabral. Len came to me as a participant in an all-male yoga class, humorously dubbed the Men's Yoga League by those attending. A professional storyteller, he has spoken frequently of the stress of a busy schedule, travel and performing. Len does not have hypertension; but he is an African American and at risk because of his race. For Len, yoga is means to prevent the onset of hypertension. He has incorporated yogic breathing and postures into his daily life. The results, he says, are, "better health, increased flexibility, and greater patience and understanding with others."

Also, there's the experience of Delores Walters, a cultural anthropologist and educator who was introduced to yoga some years ago. When she relocated to Rhode Island she joined my weekly women's yoga class. She has been taking anti-hypertensive medication for many years because of borderline hypertension. Even with medication, her doctors would like to see her blood pressure routinely lower. It is because of this and her awareness of the impact stress has on the body that she practices yoga.

Delores believes that racism is a stress factor for African Americans.

"In our society, Blacks are so often presumed to be inferior," she says. "I think that yoga helps you to focus on your capabilities so that you become less vulnerable to being undermined by others' deliberately racist or simply thoughtless attitudes or remarks…I question whether I would have needed medication for hypertension had I known about yoga and its ability to insert calm into my life."

I am encouraged that more of my family members are now involved in yoga and hopeful that we can lower the hypertension rates among African Americans by promoting the practice.

Important facts about hypertension

• Often, there are no immediate symptoms stemming from elevated blood pressure. Therefore, it is extremely important that blood pressure be checked annually.
  
• In a blood pressure reading, the systolic pressure is the first set of numbers recorded. It is normal if in the range of 120 to 130
  
• The diastolic record is the second set of numbers in your blood pressure reading. It's normal if it's in the range of 75 to 80
  
• A diagnosis of hypertension is made after four consecutive readings in the 140/90 range.

A Recommended Healthy Lifestyle Program

Many yoga centers offer programs that facilitate lifestyle changes that promote health. For example, the Kripalu Center's Healthy Living Program offers a variety of sessions designed to generate weight loss and greater fitness.