Journal of Ayurveda and Integrative Medicine 13 (2022) 100657

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Journal of Ayurveda and Integrative Medicine

journal homepage: http://elsevier.com/locate/jaim

Review Article

Effect of om chanting and yoga nidra on blood pressure and lipid

profile in hypertension e A randomized controlled trial
K. Anjana a, R. Archana b, *, J.K. Mukkadan a
a
Department of Physiology, Little Flower Medical Research Center, Angamaly 683572, Kerala, India
b
Department of Physiology, Saveetha Medical College, Saveetha Institute of Technical and Medical Sciences (SIMATS), Thandalam, Chennai 602105 Tamil
Nadu, India

a r t i c l e i n f o a b s t r a c t

Article history: Background: Hypertension (HTN) is a major public health concern, and elevated blood pressure (BP) is a
Received 17 March 2022 distinct risk factor for all - causes of morbidity and mortality.
Received in revised form Objectives: Considering the growing evidence of yoga interventions in the management of hypertension,
28 September 2022
the objective of the current randomized controlled study is to assess the effect of OM chanting and Yoga
Accepted 7 October 2022
Available online 11 November 2022
nidra (Relaxation technique) on BP and lipid profile in individuals with HTN.
Materials and methods: Eighty patients with diagnosed HTN were recruited and randomized equally to
either the experimental group or the control group. Patients in the experimental group received a
Keywords:
Yoga
combination of OM chanting and Yoga nidra, five days a week for a period of 2 months and patients in
Meditation the control group continued with their regular conventional medications. BP and lipid profile parameters
Yoga nidra were assessed at baseline, 30th day and 60th day for both the groups.
OM chanting Results: After 2 months of intervention, a significant (p < 0.05) reduction in the BP and lipid profile was
Blood pressure observed in the intervention group when compared to the control group. The reduction in systolic and
Lipid profile diastolic BP and LDL were significantly (p < 0.001) higher in the experimental group. In addition, there is
a significant increase in HDL levels in the experimental group. No adverse events were reported during
the trial period.
Conclusion: The current study demonstrates the efficacy of Om chanting and Yoga nidra in reducing
blood pressure and improving lipid profiles in patients with HTN. These particular yoga interventions
could thus be considered a safer form of complementary therapy in the management of HTN, alongside
conventional management.
Registration: Clinical trial identifier- CTRI/2020/02/023400.
© 2022 The Authors. Published by Elsevier B.V. on behalf of Institute of Transdisciplinary Health Sciences
and Technology and World Ayurveda Foundation. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

1. Introduction to endothelial dysfunction, vascular inflammation, vascular

remodeling and atherosclerosis [4]. Reduction in blood pressure, as
Hypertension is a global public health challenge and elevated little as 10 mm Hg in systolic blood pressure (SBP) and 4 mm Hg in
blood pressure is one of the leading risk factors for mortality diastolic blood pressure (DBP), is reported to reduce the risk of
globally [1]. Over 10.4 million deaths have been reported world- myocardial infarction and stroke by 23% and 30% respectively [5].
wide due to hypertension (HTN) and it is the most preventable and Thus, achieving even a smaller reduction in SBP and DBP through
modifiable vascular risk factor for premature morbidity and mor- non-pharmacological means such as diet, exercise and comple-
tality as well [2,3]. Dyslipidemia is a common metabolic abnor- mentary therapies like yoga would be of greater significance in the
mality observed in patients with hypertension. The pathological management of hypertension alongside conventional
abnormalities due to dyslipidemia and elevated blood pressure lead management.
Yoga is one of the most popular mind-body therapies widely
practiced across the world. Various practices are involved in yoga
* Corresponding author. including physical movements (asanas), controlled respiration
E-mail: [email protected] (pranayama), relaxation and meditation (dhyana) [6]. The
Peer review under responsibility of Transdisciplinary University, Bangalore.

https://doi.org/10.1016/j.jaim.2022.100657
0975-9476/© 2022 The Authors. Published by Elsevier B.V. on behalf of Institute of Transdisciplinary Health Sciences and Technology and World Ayurveda Foundation. This is
an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
K. Anjana, R. Archana and J.K. Mukkadan Journal of Ayurveda and Integrative Medicine 13 (2022) 100657

