Raga Todi Bringing Down Blood Pressure
Raga Todi Bringing Down Blood Pressure
Abstract
Several studies have indicated that music therapy may affect I. INTRODUCTION
cardiovascular health; in particular, it may bring positive changes Music may be regarded as the projection of ideas as well as
in blood pressure levels and heart rate, thereby improving the
emotions through significant sounds produced by an instrument,
overall quality of life. Hence, to regulate blood pressure, music
voices, or both by taking into consideration different elements of
therapy may be regarded as a significant complementary and
alternative medicine (CAM). The respiratory rate, if maintained melody, rhythm, and harmony. Music plays an important role in
within the normal range, may promote good cardiac health. The everyone’s life. Music has the power to make one experience
aim of the present study was to evaluate the changes in blood harmony, emotional ecstasy, spiritual uplifting, positive
pressure, pulse rate and respiratory rate in healthy and disease-free behavioral changes, and absolute tranquility. The annoyance in
males (age 50-60 years), at the completion of 30 days of music life may increase in lack of melody and harmony. Music is
therapy intervention. Eighty healthy males were divided randomly known to have healing power. Music may be effective to combat
into the experimental and the control group. Subjects of the pain (Cepeda et al., 2006), anxiety (Madhusudhan et al., 2018;
experimental group were exposed to music therapy (a twenty-
Ghasemi et al., 2017; Jhon and Upendra, 2016), coronary artery
minute instrumental session of Raga Todi of Hindustani Classical
disease (Hanser and Mandel, 2005), mental illness (Li et al.,
Music), whereas the control group was not exposed to the raga and
were only kept quite at rest for the same period of time, during the 2015), stress (Möckel et al., 1994 ), and several other forms of
period of intervention. Before and after the intervention, blood health ailments (Sarkar and Utpal, 2015). One of the major risk
pressure, pulse rate, and respiratory rate of the subjects were factors for cardiovascular diseases and cerebrovascular diseases
measured. It was found that the values of blood pressure, pulse rate is hypertension.These diseases increase the morbidity and
and respiratory rate showed significant (p < 0.001) decrement in mortality rates among adults. Increased blood pressure levels
healthy/ asymptomatic subjects exposed to music therapy. In the seen at childhood may extend into adult life as hypertension
control group, the parameters under study did not vary (McGill et al., 2001), which eventually leads to the damage of
significantly between the initial and afterward measurements (p >
blood vessels of the body. Hypertension is externally
0.05). Thus it may be concluded that raga Todi of Hindustani
asymptomatic and causes damage to certain internal organs of
Classical Music has the potential to bring down the blood pressure
levels and thereby may restrict the development of cardiovascular the body. Therefore, it has been referred to as a ‘Silent Killer’ by
disorders. the World Health Organization (WHO, 1992). In India, the
Keywords: Blood Pressure, Heart Rate, Hindustani Classical incidence of hypertension has been found to be more among
Music, Raga Todi, Respiratory Rate urban adults in comparison to rural adults. The estimated
number of hypertensive Indians will reach two hundred million
by 2025 (Bhalwar, 2009). Evidence gathered many studies displacement or distortion (immovable: Achalit Swars), and the
suggest that music may bring positive changes in the blood notes Rishabha (ri), Gandhara (ga), Madhyama (ma), Dhaivata
pressure levels (do Amaral et al., 2016), and thus may lower the (dha), and Nishada (ni) may be either Suddha (movable : Vikrut/
incidence of other diseases which are associated with Chalit), Komal or Teevra. Altogether, there are 12 notes
hypertension. It should be noted that music may be of different (Chaitanya, 1973). Thaat is the format of a sequence of selected
types, viz., Western, Indian and others. There exists scope for Swaras with variation in Suddha, Komal and Teevra Swaras
exploring the impact of different Indian ragas of Hindustani (Sobhana, 1989).
