International Journal of Research and Scientific Innovation (IJRSI) | Volume V, Issue XI, November 2018 | ISSN 2321–2705

The Effect of Non Pharmalogical (Chayote, Aerobic

Exercise, and Rosella Tea) on Blood Pressure of
Menopause Women Who Have Hypertension
Nurul Hidayah1, Marsaid2, Sulastyawati3
1,2,3
Nursing Department, Malang State Health Polytechnic
Ijen Street 77C, Malang 65112, East Java, Indonesia

Abstract—Hypertension rarely didn’t show signs and symptoms, an emergency and has heart disease, stroke, or kidney
so that it was known as ‘the silent killer’. It could continue for damage, which eventually leads to death. Hypertension is
many years till the sufferer fell down into emergency condition common in most women after the age of 55 years or who have
and it exposed to heart disease, stroke, or kidney damage and a menopouse [3].
lead to death. Hypertension often happened toward almost
women after in the age of 55 or who experienced menopause. This hypertension disease can be controlled by
Hypertension could be controlled by pharmacology and pharmacology and non-pharmacology treatment, in
nonpharmacology (complementary) treatment. Many patients pharmacologically which is with blood pressure lowering
chose a safer way than taking medicine. Those ways included drugs. These drugs include diuretic type drugs, adrenergic
doing exercise in regularly, a balanced diet, reducing salt intake,
losing weight, avoiding smoking or using traditional medicine or
inhibitors, ACE-inhibitors, ARBs, calcium antagonists, and so
herbs. Herbal therapy is a process of healing by using various on [4]. In non-pharmacology that is exercising regularly,
medicinal herbs medicine. The purpose of this research was to balanced diet, reducing salt intake, losing weight, not smoking
know the effect of chayote, rosella tea, and aerobic exercise and using traditional medicine / herbal. Herbal therapy is a
toward blood pressure of menopause women and experiencing process of healing by using various medicinal herbs medicine.
hypertension. This research useda quasy experiment with 45 Currently this kind of therapy is popular among people
subjects. Inclusion criteria were menopause and because it is considered as a treatment that has few side
hypertensivewomen with a purposive sampling method. The data effects, cheap and easily available [5]. Therefore, consuming
were analyzed to give result that there was significant effect of fruits and vegetables containing potassium, postasium and
giving chayote juice and rosella tea to the decrease of systolic and
diastolic blood pressure. However aerobic exercise had no
calcium is the right way to lower high blood pressure [6].
significant effect. Maintaining the balance of body blood pressure cannot
be separated from the role of mineral and potassium.
Keywords—chayote, exercise, hypertension,rosella tea, women
Therefore, the intake of sodium and potassium must be
balanced so that our body remains healthy. Most problems
I. INTRODUCTION occur because the intake of sodium is too high from potassium
so it leads to hypertension or high blood pressure. It happens
C ardiovascular disease could not be separated from
hypertension. Hypertension is an increase in systolic
blood pressure greater than 140mmHg and /or diastolic
because we often meet sodium a lot in the most preferred
foods such as meat, milk, preserved foods,bread (containing
greater than 90 mmHg in two measurements with an interval baking soda) and even daily food. While potassium is mostly
of 5 minutes in a rest / quiet state. Hypertension is one of the found in vegetables and fruits. Among others are contained in
non-communicable diseases that is a health problem chayote and rosella tea.
worldwide because of its high prevalence as well as its Chayote is one solution that can be used to increase
association with the incidence of cardiovascular disease. potassium intake in order to get balanced sodium levels so
Based on the Third National Health and Nutrition that our blood pressure is maintained. Rosella is rich in
Examination Survey (NHANES III) study, hypertension can phytochemicals which is for lowering blood pressure. The
increase coronary heart disease by 12% and increase the risk phytochemicals are anthocyanin, arginine, cyanidin, gossepin,
of stroke by 24%. Indonesia, as one of the developing country hibiscin, hebiscetin, delphindin-3, sambubioside, and
in the world, according to WHO in 2002, mortality from sabdaretin [7]. The anthocyanin and proantocyanidin
cardiovascular disease of 361 per 100.000 population for age- compounds, which are commonly found in the sediment of
standardize mortality rate category [1] Hibiscus sabdariffa (HS) dried flower petals, become
Hypertension sometimes does not show signs and bioactive compounds that are responsible for lowering blood
symptoms of disease manifestation, so it is known as The pressure [8].
Silent Killer [2]. It can last for years until the patient falls into