beneficial effects of yoga on various aspects of hypertension are chanting. The O part was chanted for a shorter duration (1/3 part)
well-documented, especially with pranayama (breathing tech- followed by a prolonged M part (2/3 part). They were trained to
niques), meditation and other relaxation techniques in the man- chant ‘Om’ 3 times per minute for a period of 5 min.
agement of hypertension [7e9].
The American College of Cardiology/American Heart Association 2.4.2. Yoga nidra
(AHA) task force guidelines have emphasized on the importance of After ‘Om’, yoga nidra developed by Swami Satyananda Sar-
lifestyle interventions such as regular exercise and yoga in the aswati, Bihar School of Yoga, India was given to the patients in a
effective management of hypertension [10]. Keeping in mind the supine position for a period of 20 min [12]. All patients were
increase in cardiovascular mortality in low and middle income instructed to remain in the lying down position and follow the
countries, a community based intervention would be a more instructions of the yoga trainer. The practice starts with in-
effective strategy in the management of hypertension [11]. A simple structions to relax their entire body and mind as per the in-
mind-body intervention like yoga would help patients to practice in structions provided. Followed by stating a resolve/sankalpa. The
the comfort of their homes without much hassles. Most previous sankalpa was given were same for all the subjects and was constant
studies have focused on asanas and pranayama. There are multiple throughout the study period. The subjects were instructed to rotate
other simpler practices in yoga that could be performed across all their consciousness as per the instruction followed by breath
age groups irrespective of the flexibility of a practitioner. However, awareness. The subjects were instructed to experience the different
these components of yoga are least explored scientifically. The feelings and emotions and produce a creative visualization of im-
objective of the current study is to understand and scientifically ages. They were asked to recollect the Sankalpa at this phase. The
explore the effect of integrated relaxation practices of Yoga nidra subjects were instructed gradually and carefully to return to the
and Om meditation on blood pressure and lipid profile in patients normal state.
with elevated blood pressure. No active intervention was scheduled for the control group and
they continued with their regular medications and usual activities.
2. Materials and Methods They were asked to do the follow-up on every 30th and 60th day.

2.1. Study design 2.5. Outcome measures

This study was a prospective randomized controlled study BP measurement was carried out using a validated BP monitor
conducted on patients with diagnosed HTN. The study was con- (Omron Inc., Japan). After 10 min of rest in a sitting position, BP was
ducted in a private hospital and research center in rural Kerala, estimated in the left arm. A fasting blood sample (5 mL) was
South India. BP measurement and lipid profile parameters were collected for assessment of lipid profile markers such as triglyceride
evaluated at baseline and after 2 months of intervention. (TG), total cholesterol (TC), low-density lipoprotein (LDL), and high-
density lipoprotein (HDL) at baseline, on 30th day and 60th day for
2.2. Subjects all the patients.

Patients at Little Flower Medical Research Center, diagnosed 2.6. Statistical analysis
with HTN, with a BP range of 130e139/80e89 mmHg, between 25
and 60 years of age were selected. The subjects were under a hy- Descriptive statistics were used to present the baseline charac-
pertension diet and taking essential pharmacological therapy. teristics of the data. Normally distributed quantitative data was
Exclusion criteria were patients with cardio-respiratory diseases, presented by the mean and standard deviation (SD). Binary and
Neuroendocrine diseases, and patients who are practicing yoga or categorical variables were presented using counts and percentages.
any form of exercise more than 3 days a week. Recruitment was Between group comparisons of study groups were analyzed using
done by giving fliers and were contacted by calling over the tele- Independent T test or Mann Whitney U test based on normality.
phone. 80 patients who fulfilled the inclusion and exclusion criteria The corresponding p-value of less than 0.05 was considered sig-
were recruited and randomly assigned to control group (n ¼ 40) nificant for each outcome. All the data entered in Microsoft Excel,
and experimental group (n ¼ 40). and analyzed using SPSS version 20.00.

2.3. Randomization 3. Results

For the process of recruitment, 320 patients with HTN were pre- Baseline demographical details of the patients who participated
screened. Out of which, 117 patients were screened for eligibility in the present study are shown in Table 1. In the experimental
and after applying further inclusion and exclusion criteria, 80 pa-
tients who provided informed written consents were randomly
allocated to either intervention group (40) or control group (40) Table 1
through block randomization method. Allocation concealment was Baseline characteristics of the study participants.

done in a sequentially numbered opaque and sealed envelope Variables Control group Experimental group P value
(SNOSE method), handled by a researcher who was not directly n ¼ 31 n ¼ 34
involved in the study. Six patients from the experimental group and Age (yrs, Mean, SD) 43.90 ± 9.24 49.13 ± 8.106 0.023*a
nine patients from the control group dropped out of the study. 20-30 (n, %) 4 (13) 4 (13) 0.64#
30-40 (n, %) 10 (33.30) 12 (40)
40-50 (n, %) 15 (50) 14 (46.70)
2.4. Intervention
50-60 (n, %) 2 (3.30) 4 (13.30)
Gender (n, %)
2.4.1. Om chanting Male 14 (45.1) 15 (44.1) 0.34#
Patients were trained in ‘Om’ chanting by an experienced yoga Female 17 (54.8) 19 (55.8)
trainer. The patients were trained to chant the vowel (O) part of the BMI (kg/m2) 24.31 ± 1.21 25.27 ± 1.38 0.95*

‘Om’ followed by the consonant (M) part of the ‘Om’ for 20 s in each * Unpaired t test; # chi-square test.