Classical music on blood pressure, especially in healthy Raga is an array of Swaras that inputs suitable rasa / aesthetic
individuals, so that ragas can be used more efficiently in music emotion/ mood in a song/ music. A raga has the ability to induce
intervention programs targeting the prevention of cardiovascular or magnify the feeling of excitement, joy / rejoice, peace, love,
disease. compassion, peace, courage , sorrow, and mental / emotional
The American Society of Hypertension in their study have calmness (Karuna et al., 2013). This makes raga appropriate for
noted that the blood pressure measured at regular intervals, as music therapy. A particular raga has a definite number of Komal
the individual move around, carrying out his/ her normal daily or Teevra Swaras, based on which the Thaat can be easily
routine, that is, the 24-hour ambulatory blood pressure (ABP), recognized (Sobhana, 1989). Positive physical / physiological /
significantly reduced in mild hypertension patients listening psychological changes have been found to be induced by
Indian classical raga for half an hour per day, for four weeks positive emotions (Tugade et al., 2004), which can be elicited by
(Sherry, 2008). raga therapy.
From time to time, continuously, the blood pressure targets
B. Present Concept of Hypertension in Adults
have been redefined (Pradhan and Vishwakarma, 2017), to help
in the early detection of subjects at risk of developing Conventionally, systolic blood pressure (SBP) > 140 and
hypertension and to speed up the treatment strategies, which diastolic blood pressure (DBP) > 90 mm Hg is widely accepted
could be either drug-based for hypertensive patients, and non- as hypertension (Sadiq et al., 2017). In the year 2018, guidelines
pharmacological therapies and techniques for subjects who are framed by the European Society of Cardiology (ESC) / European
not hypertensive but are at the risk of developing hypertension in Society of Hypertension (ESH), defined hypertension using the
future. same values of SBP and DBP (Williams et al., 2018). Subjects
The conventional non-pharmacological strategies to lower having systemic arterial blood pressure more than it is generally
blood pressure include lifestyle modifications such as reduction exposed to the treatment.
of body weight, dietary changes, restriction in the intake of salts, Treated blood pressure must be about 130/ 80 mm Hg if the
lowering of stress levels, and participation in exercises / physical patient is able to tolerate drug treatment. In the guidelines (2017)
activity. In recent times, the use of complementary and provided by the American College of Cardiology (ACC) and
alternative medicine (CAM) to reduce blood pressure has gained American Heart Association (AHA), SBP > 130 and DBP > 80
importance. The CAMs include meditation, yoga, and music mm Hg was known as hypertension. Generally, health care
therapy (Mcelroy et al., 2012). professionals recommended that all subjects should maintain
their blood pressure below 140/ 90 mm Hg. However, the
A. Musicological Analysis of Indian Music Therapy European, as well as American guidelines, suggest that blood
In Sama Veda and other ancient music therapy-related Indian pressure should be maintained at < 130/ 80 mm Hg.
music literature, it has been mentioned that ragas such as Todi, Subjects of any age may become hypertensives. However,
Bhupali, Ahir Bhairava, Puriya, Hindol, Bhimpalas, and Kausi with age, the prevalence of hypertension has been seen to rise.
Kanada are effective in lowering blood pressure (Kunikullaya et Hypertension is mainly of two types- Primary hypertension
al., 2016). (essential hypertension) and Secondary hypertension. Primary
In Indian context, a subject may be said to be exposed to music hypertension is most common and is found in the majority (90 -
therapy when sound (nada), note (Swara), melody (raga), music 95 %) of hypertensive patients . It has no single identifiable
interval (Shruti), beat (tala), rhythm (laya) are rightfully and causes ; its causes are unknown and are multifactorial in nature.
systematically intonated, clinging to the aesthetic emotion/ mood Genetics, sedentary lifestyle, high intake of salts, alcohol intake,
(rasa) and format / mode (Thaat) (Sharma, 2007). It may be smoking, stress, insulin resistance, aging, and obesity have a role
mentioned that there are seven notes Sa, Re, Ga, Ma, Pa, Dha, in its development. Secondary hypertension is a less prevalent
and Ni of Swara. The individual notes may be of decreased pitch type, affecting 5-10 % of hypertensives. It may occur due to
or higher pitch. If the note is in decreased pitch, it is known as a different underlying medical conditions such as diseases of
flat note (Komal), whereas if the note is in a higher pitch, it is kidneys, heart , endocrine system, and even by drugs (Mohamed
known as the sharp note (Teevra). The natural/ Suddha/ pure et al., 2013).
