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 pre-hypertensive 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.