Abstract

Hypertension is a prevalent health concern among professionals, often exacerbated by high stress and demanding work conditions. This study explores the effectiveness of Indian Raaga-based Music Therapy (IRMT) in reducing blood pressure and stress among hypertensive individuals from both IT and non-IT sectors. Conducted as a randomized controlled trial, the research involved 67 participants aged 35 to 58 years, who were divided into an IRMT group that listened to specific Indian Classical Raagas and a control group. The intervention comprised 45-minute music sessions, split into three 15-minute sessions each day, five days a week, over six weeks.

The results showed a significant 10% reduction in systolic and diastolic blood pressure in the IRMT group, with a two-sided p-value of 0.0001 for both pretest and between-group comparisons. Stress levels decreased by 21%, shifting from a pre-test mean of 43.2±11.4 to 34.2±12.5 post-intervention, with a p-value of 0.0001 and a between-group p-value of 0.02. Symptoms of hypertension, measured using the Hypertension Symptom Detection Questionnaire, dropped from 9.6±4.5 to 6.1±3.8 (p = 0.0001). Additionally, the anger trait associated with emotional imbalances, reflected in the Vikruti Tri-Dosha Diagnostic Scale, reduced from 2.9±0.3 to 1.2±0.4 (p = 0.0001) for predominantly Pitta, Vata-Pitta, or Pitta-Kapha body types, as analyzed by the Prototype Prkriti Analysis Tool (PPAT). ​With an average attendance rate of 89%, these findings suggest that IRMT could be an effective non-pharmacological approach to managing hypertension and fostering emotional healing.​

Keywords: Indian classical music, Raaga therapy, hypertension, randomized controlled trial, IRMT.

Introduction:

Hypertension is a significant contributor to cardiovascular diseases and has become increasingly prevalent among working professionals due to factors such as high stress, unhealthy diets, and sedentary lifestyles ^[1]. Traditional treatments often rely on medication, which may carry side effects and fail to tackle the underlying causes of stress-related hypertension. ^[2] Recent findings from the Million Hearts® campaign and the Centres for Disease Control and Prevention indicate that approximately 22% of adults aged 18 to 39 and 54% of those aged 40 to 59 are affected by hypertension ^[1].

In Ayurveda, the ancient healer Acharya Charaka highlights the therapeutic use of music for healing the mind and body. Ayurveda identifies three biological humors, known as Tri-Doshas: Vata (movement), Pitta (transformation), and Kapha (structure). The balance of these Doshas varies among individuals, creating a unique constitution called Prakruti. Disease arises when there is discord in the Doshas, referred to as Vikruthi. The goal of treatment is to restore this balance and return to one’s Prakruti ^[3]. Ayurveda also emphasizes the importance of cultivating Sattva Guna to promote mental health, while an overabundance of Rajas and Tamas can lead to issues such as stress and anxiety^[4].

Music therapy functions as a relational approach designed to promote emotional healing by alleviating negative emotions and fostering a healthy internal environment, as defined by Sattva Guna ^[5]. This therapeutic practice integrates components such as Nada (primordial sound), Shruti (pitch), Svara (tone), Raaga (melodic scale), Tala (rhythm), and Rasa (emotion), which work together to restore equilibrium in both physical and mental health, thereby addressing conditions that can lead to illness. In particular, Indian Classical Music, and Raaga therapy, are thought to help in balancing the Doshas and alleviating stress ^[6]. Although previous studies have shown that music therapy has positive effects on cardiovascular health, there is a significant lack of research specifically focusing on the effects of IRMT on hypertension. ^[7]. This study intends to fill this gap by assessing the effectiveness of IRMT in modifying the Pitta Dosha, aiming to alleviate blood pressure, stress, and hypertension symptoms in working professionals through the application of time-specific Raagas characterized by distinctive tonal qualities. ^[8].