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K. Anjana, R. Archana and J.K. Mukkadan Journal of Ayurveda and Integrative Medicine 13 (2022) 100657

Table 2
Within group comparison of blood pressure parameters among the study groups.

Blood pressure parameters Experimental group Control Group

Initial, 30th day, 60th day, P Value Initial, 30th day, 60th day, P Value
Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD

SBP(mmHg) 137.53 ± 3.70 134.53 ± 4.66 129.93 ± 5.97 <0.001 133.13 ± 3.09 132.94 ± 2.83 132.88 ± 2.73 0.395
DBP(mmHg) 86.13 ± 2.40 83.93 ± 2.37 81.93 ± 2.43 <0.001 84 ± 4.42 83.69 ± 4.04 84.69 ± 2.57 0.051
PP(mmHg) 52.87 ± 5.77 51.33 ± 5.57 42.67 ± 3.65 <0.001 48.33 ± 4.55 48.13 ± 5.04 46.93 ± 3.27 0.221
MAP(mmHg) 103.72 ± 2.56 100.97 ± 2.81 99.23 ± 3.65 <0.001 100.38 ± 3.17 100.1 ± 2.71 100.75 ± 1.82 0.056
RPP (bpm-mmHg) 10446.67 ± 1063.87 10012.13 ± 967.53 9099.47 ± 887.03 <0.001 9973.75 ± 1293.86 9972.5 ± 1232.06 9974.81 ± 1188.13 0.869

Repeated measures ANOVA, P < 0.05 shows statistical significance.

SBP- systolic blood pressure, DBP- diastolic blood pressure, PP-pulse pressure, MAP-mean arterial pressure, RPP-rate pressure product.

group, the range of age varies from 34 to 60 years with an average of study period. In the control group, there was no significant differ-
49.13 ± 8.11 years and in the control group age varies from 25 to 58 ences were observed during the study period. (p > 0.05). The mean
years with an average of 43.90 ± 9.24 years. Gender is distributed difference of TGL (9.33 ± 1.69 vs 0.16 ± 0.63), VLDL (1.87 ± 0.34 vs
almost equally in both groups as more than half of the population 0.03 ± 0.13), HDL (4.43 ± 1.72 vs. 0.34 ± 0.87 mg/dl), LDL
were females in both groups. BMI distribution shows that our study (9.74 ± 2.30 vs. 0.08 ± 0.26 mg/dl), LDL/HDL (0.64 ± 0.32 vs
population is overweight. 0.04 ± 0.09) ratio, TC (6.43 ± 1.75 vs 0.46 ± 0.89) and TC/HDL ratio
(0.79 ± 0.4 vs 0.05 ± 0.12) were significantly higher at the end of the
3.1. Blood pressure variables 60th day.

Within group comparison of study groups shows that in 4. Discussion

experimental group, compared to initial value, systolic blood
pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), In the current study, the combination of the two relaxation
mean arterial pressure (MAP), and rate pressure product (RPP) practices- ‘Om’ chanting and Yoga nidra, showed a statistically
showed a significant reduction on 30th day and it was consistent on significant reduction in SBP, DBP, PP, MAP and, RPP. Similarly, an
60th day (p < 0.001). There was no statistically significant differ- improvement in the lipid profile was also observed in the inter-
ence was obtained in control group during the study period. vention group.
(p > 0.05). The changes in BP variables (SBP, DBP, PP, MAP and RPP) The mechanism of action and impact of ‘Om’ chanting on
in the experimental group at various time points with a significant breathing pattern is well-documented. During Om chanting, the
improvement (p < 0.001) post-intervention. The improvement in breathing rate is slowed down and airway resistance is induced due
SBP (7.6 ± 3.58 vs 0.88 ± 1.01 mmHg), DBP (4.2 ± 1.52 vs. to the laryngeal contraction to generate the particular sound and
1.81 ± 1.99 mmHg), PP (4.6 ± 3.86 vs 2.06 ± 2.12 mmHg), MAP vibrational effects, thereby increasing the vagal tone, and resultant
(4.62 ± 1.68 vs 1.29 ± 1.37 mmHg) and RPP (1347.2 ± 459.58 vs. physiological relaxation via parasympathetic arousal [13,14]. The
128.69 ± 153.3 mmHg) for the experimental group at 60th day were changes induced in the respiratory tract impact the ascending vagal
significantly higher than control group (Table 2). activity which would produce a widespread action in critical reg-
ulatory centers of the brain. The parasympathetic nervous system
3.2. Lipid profile (PNS) which gets stimulated by the neurotransmitter GABA from
the pre-frontal cortex and insular cortex reduces the hyper activity
There was significant improvement (Table 3) in serum lipid of the amygdala [15]. Similarly, the changes in breathing patterns
markers (TGL, VLDL, LDL, HDL, LDL/HDL and TC/HDL and total will increase the release of hormones such as oxytocin, vasopressin
cholesterol) as well in the experimental group at the end of 30th and prolactin, meanwhile reducing the stress markers such as
day (P < 0.001) and 60th day of intervention (P < 0.001). Difference cortisol, via the hypothalamo pituitary adrenal (HPA) axis [16,17].
observed among the experimental group shows that Triglycerides Mind-body therapies such as yoga have already been shown to
(mg/dl), VLDL (mg/dl), LDL (mg/dl), TC (mg/dl), LDL/HDL, TC/HDL improve heart rate variability (HRV) in previous studies, especially
were showed statistically significant decrease on 30th day and on slow breathing is reported to influence cardiovagal centers [18].
60th day after receiving Om chanting and yoga nidra (p < 0.05) The Previous studies have reported that ‘Om’ sound activates the
HDL (mg/dl), values increased (p < 0.05) significantly during the middle frontal cortex and right supramarginal gyrus which are

