Effectiveness of Bhramari Pranayama with diaphragmatic breathing exercise in pre-hypertensive patients: A quasi-experimental study

Background: Pre-hypertension is a critical, modifiable transitional phase that substantially elevates the risk of cardiovascular disease and end-organ damage if left unaddressed.Non-pharmacological therapies-specifically breathing-based yogic practices such as diaphragmatic breathing and Bhramari Pranayama-have emerged as accessible, cost-effective modalities capable of modulating autonomic tone and enhancing baroreflex sensitivity.This study aimed to investigate the hemodynamic effects of a structured, four-week combined breathing protocol on systolic and diastolic blood pressure in unmedicated prehypertensive adults.Methods: A quasi-experimental intervention study utilizing purposive sampling was conducted in Navi Mumbai.The cohort comprised 40 pre-hypertensive adults aged 18-80 years who were not receiving any antihypertensive pharmacotherapy.Participants engaged in a supervised regimen consisting of paced diaphragmatic breathing (6 breaths per minute for 10 minutes), followed by a 2-3-minute rest interval, and concluding with Bhramari Pranayama for 5 minutes.The protocol was performed three days per week across four consecutive weeks.Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded at baseline and immediately post-intervention using a standardized mercury sphygmomanometer under resting conditions.Changes were analyzed using paired-samples t-tests.Results: Following the 4-week intervention, participants demonstrated statistically significant reductions across both hemodynamic parameters.Mean SBP decreased from 133.3 ± 4.5 mmHg at baseline to 128.8 ± 3.8 mmHg post-intervention, reflecting an average reduction of 4.5 mmHg ($t = 8.366, p < 0.001$).Concurrently, mean DBP declined from 85.3 ± 2.6 mmHg to 81.3 ± 2.4 mmHg, representing an average reduction of 4.0 mmHg ($t = 6.976, p < 0.001$).Conclusion: A four-week combined protocol of paced diaphragmatic breathing and Bhramari Pranayama produced significant, clinically relevant reductions in both systolic and diastolic blood pressure among pre-hypertensive individuals.These findings highlight the potential of targeted respiratory interventions as viable, non-invasive lifestyle strategies in preventive cardiovascular care and physiotherapy.Further randomized controlled trials with extended follow-up windows are warranted to evaluate long-term hemodynamic retention and broader clinical outcomes.