Modern Cause of Hypertension

Working professionals face unique risk factors that contribute to health issues, including a sedentary lifestyle, high stress, unhealthy eating habits, irregular sleep patterns, and symptoms of anger and frustration. Additionally, a lack of work-life balance exacerbates these challenges. Lifestyle-related elements such as body mass index (BMI), smoking, and alcohol intake, as well as, Sociodemographic factors, including gender, age, and occupation significantly contribute to the increasing prevalence of hypertension within this population^[9]. Recent statistics show a concerning upward trend in hypertension cases among working professionals, highlighting the importance of addressing this issue for their overall health and wellness ^[10].

Hypertension-Ayurvedic Concept

In Ayurveda, the Tri-Dosha framework comprises Vata, which signifies movement; Pitta, linked to transformation; and Kapha, which pertains to structural integrity. Each individual possesses a unique constitution, termed Prakriti, based on the varying levels of these Doshas. ​Health issues emerge when there is an imbalance among the Doshas, known as Vikruthi.​ Notably, significant differences in Vata or Kapha Prakriti can lead to a reduced Agni, negatively affecting digestion and resulting in the buildup of toxins called Ama, which can trigger inflammation. In contrast, individuals with a Pitta constitution generally have higher levels of Agni, though some may experience fluctuations in Agni’s stability ^[11] . Additionally, Ayurveda associates the physical manifestation of hypertension with an imbalance in the Pitta Dosha^[6], while psychological factors contributing to hypertension encompass traits such as anger, arrogance, self-absorption, and aggression, which are influenced by Rajasic Guna ^[12].

Emotional Cause of Hypertension

Alongside physical symptoms, individuals with hypertension often display perfectionist tendencies and a desire to exert control over people and situations.​ This behavior can foster feelings of anger and frustration about their circumstances, leading to difficulties with self-esteem and job security, as well as other everyday stressors ^[12,13]. Often, such individuals carry unexpressed or suppressed emotions, which can create significant internal pressure. Music that encompasses particular tonal qualities can stimulate emotional responses that promote feelings of joy, tranquillity, and compassion, helping to enhance their overall mood.

Music and Music therapy

The Sangita Ratnakara, a pivotal text in the field of Indian classical music authored by Sarangadeva, describes Music as “gitam vaadyam tatha nrutyam trayam sangitamucyate,” which means the three forms of music—vocal, instrumental, and dance—are all collectively known as Music.^[14]. This discipline encompasses the art and science of creating harmonious and cohesive compositions by organizing tones or sounds in particular sequences, combinations, or relationships^[15].

​Music therapy utilizes musical components to promote learning, enhance relationships, and fulfill diverse therapeutic goals, addressing the mental, emotional, cognitive, social, and physical needs of individuals^[15].​ In this approach, a certified music therapist collaborates with individuals or groups to enhance communication and learning through musical aspects such as sound, pitch, harmony, melody, and rhythm^[16].

Indian classical music is characterized by seven fundamental elements:

• Nada refers to sound with a consistent quality, representing a single frequency or a group of similar frequencies^[12].
• Shruti indicates a specific pitch within an octave that aligns with a particular frequency^[17].
• Svara denotes a precise pitch tied to a fixed tonic, deriving its character from that tonic ^[18].Notes or Svaras with altered pitches are known as Komal (lowered) and Tivra (raised)^[19].
• Tala describes the rhythmic structure that is vital to music^[12].
• Raaga consists of a selection of tones (svaras) that, when played together, evoke specific emotions or moods^[20].
• Rasa embodies the emotional essence experienced in the body and mind, encompassing fundamental feelings such as love, pleasure, amazement, courage, calmness, anger, aversion, sadness, and fear^[12]. It is rooted in emotional states called Bhaava, with each Raaga able to elicit a distinct aesthetic mood or Rasa.^[21].
• Finally, Thaata refers to the framework that organizes all seven notes in ascending and descending sequences^[22].