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International Journal of Research and Scientific Innovation (IJRSI) | Volume V, Issue XI, November 2018 | ISSN 2321–2705

Another factor that causes hypertension is lack of Blood pressure (y) as chronic medical conditions with
physical activity [9]. Less physical activity increases a blood pressure in the arteries are increased by involving two
person's risk of developing hypertension. People who are measurements, systolic and diastolic. Data were collecting
inactive tend to have higher heartbeat frequency so that heart by criteria as follows:
muscle must work harder during contraction [10]. Someone
who is not physically active has a 30-50% greater risk of  Normal: <130 / <85
developing hypertension [11]. Based on the most of cases, it  Normal height: 130-139 / 85-89
indicates that hypertension is one of the major health  Hypertension stage 1: 140-159 / 90-99
problems and requiring proper handling and good prevention  Hypertension stage 2: 160-179 / 100-109
as well because nowadays people tend to use alternative  Hypertension Stage 3: 180-209 / 110-119
medicine which can be found with many choices.  Hypertension Stage 4> 210 /> 120
For each statement, the respondent will be scored
II. METHODS according to the value of the category of answer given.
1) Research Ethics Scores of respondents on each statement then summed
In conducting this research, researchers emphasize which is the score of respondents on the attitude scale.
ethical issues include: informed consent, anonymity, 4) Data Analysis
confidentiality.
The data obtained are then processed and the results are
2) Research Design presented in the form of data collection. While knowing the
The research was conducted in Sumberngepoh for 3 influence between variables used Paired Sample Test with
months, July to September 2016.This research used Quasi significance value p≤0.05. Furthermore, to see the effect
Experimental research design in three groups.The first group difference between the three interventions using One Way
was group that received the treatment of chayote Anova test followed by Tukey test.
consumption, the second group got aerobic exercise and
group three got the treatment of rosella tea. The subject of III. RESULT
groups were observed prior to intervention, then observed 1) The results of measurement and monitoring of blood
after intervention, and seeing the difference of the three pressure of respondents who got chayote
treatments. The population in the research was menopause/
adult women with mild high blood pressure, in a month This studyshows that difference between pre and post
approximately as many as 60 people. The amount of sample treatment of chayote to respondents between systolic have
was 45 people [12, 17] with sample inclusion criteria was mean difference of 10.9 mmHg and diastolic average
menopause with mild hypertension, while the sample difference of 7.5mmHg.
exclusion was uncooperative, suffered from chronic/ chronic TABLE 1 : THE RESULT OF SYSTOLIC BLOOD PRESSURE
disease/ weak condition. The sampling technique used in MEASUREMENT ON PRE TEST AND POST TEST
this research is purposive sampling
Systolic Pre
Category Freq Freq Systolic Post test
3) Data Collection test
Normal - - - -
Data collection was done by measuring blood
High Normal - - 5 33.3%
pressure. Instruments used in this research is the Checklist /
check list, the tool: Tension meter was to measure blood Hypertension of
8 53.3% 7 46.7%
stage 1
pressure before and after intervention. Data were collecting
Hypertension of
bygiven variables: stage 2
5 33.3% 2 13.3%

 Chayote (X1): Provision of chayote (Sechium Hypertension of

2 13.4% 1 6.7%
stage 3
edule) juice given during the day as a distraction of
Hypertension of
50-75 cc every day for 4 weeks, every 3 days if the - - - -
stage 4
tension improves to stop a day and then drink again Total 15 100% 15 100%
the next 3 days.
 Aerobic exercise (X2): Giving aerobic exercise by TABLE 2 : THE RESULT OF DIASTOLIC BLOOD PRESSURE
gymnastics instructor in the afternoon for 20-60 MEASUREMENT ON PRE TEST AND POST TEST
minutes of practice, done 2 times per week for 4 Diastolic Pre Diastolic Post
Category Freq Freq
weeks. test test
 Rosella tea (X3): dried rosella flower 1.5 brewed Normal 8 53.4% 12 80%
with hot water, given 50-75 cc every day, every 3 High Normal 5 33.4% 3 20%
days if tension improves to stop one day and drink Hypertension of
again in the next 3 days, for 4 weeks. 1 6.6% - -
stage 1

