Journal of Nursing Science Update
Vol. 11, No. 2, November 2023 e-ISSN: 2829-0003 DOI : http://dx.doi.org/10.21776/ub.jik.2023.011.02.05 p-ISSN: 2829-7075 Website : http://www.jik.ub.ac.id
@JNSU. This is an open access article under the CC BY-NC 4.0 license
143 Original Research
Effectiveness of Citrullus vulgaris rubrum and Solanum lycopersicum Juices on Reducing Blood Pressure in Hypertension Patients Aged 26-45 Years
Nur Tias Setianingsih1, Kurnia Rachmawati2*, Tina Handayani Nasution3
1Student at School of Nursing, Faculty of Medicine, Universitas Lambung Mangkurat
2Community Health Nursing Department, School of Nursing, Faculty of Medicine, Universitas Lambung Mangkurat
3Critical Nursing Department, School of Nursing, Faculty of Medicine, Universitas Lambung Mangkurat
*Corresponding author:
Kurnia Rachmawati
Community Health Nursing Department, School of Nursing, Faculty of Medicine, Universitas Lambung Mangkurat Jl.A Yani, Banjarbaru, Kalimantan Selatan, Telp: +6282157802469
Email: [email protected]
Article Info ABSTRACT
Article History:
Received 6 Juni 2023 Revised 11 November 2023 Accepted 28 November 2023
Hypertension is the second most common disease in the world, and the majority of those who suffer from it are adults. This study seeks interventions for lowering the prevalence of hypertension in the elderly and controlling blood pressure. This study compared the effects of tomato juice and watermelon juice in decreasing blood pressure in hypertensive patients at UPT Puskesmas Karang Intan 2 between the ages of 26 and 45, South Kalimantan. With pretest and post-test groups, this study used a quasi-experimental design. Thirty- two respondents were divided into intervention group 1 (watermelon juice) and intervention group 2 (tomato juice).
Respondents were chosen based on research criteria and given interventions for five days. The Wilcoxon and Mann-Whitney tests were used to analyze the data. Watermelon juice and tomato juice had the same effect in lowering blood pressure in hypertensive patients aged 26 and 45 (p=0.102, =0.05). It implies that they were equally effective at lowering blood pressure because they contain the same beneficial substances in controlling blood pressure, such as potassium and citrulline.
Keywords:
Hypertension Intervention Non-pharmacology.
Tomato Juice Watermelon Juice
How to cite this article: Setianingsih, N. T., Rachmawati, K., & Nasution, T. H. (2023). Effectiveness of Citrullus vulgaris rubrum and Solanum lycopersicum Juices on Reducing Blood Pressure in Hypertension Patients Aged 26-45 Years. Journal of Nursing Science Update, 11(2), 143–150.
Effectiveness of Citrullus vulgaris rubrum …
144 Introduction
Hypertension is a common health issue throughout the world. According to WHO data, there are approximately 972 million people worldwide who have hypertension.
The estimated hypertension population in Indonesia is 63,309,620 persons, and hypertension is the second most frequent disease in the country (Bulu et al., 2021).
According to the 2019 Riskesdas data, there are 10.81% or 15,793 residents with hypertension in Banjar Regency, South Kalimantan ranking second out of 13 regencies with a population of hypertension of 9.19% or 2,173 residents (Kementrian Kesehatan RI, 2019).
According to Yulanda and Rika's (2017) research, hypertension is classified into two types based on the cause: primary hypertension and secondary hypertension.
90% of hypertension worldwide is primary hypertension, the cause of which is still unknown. Secondary hypertension accounts for 10% of all hypertension caused by comorbid diseases or specific drugs (Yulanda et al., 2017). There are both controllable and uncontrollable risk factors for primary hypertension. Obesity, smoking, inactivity, excess salt, alcohol consumption, and stress are all preventable risk factors (Yusfar & Fitri, 2020). Gender, family history, and age are uncontrollable risk factors (Nurleli et al., 2020). The most critical risk factor for hypertension in adults is their way of life (Ashfiya et al., 2017).