To balance the Pitta Dosha, which is linked to anger, Raagas that evoke Shanta and Karuna Rasa are beneficial. These Raagas are connected to a time theory that aligns with the circadian rhythms of Vata, Pitta, and Kapha:^[23]:

• Vata prevails from 2 a.m. to 6 a.m. and 2 p.m. to 6 p.m.
• Pitta isdominant from 10 a.m. to 2 p.m. and 10 p.m. to 2 a.m.
• Kapha is most prominent between 6 a.m. to 10 a.m. and 6 p.m. to 10 p.m.

Fig.1Raagas for Pitta imbalance using Ri and Dha Komal based on the Diurnal circadian cycle of Vata, Pitta, and Kapha from Bhairav, Marwa and Poorvi Thaata which produces Shanta and Karuna Rasa.^[12]

Effect of Music on Hypertension

Research has shown a significant reduction in stress levels, as well as a decrease in both diastolic and systolic blood pressure among hypertensive participants when exposed to specific Raagas, such as Raaga Todi^[24], Raaga Bhimpalasi^[25]. These findings emphasize the positive impacts of music intervention in the treatment of hypertension. Ancient texts on music suggest that engaging with Raagas according to time theory, which aligns with the circadian cycles of Doshas in Ayurveda, could promote balance at both physiological and psychological levels ^[19]. However, there is currently no structured study on IRMT that utilizes time theory to address the psychological aspects of Pitta, an anger-related trait associated with hypertension management.

Materials and Methods

Participants

The study recruited 67 working professionals having elevated blood pressure or stage 1 or 2 hypertension aged between 35-58 years. Participants were randomly allocated to the IRMT group (n=34) or the control group (n=33).

Intervention

Participants in the IRMT group were exposed to selected Indian Raagas associated with the Pitta Dosha, specifically from Bhairav, Marwa, and Purvi Thaata. They also engaged with the Raagas from the corresponding Carnatic Melas such as Mayamalava Govla, Gamanashrama, and Kamavardhini, known for their calming effects ^[6].

The daily sessions lasted 45 minutes and occurred five days a week over six weeks. Each session was segmented into three parts of 15 minutes each, scheduled for the morning, afternoon, and late evening/night, totalling 90 sessions. These sessions focused on different musical instrumental compositions tailored to specific times of the day to enhance therapeutic effects. Music sessions were held online using the Zoom application, employing screen sharing to enhance the experience and enabling participants to enjoy the sessions from the comfort of their homes or offices. Participants used headphones at lower volumes (approximately 50-70 dB) to ensure a pleasant listening experience^[26].

Steps of the IRMT Intervention: 

1. Breathing Exercises: Begin the session with breathing exercises to calm the mind (2 minutes).
2. OM Chanting: Engage in OM chanting to cultivate mindfulness (1 minute). The chant of Omkara serves as a foundation for the music and is performed as a preparatory practice before the music is played^[27].
3. Positive Affirmation: Repeat a positive affirmation related to hypertension three times (1 minute) ^[28]
4. Explain the specific Raaga of the IRMT session, its therapeutic significance, and the artist performing the music, followed by playing the song (12 to 15 minutes) ^[8]
5. Conclude the session with palming techniques and request feedback.

These steps are repeated during the three daily sessions, which take place at the following times for participants in the Indian Standard Time (IST) zone:

• Morning: 6:30 AM – 6:45 AM
• Afternoon: 1:30 PM – 1:45 PM
• Evening: 8:30 PM – 8:45 PM

For one participant from the USA, separate sessions were conducted twice a day at the following times in the Pacific Standard Time (PST) zone:

• Morning: 8:30 AM – 8:45 AM
• Evening: 7:30 PM – 7:45 PM

The IRMT program features instrumental music from both Hindustani and Carnatic traditions across various genres. ​Each selected piece is transformed into a frequency of 396 Hz, which is pleasing to the human ear and offers long-term therapeutic benefits ^[29,30]. The specific Raagas used in the six-week IRMT intervention are illustrated in Figure 2.