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International Journal of Research and Scientific Innovation (IJRSI) | Volume V, Issue XI, November 2018 | ISSN 2321–2705

Hypertension of TABLE 5 : THE RESULT OF DIASTOLIC BLOOD PRESSURE

1 6.6% - -
stage 2 MEASUREMENT ON PRE TEST AND POST TEST
Hypertension of
- - - - Diastolic Diastolic
stage 3 Category Freq Freq
Pre test Post test
Hypertension of
- - - - Normal 3 19.9% 9 59.9%
stage 4
Total 15 100% 15 100% High Normal 4 26.7% 3 20.1%
Hypertension of
5 33.4% 2 13.4%
From the data we know that systolic blood pressure stage 1
pre-test and post test in hypertension adult women that there is Hypertension of
2 13.4% 1 6.6%
a significant difference, after the chayote juice 50-75 ml every stage 2
Hypertension of
day for 4 mg, every 3 days if the tension improved to stop a stage 3
1 6.6% -
day then drink again. The next 3 days were given a chayote so Hypertension of
that there was a change of frequency of category hypertension - - -
stage 4
stage 1,2,3 changed to high normal category, stage 1,2,3. Total 15 100% 15 100%

Based on table 2 above shows that diastolic blood TABLE 6 : Paired Samples Test
pressure pre-test and post test in adult women with
hypertension, there is a significant difference, ie there is a Paired
Sig. (2-
Differences 95% Confidence Interval of the t df
change in frequency of normal stage of hypertension tailed)
Difference Upper
categories, normal height, hypertension stage 1,2,3 turns into
normal and high- normal category. Pair 1 Systolic pretest ofchayote-
14.84 7.37 14 .000
systolicposttest of chayote
TABLE 3 : Paired Samples Test
Paired Pair 2 Diastolic pretest of chayote
Sig. (2- 9.51 5.02 14 .000
Differences 95% Confidence Interval of t df – diastolic posttest of chayote
tailed)
the Difference Upper
Pair 1 Systolic pretest 3) The effect of aerobic exercise toward hypertension of adult
ofchayote- systolicposttest of 13.61 10.46 14 .000
chayote women
Pair 2 Diastolic pretest of
chayote – diastolic posttest of 9.79 4.10 14 .001
The result on observing blood pressure of respondents
chayote which got aerobics exercise in Sumber Ngepoh Village, its
known that there is difference between pre and post of aerobic
2) The results of measurement and monitoring of blood exercise treatment on the respondents between systolic
pressure of respondents who got Rosella tea (average difference of 9.25 mmHg) and diastolic (average
difference of 4.02 mmHg).
The result shows that systolic blood pressure on pre-
TABLE 7: THE RESULT OF SYSTOLIC BLOOD PRESSURE
test and post-test of menopause women, there is a significant MEASUREMENT ON PRE TEST AND POST TEST
difference after getting rosella tea. Pre-test found that there is
still a category of hypertension on stage 3, on post-test, there Systolic Systolic Post
Category Freq Freq
Pre test test
is no hypertension stage 3. Paired test also showed that there
Normal 6 40% 8 53.4%
is difference in systolic and diastolic between before and after
High Normal 3 20% 3 20%
drinking rosella tea (table 6).
Hypertension of
5 33.4% 3 20%
TABLE 4 : THE RESULT OF SYSTOLIC BLOOD PRESSURE stage 1
MEASUREMENT ON PRE TEST AND POST TEST Hypertension of
1 6.6% 1 6.6%
stage 2
Systolic Systolic Post Hypertension of
Category Freq Freq - - - -
Pre test test stage 3
Normal - - 2 13.4% Hypertension of
- - - -
High Normal - - 5 33.3% stage 4
Hypertension of Total 15 100% 15 100%
10 66.7% 7 46.7%
stage 1
Hypertension of TABLE 8 : THE RESULT OF DIASTOLIC BLOOD PRESSURE
4 26.7% 1 6.6%
stage 2 MEASUREMENT ON PRE TEST AND POST TEST
Hypertension of
1 6.6% - -
stage 3 Diastolic Diastolic
Category Freq Freq
Hypertension of Pre test Post test
- - - -
stage 4 Normal - - 4 26.7%
Total 15 100% 15 100%
High Normal 7 46.7% 3 20%

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International Journal of Research and Scientific Innovation (IJRSI) | Volume V, Issue XI, November 2018 | ISSN 2321–2705