Swars are the Shadja (Sa) and Panchama (Pa) with no
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Todi of Hindustani Classical Music (Instrumental), employing systolic blood pressure was reduced to 130.2 (mm Hg) from
headphones in a sitting posture. 136.3 (mm Hg), and the diastolic blood pressure was reduced to
All the subjects of the study were asked to remain at rest for 5 80.5 (mm Hg) from 86.2 (mm Hg). The observed drop in blood
minutes in sitting posture, before the start of the study so that pressure was significant ( p < 0.001).
various physiological parameters of the body remain at a steady Table 1: Distributions of Participants by Characteristics
level. The intervention of maintenance of resting state in case of No. Category Frequency Percentage
the control group and exposure to music in the case of the (%)
experimental group was continued daily (once a day) in the Education
morning hours for a time period of 30 days.
1 10 + 2 7 8.75
The study employed Pre-test and Post-test design to evaluate
the changes in blood pressure (SBP and DBP), pulse rate, and 2 Graduate 44 55
respiratory rate, before and after music therapy intervention. On 3 Post Graduate 23 28.75
the first day (Pre-test- Before Intervention), and on the 30th day 4 Higher 6 7.5
(Post-test- After Intervention), the determination of blood Degrees
Total 80 100
pressure, pulse rate, and respiratory rate in the control group
subjects and the experimental group subjects were carried out. Marital Status
The blood pressure was measured in the sitting position by 1 Married 75 93.75
using a digital blood pressure apparatus (OMRON HEM-7130). 2 Unmarried 5 6.25
The average of two consecutive measurements, at an interval of Total 80 100
5 minutes in the upper arm of the subject, was taken to be the Employment
final blood pressure of an individual. The same instrument also 1 Government 22 27.5
measured the heart rate or pulse. employees
The determination of respiratory rate was done by counting 2 Private 28 35
the respiratory movements of the chest for one minute from a employees
distance (Kumar and Clerk, 2001; Michel, 1995). 3 Business 25 31.25
It is necessary to mention that initially, a pilot study was 4 Others 5 6.25
conducted for pretesting the study design and for feasibility. Total 80 100
Then necessary alterations were made before the final study. All Mean Age 57± 6
the measurements of the Pre-test and Post-test were done at a
similar timing of the day to restrict circadian effects and promote Table 2: Analysis of blood pressure in the Control Group
the reliability of the collected data. (initially and after resting period), and Experimental Group
(before and after exposure to music)
Raga Todi (morning raga) used on the experimental group is a
Control Group (Mean + SD)
Sampurna raga and permits seven notes in ascent and seven in
Variable Pre test- Post test- p-
descent. This deep raga is known to create an atmosphere full of Initial level After resting value
Karun and Bhakti ras. before resting period of 20
Statistical Analysis: All the data obtained were expressed as period of 20 minutes, in no
mean ± SD (standard deviation). A comparison of the parameters minutes, in no music condition
under study was made by using the t-test. A p-value of ≤ 0.05 or music condition
lower was considered significant. SBP (mm 137 + 1.26 136.5 + 1.53 >
Hg) 0.05
DBP 87.1 + 1.62 86.5 + 1.72 >
III. RESULTS 0.05
(mm Hg)
The complete characteristics of the study participants have Experimental Group (Mean + SD)
been presented in Table 1. From the table, it was seen that the Variable Pre test- Post test- p-
majority of the participants were graduates, married, and were Before Music After Music value
private-sector employees. The mean age of the participants was Therapy Therapy
57 ± 6. Intervention Intervention
SBP (mm 136.3 + 2.42 130.2 + 4.21 <