Table 3
Within group comparison of lipid profile among the study groups.

Lipid Profile Experimental group Control Group

Initial, 30th day, 60th day, P Value Initial, 30th day, 60th day, P Value
Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD

Triglycerides (mg/dl) 194.17 ± 73.27 190.17 ± 73.50 184.83 ± 72.67 <0.001 245.16 ± 45.22 244.94 ± 45.03 245 ± 45 0.097
VLDL (mg/dl) 38.8 ± 14.66 38.03 ± 14.59 37.03 ± 14.59 <0.001 49.03 ± 9.04 48.99 ± 9.01 49 ± 9 0.097
HDL (mg/dl) 40.10 ± 4.58 41.23 ± 4.47 44.53 ± 3.86 <0.001 35.13 ± 5.75 34.91 ± 5.44 34.78 ± 5.43 0.052
LDL (mg/dl) 164.9 ± 34.421 159.90 ± 34.39 155.93 ± 34.39 <0.001 166.58 ± 34.34 166.61 ± 34.37 166.66 ± 34.3 0.264
TC (mg/dl) 243.75 ± 35.07 239.08 ± 35.41 237.32 ± 35.07 <0.001 250.73 ± 35.5 250.51 ± 35.5 250.44 ± 35.5 0.326
LDL/HDL 4.17 ±0.98 3.83 ±0.91 3.50 ±0.777 <0.001 4.89 ± 1.37 4.91 ± 1.35 4.92 ± 1.34 0.070
TC/HDL 6.13 ± 1.104 5.8 ±0.92 5.37 ±0.765 <0.001 7.32 ± 1.58 7.35 ± 1.56 7.37 ± 1.55 0.054

Repeated measures ANOVA, P < 0.05 shows statistical significance.

TG-triglyceride, TC-total cholesterol, LDL-low density lipoprotein, HDL-high density lipoprotein.

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K. Anjana, R. Archana and J.K. Mukkadan Journal of Ayurveda and Integrative Medicine 13 (2022) 100657

neural systems associated with the emotion of ‘empathy’ [19] An Author contribution statement
fMRI study has demonstrated that 15 s loud ‘Om’ chanting stimu-
lates the auricular part of the vagus nerve [20]. Anjana.K: Conceptualization, Methodology, Formal analysis,
Similar to ‘Om’ chanting, Yoga nidra is also an equally effective Investigation, Resources, Data curation, Validation, Writing - orig-
relaxation practice. Yoga nidra is considered to be a state of relax- inal draft, Visualization. Archana. R: Conceptualization, Method-
ation with an altered state of consciousness [21]. The integrated ology, Formal analysis, Validation Writing - review & editing,
response of Yoga nidra on the hypothalamus results in decreased Supervision. Mukkadan. J.K: Conceptualization, Methodology,
sympathetic nervous system activity and simultaneously increases Supervision.
the parasympathetic activity as well, by possible activation of the
HPA axis [22]. EEG studies showed an initial increase in the beta Declaration of competing interest
wave activity during the practice, indicating a calm state of mind
being induced in the practitioners [23]. The authors declare no conflict of interest.
Serum cholesterol levels may be elevated during sympathetic
overactivity. Chronic stress may raise cholesterol levels indepen-
Acknowledgements
dent of dietary measures [24].
Studies on yoga nidra proved that Yoga nidra effectively reduces
Ms. Anitha Devi. T.S for all the help provided in statistical
stress and anxiety [21].
analysis. We are also grateful to the subjects who are participated in
Previous studies show that pranayama and yogasanas are
the study.
effective in patients with defective lipid metabolism [25]. This
might be due to the parasympathetic stimulatory activity of Om
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