Hypertension of
7 46.7% 7 46.7% for pre- test is mostly gained normal category is 6 people
stage 1 while for post-test is mostly also gained normal is 8 people.
Hypertension of
1 6.6% 1 6.6%
stage 2 Diastolic blood pressure on pre and post-test for third
Hypertension of
- - - - treatment can be seen on the figure 2.
stage 3
Hypertension of
- - - -
stage 4
Total 15 100% 15 100%

Based on the table above, it shows that systolic

blood pressure in pre-test and post test of menopause women
there are differences, after doing aerobic exercise. Both
systole and diastole examinations still have hypertension
stage 2 which only decrease in number in stage 1.
TABLE 9 : Paired Samples Test
Paired
Sig. (2-
Differences 95% Confidence Interval of the t df
tailed) Figure 2.Diastolic blood pressure on pre and post-test for third treatment
Difference Upper
Pair 1 Systolic pretest Based on the table above, it could be known that the
ofchayote- systolicposttest of 4.92 .798 14 .44 treatment by using the chayote for pre-test mostly obtained
chayote the normal category of 8 people, while for post-test mostly
Pair 2 Diastolic pretest of also get the normal category of 12 people.The treatment by
chayote – diastolic posttest of 2.03 .000 14 1.00 using rosella tea for pre-test mostly obtained category of
chayote stage 1 hypertension for 5 people while for post-test mostly
got the normal category of 7 people.The treatment using
From the result on pair t test we knew that there is aerobic exercise for pre-test mostly obtained high normal
no difference between systolic and diastolic as well as category and stage 1 hypertension for 7 people while for
before and after aerobic exercise. post-test mostly got category of stage 1 hypertension for 7
4) The effect of chayote juice,rosella tea,aerobic exercise people.
through hypertension of women Data normality test is done to test the response of
Systolic blood pressure on pre and post-test for third each treatment used, where the method used is Shapiro-wilk.
treatment can be seen on the figure 1. Basic decision-making is if the value of significance (α) is
greater than 5% , all treatment data has a significance value
greater than 5% alpha on both systolic and diastolic data.
Therefore it can be concluded that the observed data is
normally distributed and the data normality assumption is
fulfilled.
Based on result of analysis with ANOVA method to
the systolic data of the respondent, it is gained F value 15.88
and significance equal to 0.0. The significance value (0.00)
is smaller than α, so that indicates that there is a marked
difference between treatments. To find out which treatments
producing different responses is real, then for the further test
is done using Tukey test.The follow-up test using the Tukey
test, found that the treatment of rosella tea has the average
value of pre-test difference with the largest post-systolic test
Figure 1.Systolic blood pressure on pre and post-test for third treatment of -11.50 but not significantly different with the treatment of
Based on the diagram above, it could be seen that the chayote that has a pre-test difference with post-test of -
treatment by using chayote for pre-test mostly got by 11.30.While aerobic treatment has the average value of pre-
hypertension category stage 1 as many eight people while test difference with the smallest systolic test post which is -
for post-test is mostly got hypertension category stage 1 as 1.33 and it is significantly different from the treatment of
many as seven people. The treatment by using rosella tea for rosella tea and chayote.
pre-test is mostly gained hypertension stage 1 is 10 people Assesment on the diastolic data of the respondent is
while for post-test as many as gained hypertension category also followed by ANOVA method, and it shows a F
stage 1 is 7 people. The treatment by using aerobic exercise value8.39 and significance equal to 0.001, smaller than the

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International Journal of Research and Scientific Innovation (IJRSI) | Volume V, Issue XI, November 2018 | ISSN 2321–2705