Fig-2: Week-wise IRMT Raagas based on the circadian cycle

Control Group

The control group did not receive any musical intervention and instead maintained their regular activities.

Data Collection

• Demographics and Medical History: Age, gender, location, type of industry, Duration of hypertension, current medications, and other comorbidities.
• Blood Pressure: Systolic and diastolic blood pressure measurements were taken using a sphygmomanometer both before and after the intervention period.
• Prototype Prakriti Analysis tool (PPAT) ^[31,32] : Questionnaire to determine the dominant Dosha /Prakriti/body constituent of the participant taken before the intervention period.
• Hypertension Symptoms Detection: HSD questionnaire ^[33,34] was measured to assess the likelihood of hypertension before and after the intervention period.
• Stress Levels: The Perceived Stress Scale (PSS) ^[35] was utilized to assess changes in stress levels before and after the intervention.
• Vikruti Tri–Dosha Diagnostic Scale(VTDS) ^[36]: Questionnaire used to determine the Dosha which is vitiated and particularly the anger trait before and after intervention
• Adherence to music therapy: The researcher maintained a daily attendance log to evaluate the acceptance of IRMT as an integrated approach in the hectic lives of working professionals.

Statistical Analysis

Data were analyzed using paired t-tests to compare measurements before and after the intervention, and between groups. The p-value for blood pressure, stress level, hypertension symptoms, and anger traits found to be less than 0.05 was deemed statistically significant.

Results and Discussion

Blood Pressure

• The IRMT group demonstrated a significant reduction of 10% in both systolic (mean reduction of 14.5 mmHg) and diastolic blood pressure (mean reduction of 9 mmHg) compared to the control group, with a two-tailed p-value of 0.0001 for both pre-assessment and inter-group comparisons ^[37].
• This aligns with previous studies that have demonstrated the beneficial effects of IRMT on cardiovascular health ^[38].

Hypertension Symptom Detection (HSD)

There was a notable reduction of 37% in HSD parameters in the IRMT group, indicating enhanced parasympathetic activity and reduced sympathetic dominance ^[15]. Symptoms of hypertension, assessed using the Hypertension Symptom Detection Questionnaire, decreased from 9.6±4.5 in the pre-test to 6.1±3.8 in the post-test (p = 0.0001). The inter-group comparison revealed a highly significant difference in the post-test (p=0.006) and no significant difference in the pre-test (p=0.2). ​This indicates improved autonomic regulation and stress management.

Stress Levels

• Participants in the IRMT group experienced a 21% reduction in perceived stress scores, while the control group exhibited no notable changes. ​Stress levels decreased from a pre-test mean of 43.2 ± 11.4 to a post-test mean of 34.2 ± 12.5, with a p-value of 0.0001 indicating significant improvement.​ Furthermore, the inter-group post-test demonstrated a significant result with a p-value of 0.02, while no significant difference was observed in the pre-test scores (p = 0.2).
• The soothing effect of the Pitta Dosha-related IRMT module likely contributed to the reduction in stress, supporting its use in therapeutic settings ^[39].

Anger traits

• Approximately 97% of participants in the IRMT group pre-dominantly displayed Pitta or dual Prakriti (Pitta with Kapha or Pitta with Vata) indicating significant changes in their Pitta imbalance.
• There was a notable reduction in the VTDS (Vikruti Tri-Dosha Diagnostic Scale) test score related to Pitta, along with marked improvements in psychological symptoms associated with Pitta. Specifically, the trait of anger showed a significant decrease in scores, reducing from a pre-test mean of 2.9 ± 0.3 to a post-test mean of 1.2 ± 0.4 with a p-value of 0.0001.

Adherence to Music Therapy

From the regular 6-week IRMT program, the average attendance adherence % is 89% with a mean± standard deviation of 80± 16.1.

