Pranayama for Cardiovascular Health: Physiological Mechanisms, Clinical Evidence, and Future Perspectives - A Comprehensive Narrative Review

Pranayama, the yogic practice of controlled breathing, has gained considerable scientific attention as a complementary lifestyle intervention for promoting cardiovascular health. Cardiovascular diseases remain the leading cause of morbidity and mortality worldwide, necessitating safe, affordable, and evidence-based preventive and rehabilitative strategies alongside conventional medical treatment. Pranayama has been shown to influence multiple physiological systems involved in cardiovascular regulation, including the autonomic nervous system, respiratory function, endothelial function, neuroendocrine responses, oxidative stress, and inflammatory pathways. Growing evidence from randomized controlled trials, observational studies, systematic reviews, and meta-analyses suggests that regular pranayama practice may improve heart rate variability, reduce resting heart rate and blood pressure, enhance vascular function, improve exercise tolerance, and alleviate psychological stress. Among cardiovascular disorders, the strongest evidence currently supports its adjunctive role in the management of hypertension, while emerging evidence indicates potential benefits in coronary artery disease, cardiac rehabilitation, and stable heart failure. Despite these encouraging findings, heterogeneity in study design, breathing protocols, intervention duration, and outcome measures limits direct comparison among studies and underscores the need for standardized research methodologies and large multicenter clinical trials. This comprehensive narrative review critically synthesizes the current evidence on the physiological mechanisms, clinical applications, and future perspectives of pranayama in cardiovascular health, while proposing practical directions for future research and clinical integration into evidence-based cardiovascular care.