The blood pressure before and after music therapy in the
Hg) 0.001
experimental group, and the blood pressures of the control group DBP 86.2 + 1.93 80.5 + 2.51 <
initially and after the intervention (rest) have been presented in (mm Hg) 0.001
Table-2 and illustrated in Figures 1A and 1B. It was found that The pulse rate and respiratory rate before and after music
after music therapy intervention in the experimental group, the therapy in the experimental group, and the same in the control
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IV. DISCUSSION
The present study evaluated the effects of raga Todi of
Hindustani Classical Music (instrumental) on vital physiological
variables (blood pressure, pulse rate, and respiratory rate)
concerned with cardiovascular and respiratory health. The
comparison between Pre-test and Post-test results of the present
study revealed that healthy / asymptomatic elderly males
experienced a significant decrement in systolic blood pressure,
diastolic blood pressure, pulse rate and breathing/ respiratory
rate on exposure to music therapy intervention (listening to raga
Todi) for a time period of 30 days, in the morning hours of the
day. An earlier study found a significant lowering of blood
In contrast , since the present study was only of 30 days
pressure on exposure to long term raga therapy in chronic
duration, no such measures were taken to prevent monotony. A
hypertensive patients (Kulkarni and Chittapur, 2017). This
lowering in systolic blood pressure by 6.1 mmHg and diastolic
earlier study to prevent monotony among the subjects exposed
blood pressure by 5.7 after listening to raga Todi was observed
them to six different ragas such as Asavari, Ahir Bhairavi,
in the present study. Raga Todi has also been found to be
Hansadhwani, Bhimpalas, Darbari and Todi. However, each of
effective in lowering blood pressure in essential hypertension
the ragas was allowed to be listened for 1 week alternatively for
patients of > forty years of age by an earlier study (Kamat-
1 hour a day for a time period of 6 months.
Nadkarni, 2013). The data obtained in the present study
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,possibly for the first time, showed similar blood pressure- respiratory range has been raised to 15 breaths per minute from 8
lowering effect of Raga Todi in a sample of healthy elderly breaths per minute. In the Pre-test phase of the present study, the
males of 50-60 years. Thus it may be said that Raga Todi mean values of the respiratory rate were 16.2 per minute and
appears to have the ability of beneficially controlling the blood 15.7 per minute, in the control group and experimental group,
pressure levels not only in hypertensive patients but also in respectively. It may be mentioned that heart disease patients are
asymptomatic individuals. often seen to have a respiratory rate of up to about 15 breaths per
In traumatic brain injury (TBI) patients, after neurosurgery, minute. Hence, all individuals should strive to maintain their
Raga Todi, Hindola and Kalyani have been seen to cause an respiratory rate below 15 breaths per minute to reduce their risk
improvement of respiratory rate, heart rate, and SBP, in a study for cardiovascular diseases and associated medical conditions
conducted at Tertiary Hospital of Nellore, India (Reddy et al., (Siritunga et al., 2013; Rakhimov, 2011). The results of the
2017). A meta-analysis study, which evaluated several other present study showed that listening to raga Todi may be
studies, indicated that listening to music may result in effective in maintaining a respiratory rate below 15 breaths per
improvement in the systolic blood pressure levels, and music minute in healthy males. Raga Todi to some extent may thus
should be given due importance during the treatment of reduce the risk of developing cardiovascular diseases.