This study can help hypertensive people pay more attention to their physical condition and provide a simple alternative therapy for hypertension. Although hypertension cannot be cured, it can be managed. Pharmacological treatment (antihypertensive drugs) can be used to control hypertension (Setyawati et al., 2017).
Long-term use of antihypertensive medications can result in cardiac arrhythmias, fluid retention, allergies, fatigue, dizziness, and coughing (Nurleny, 2019). Non- pharmacological therapy can reduce salt intake, maintain body weight, reduce alcohol, exercise, stop smoking, and use herbal therapy to reduce the side effects of pharmacological drugs. Watermelon juice, tomato juice, cucumber juice, star fruit juice, papaya juice,
melon juice, avocado juice, bay leaves, and celery are examples of herbal therapies that can lower blood pressure (Agustin et al., 2021;
Redaksi Trubus, 2021; Tika, 2021).
The herbal therapies mentioned above are readily available to the general public.
Watermelon and tomatoes, on the other hand, are the most popular fruits among the general public. Whereas watermelon is frequently used as a dessert or commonly referred to as a dessert, watermelon has a sweet and fresh taste that most people enjoy. Similarly, tomatoes are frequently used as a cooking ingredient and are widely available in markets and supermarkets (Nurleny, 2019).
Furthermore, numerous studies have shown that watermelon juice and tomato juice effectively lower blood pressure in hypertensive individuals. According to previous research by Wilda (2021), watermelon is a fruit that contains fibre and potassium, which help prevent hypertension.
Watermelon flesh also contains lycopene, an antioxidant compound (Wilda, 2021).
Similarly, Handari et al. (2020) found that As potassium can lower blood pressure (Handari et al. 2020), tomato juice can lower both systolic and diastolic blood pressure.
Watermelon juice will be effective if consumed at the right time and dose. In Romanda's research (2019) and Fadlilah's (2016), the duration of the study used to determine the effectiveness of watermelon juice in lowering blood pressure was five days.
The dose used in giving watermelon juice is adapted from previous research, including research by Manno, Nilawati, and Idauli (2016), Hutasoit and Edy (2018), and research conducted by Hutasoit and Edy (2018) on giving watermelon juice interventions for hypertension at a dose of 250 grams without any additions.
Tomato juice will be effective if consumed at the right time and dose. In Nurrofawansri's research (2019) and Lavenia's (2018), The study performed to test how well tomato juice lowers blood pressure lasted five days. The dosage used in giving tomato juice is adapted from the research by Wahyuni and Ferti (2017), Hidayah et al.
(2018), and Nugraha (2018), who studied the effects of giving a dose of 150 grams of tomatoes and 50 cc of water as tomato juice as
Effectiveness of Citrullus vulgaris rubrum …
145 an intervention for hypertension. Cholifah and Dewi (2021) and Hidayah et al. (2018) conducted research on tomato juice intervention by adding 5 grams of sugar. The addition of 5 grams of granulated sugar does not violate the rules made by Permenkes Number 30 of 2013; It suggests that 10% (200 kcal) of the recommended daily intake for sugar per person is the standard, which is said to be equivalent to 4 tablespoons of sugar, or 50 grams per person per day. Thus, the sugar added to tomato juice does not exceed the recommended standards (Permenkes, 2013).
According to the findings of interviews with nurses managing the hypertension program, some cases of hypertension at UPT Puskesmas Karang Intan 2 were primary hypertension, which is estimated to be around 90%. A list of 78 visits with complaints of hypertension was obtained from data from the Karang Intan 2 Health Center from January to June 2022. Mandikapau Timur Village has 400 households, and 150 people with hypertension live in 200, a mix of adults and the elderly divided into four households. This study is essential because many hypertensive adults are in the village of Mandikapau Timur.
Adults with hypertension are being studied in order to reduce the rate of hypertension later in life when adulthood transitions into old age.
This study was carried out to help adults control their blood pressure and reduce hypertension rates in Mandikapau Timur village.