value of α, which indicates that there is a marked difference Chayote can lower blood pressure due to the potato
between treatments.Based on the results of Tukey test, it was gourd has potassium content. Potassium is a good mineral for
found that the treatment of rosella tea has the average value lowering or controlling the tension. Potassium is a strong
of pre-test difference with the largest systolic post-test is - diuretic that helps maintain the balance of urine, helps
6.67 but not significantly different with the treatment of dissolve stones in the urinary tract, bladder and kidneys.
chayote that has the difference of pre-test with post-test of - Potassium is also very important in converting blood sugar
6.43 . While aerobic treatment has the average value of pre- into muscle sugar [17].
test difference with the smallest systolic test post 0 and it is
2) The effect of rosella tea on blood pressure in menopause
significantly different from the treatment of rosella tea and
women
chayote.
Based on research done by giving rosella tea to 15
IV. DISCUSSION
respondents got average systolic blood pressure before
Menopause is a condition that is often a frightening treatment was 293 mmHg and mean systolic blood pressure
thing for women. Where at the time, women feel no longer after treatment was 271.4 mmHg. The results of these
young, the ability of organs decreased because the measurements showed that the average decreased in systolic
hormoneestrogen has decreased in number. Flexibility in the blood pressure, which amounted to 22.3 mmHg. While
vagina, bladder and ovarian ability has been lost. This period average diastolic blood pressure before treatment 176 mmhg
for some women will make her feel diminished existence as a and average diastolic blood pressure after treatment 163.5
woman. Moreover, the bone density also decreases along with mmhg. The mean results of these measurements showed that
the decrease in estrogen produced.WHO mentions that the age the average diastolic pressure is 12.5 mmHg (table 4 and 5).
of women start menopause in general ranges from 45 to 55
Rosella tea broth were known for the richness in
years. And classify the age in the middle age (45-60 years).
phytochemicals which are efficacious for lowering blood
Even at the age of 30 yearly there is already a pressure. The phytochemicals are anthocyanin, arginine,
menopause. In general, the age of menopause a person will cyanidin, gossepin, hibiscin, hebiscetin, delphindin-3,
not be much different from the age of his mother's sambubioside, and sabdaretin [7,18]. Administration of rosella
menopause. For example his mother menopause age is 53 petal extract containing 9.6 milligrams of anthocyanin daily
years then the child will menopause around the age of 50 to for 4 weeks, it was able to reduce hypertension or high blood
55 years [13]. The average age of menopausal women in the pressure similar to captopril 50 mg/day [7,19]. The
USA is around 52 years, while for Indonesia the average is anthocyanin and proantocyanidin compounds, which are
48-52.2 years [14]. The frequency distribution of respondents commonly found in the sediment of Hibiscus sabdariffa dried
in this study was 45-55 years old 71%, 56 years-60 years of flower petals, become bioactive compounds that are
29%.This is in line with the theory that age over 55 years, responsible for lowering blood pressure [8].
hypertension suffered [4]. Menopausal women have a higher
3) The effect of aerobic exercise on blood pressure in
risk of hypertension. This is related to decreased estrogen
menopause women
hormone in women with atherosclerosis as one of the factors
causing hypertension [15].The more age the higher the risk of Research conducted by giving aerobic exercise to 15
hypertension is. The risk of hypertension is caused by the respondents got average systolic blood pressure before
aging process in the cardiovascular system [16]. The aging treatment was 115 mmHg and mean systolic blood pressure
process of the cardiovascular system causes arterial blood after treatment was 257 mmHg. The results of these
vessels to become stiff and not straight, in addition to measurements show that the average decrease in systolic
thickening and formation of a bulge in the heart valve that can blood pressure, which is equal to 9.25 mmHg. While average
cause hypertension [18]. diastolic blood pressure before treatment 168 mmHg and
average diastolic blood pressure after treatment 168.3 mmHg.
1) The effect of chayote on blood pressure in menopause
The mean results of these measurements show that the
women
average diastolic pressure is 4.02 mmHg.
Research conducted by giving juice of chayote (table 1
Gymnastics in this research is using aerobic
and 2) to 15 respondents got average systolic blood pressure
gymnastics in accordance with the age of respondents.
before treatment was 158 mmHg and mean systolic blood
Gymnastics can affect blood pressure. It is proven to lower
pressure after treatment was 146.9 mmHg. The results of
blood pressure although the results obtained are very small
these measurements show that the average decrease in systolic
difference between the decline before and after
blood pressure, which is 10.9 mmHg. While average diastolic
treatment.There is a fixed or unchanged blood pressure, many
blood pressure before treatment 84.5 mmHg and average
factors that affect blood pressure even though given the
diastolic blood pressure after treatment of 78 mmHg. The
treatment of gymnastics but the respondents still consume
mean results of these measurements show that the average
foods high in salt, especially if the respondent also has a
diastolic pressure is 7.5 mmHg.
descent of hypertension or even the respondent has a stressor

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International Journal of Research and Scientific Innovation (IJRSI) | Volume V, Issue XI, November 2018 | ISSN 2321–2705

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