Discussion

The anger and stress associated with Pitta imbalance can be alleviated by utilizing Saamaanya Vishesha Siddaanta through Raagas that evoke the aesthetic moods or Rasa of Calmness and Compassion. Raagas that employ Ri, Dha Komal particularly foster Shanta and Karunaa Rasa ^[40]. According to the theory of Saamaanya Vishesha Siddaanta (Ch. Su.1/44.), similar properties enhance the desired effect, while dissimilar properties diminish it^[19,41]. Sage Patanjali in his Yoga Sutra (2.33), also states “Vitarka badhane pratipakshabhavanam” which advises that during conflicts, we should adopt the opposite attitude to facilitate ease and resolution^[42]. Therefore, we played compositions compatible with Pitta Dosha agreeable Raagas from Bhairav, Marwa, Poorvi Thaata, and Mayamalava Govla, Gamanashrama, and Kamavardhini Melas. Each musical piece was converted to a frequency of 396hz which is pleasing for human ears ^[43].

The Possible mechanism for reducing blood pressure is given below:

• Music can stimulate serotonin production, a neurotransmitter that enhances feelings of well-being and happiness, thereby helping to lower stress and anxiety, both significant contributors to high blood pressure. The calming effects of music also improve blood flow and induce relaxation, further assisting in hypertension reduction^[44]. Research has demonstrated that listening to music can elevate mood by increasing serotonin levels, which contributes to lowering hypertension.
• The perceived stress scale significantly decreased in the IRMT group. Mindfulness, relaxation, and cognitive-behavioral therapies are known to lower stress by reducing cortisol levels and, subsequently, blood pressure. Musical interventions, particularly Indian classical Raagas, have proven effective in emotional regulation, with research indicating that improved self-awareness and emotion regulation through mindfulness and meditation contribute to better cardiovascular health ^[45].
• Hypertension Symptoms have reduced significantly using IRMT interventionaids in emotional healing. Research has shown that improved self-awareness and emotion regulation through mindfulness and meditation can lead to better cardiovascular health by reducing the impact of negative emotions on the heart^[46].
• Following the six-week IRMT intervention, all participants in this group demonstrated significant changes in their Pitta imbalance.​ There was a marked reduction in the VTDS (Vikruti Tri–Dosha Diagnostic Scale) test score related to Pitta, along with noticeable improvements in psychological symptoms associated with Pitta, particularly in the anger trait scores which showed a significant reduction. Most participants reported experiencing relaxation after the music sessions. Integrating psychological and behavioral interventions encourages healthier lifestyle choices, which are essential for hypertension management ^[46].

Furthermore, the IRMT group exhibited a high adherence rate, with an average attendance of 89% for the sessions reflecting efforts to enhance cultural acceptance, engagement, and compliance.

This implies that the IRMT intervention, using Raagas aligned with time theory and the circadian cycle, had a significant impact on the scores between the pre-test and post-test. The results are consistent with Ayurveda’s emphasis on music therapy for balancing Doshas and promoting holistic health ^[47,48]. Future research could explore the application of other Raagas and their effects on different demographics.

Conclusion

The deliberate engagement with the music elements of Ri & Dha Komal from Bhairav, Marwa & Poorvi Thaatas in Hindustani Classical along with the corresponding Carnatic Melas such as Mayamalava Govla, Gamanashrama, and Kamavardhini that embody Shanta and Karuna Rasa can facilitate emotional healing by fostering calmness and compassion. Music therapy promotes relaxation, reduces respiratory rates, and soothes the mind. ​This study highlights that IRMT through the application of time theory, significantly lowers blood pressure and stress levels among hypertensive working professionals.​ This IRMT intervention presents a culturally appropriate and non-invasive strategy for managing hypertension and enhancing quality of life. Future research should involve larger sample sizes and extended intervention durations to confirm these results.

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