hypertension (do Amaral et al., 2016). Based on several earlier The reduction in blood pressure, heart rate, and respiratory
studies (Angeline, 2018; Kulkarni and Chittapur, 2017; rate due to the application of music intervention may be
Kunikullaya et al., 2016; Nagarjan et al., 2015; Sobna et al., attributed to the influence of music on the central nervous
2013; De Oliveira et al., 2009; Mathew, 2008 ), it may be said system, autonomic nervous system, and endocrine system. More
that music may be used as a supplement to the main treatment of specifically, music may lower sympathetic drive and enhance
hypertension. Turkish classical music has also been found to vagal control / parasympathetic drive. Simultaneously, music by
have positive effects on blood pressure in Turkish elderly lowering stress hormone levels such as serum cortisol and
patients with hypertension (Bekiroglu et al., 2013). adrenaline may reduce stress (Mockel et al., 1994 ) and promote
Much similar to the present study, a study was conducted in relaxation. Slow tempo music with soothing notes may be
Sri Lanks but with a different raga. In the study at Sri Lanka, a responsible for parasympathetic activation (Nagarajan et al.,
test group formed of asymptomatic male and females of age 45 2015). Rhythms of music bring beneficial adaptations in the
and 46 years were made to listen to Rag Darbari Kanada of physiology of bodily rhythms (Mac Donald et al., 2009). It has
Indian classical music for twenty-two minutes whereas the been known that the tempo of the music may modulate the
control group were not exposed to music and were simply dynamics of the cardiovascular system, promoting
maintained at silent state for the same duration of time. Before cardiovascular health (Bartlett, 1996). The cardiac vagal tone
and after-test comparison was made. A significant decrease in may have a role in the sustenance of attentiveness and
the blood pressure, pulse rate, and respiratory rate were observed modulation of emotional aspects of behavior (Porges et al.,
in the test group after listening to the music (Siritunga et al., 1994). This may lead to positive changes in the mind, lowering
2013). stress and thus benefitting cardiovascular health. Sedative music
Lowering of the blood pressure (by two - six mm Hg) and may lower tension. Physiological parameters such as heart rate,
heart rate may reduce the risk of developing cardiovascular respiration and blood pressure may be lowed by calm music
diseases such as coronary artery disease (CAD), hypertension, (Bernardi et al., 2006). Furthermore, the calm mood promoted
stroke (MacMahon, 2000). by such music may relax the body and brain. The calm brain will
Heart rate or pulse is the number of times the heart beats per lead to the stimulation of the body to liberate Nitric oxide (NO),
minute. Although the normal resting heart rate is 60-100 bpm, which in turn acts on the blood vessels and lowers the blood
individuals having a resting pulse greater than 84 bpm have been vessel tone, dilating the blood vessel, and hence reducing the
found to have increased risk of developing cardiovascular blood pressure. Additively, music causes the release of
diseases by earlier studies (Reil et al., 2011; Singh, 2003). In the endorphins, a hormone responsible for imparting pleasure and
present study, the pulse was a little higher than this limit. In the lowering of stress / tension. This may allow achieving a better
Pre-test phase, the mean values of the pulse were 85.4 bpm and steady-state of the cardiovascular and respiratory system. Even
85.3 bpm, in the control group and experimental group, religious music therapy intervention has been found to lower the
respectively. The Post-test measurement of pulse in the present systolic and diastolic blood pressure in hypertensive patients
study clearly showed that raga Todi significantly helped to bring (Bustami, 2018).
down the pulse below 84 bpm. Thus listening to raga Todi may Positive changes in the respiratory system may influence the
ensure better cardiac health and promote efficient working of the prime brain centers concerned with emotion, thought, and
heart muscles. related behavior (Adhana et al., 2013; Matayan et al., 2009).
At rest, the normal respiratory rate range is about 8 - 20 Lower respiratory / breathing rates may lower blood pressure by
breaths per minute. But nowadays, in adults, the lower end of the enhancing the sensitivity of baroreceptor reflex in patients of
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Journal of Scientific Research, Volume 64, Issue 1, 2020
hypertension. Thus lower breathing rate achieved by music in types of music in musicians and non-musicians: The
the present study is a significant finding in relation to the importance of silence. Heart , 92, 445-452.
management of high blood pressure. Moreover, the stimulation Bhalwar, R. (2009). Systemic Arterial Hypertension and Stroke.
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CONCLUSION
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Institute of Science, BHU Varanasi, India