Method
Quasi-experimental research was conducted using a pretest-posttest group design approach without a control group. The study measured blood pressure before (pretest) and after (post-test) the intervention with a manual sphygmomanometer. The intervention was given for five days through watermelon juice or tomato juice. The intervention was taken once a day, in the morning, afternoon, or evening. Watermelon juice was prepared by mashing 250 grams of watermelon, both the rind and flesh parts of the watermelon. Meanwhile, the tomato juice intervention was prepared by mashing 150 grams of tomato with 5 grams of sugar and 50 ml of water. Both juices were processed using a blender.
The participants in this study were hypertensive patients aged 26 to 45 who lived in Mandikapau Timur, UPT Puskesmas Karang Intan 2, Kalimantan Selatan. According to data from Puskesmas Karang Intan 2, the total adult population in Mandikapau Timur with hypertension but no diabetes is 41 people. The initial sample size in the study was 36 people.
Randomization was carried out to divide the sample into two groups (randomization using an online lottery): Intervention Group 1 (watermelon juice), as many as 18 people, and Intervention Group 2 (tomato juice), as many as 18 people. However, two people in Group 1 dropped out due to health issues, and two people in Group 2 dropped out because of health issues and resigned during the research process, resulting in a final sample size of 32 individuals, 16 of whom were given tomato juice and 16 of whom were given watermelon juice. Simple random sampling was used to select the sample. A sphygmomanometer, stethoscope, glucometer, observation sheet, daily observation sheet, and standard operating procedure of the interventions were the instruments utilized during the study. Data there were analysed using the Wilcoxon and Mann-Whitney tests.
The glucometer is used for the sample selection process, in which respondents with high blood sugar levels will be included in the exclusion criteria. This is done to reduce losses that respondents may obtain, even though many studies state that watermelon and tomato juice are safe even if consumed by people with diabetes. In Yuliastuti et al study (2018), it was stated that the decrease in blood glucose levels was influenced by several compounds contained in red watermelon, namely, that it was rich in vitamin C, which acts as an antioxidant, and high in fibre, which can slow down glucose absorption. Likewise, with tomatoes, Sari dan Ridhyalla's (2020) study found that tomato juice can reduce the respondents' GDS.
Results and Discussion
The Wilcoxon test was used to compare blood pressure before and after interventions in the form of watermelon juice or tomato juice. The Mann-Whitney test was used to compare the efficacy of post-test blood
Effectiveness of Citrullus vulgaris rubrum …
146 pressure in the watermelon juice and tomato juice groups.
Table 1. The Results of The Analysis of Differences in Blood Pressure Before and
After The Intervention in Intervention Group 1 (watermelon juice)
The p-value for systolic pressure in the watermelon juice group was 0.003, indicating a difference in the respondents' systolic pressure before and after the intervention, while the p-value for diastolic pressure was 0.084, indicating there was no statistically significant difference in the respondents' diastolic pressure before and after the watermelon juice intervention.
Based on Table 1, the results obtained are in line with Nurleli's research (2019);
Yanti and Rizki (2019), the intervention in the form of watermelon juice caused a reduction in systolic blood pressure both before and after it was administered (Nurleli, 2019; Yanti
& Rizki, 2019). According to Augustin et al.
(2019), age differences, which range from 26 to 45 years, lead to differences in the structure and function of the peripheral vascular system because of a reduced capacity to accommodate the blood pumped by the heart. As a result, a person experiences hypertension by experiencing a decrease in cardiac output and an increase in peripheral resistance. Other factors affecting the respondent's blood pressure are attitude, family support, knowledge, lifestyle, and medication adherence (Naryati & Nur, 2022).
It was found that some respondents admitted that they did not regularly take antihypertensive drugs and would use drugs only when they felt symptoms, such as stiffness in the back of the neck, dizziness, or feeling tired. If they did not experience symptoms, the respondents only consumed cucumbers to control their blood pressure.
Despite some respondents taking hypertension medication, the intervention using watermelon and tomato juice was said to be successful. The high prevalence of hypertension cases in the neighbourhood indicates that antihypertensive medications have not been widely effective there. The participants in the study appeared to be quite enthusiastic about the watermelon juice intervention, which impacted their willingness to consume the juice.
According to Table 1, Systolic blood pressure significantly varied between the time before and after the watermelon juice intervention. It is in keeping with the prevailing idea that the drop in blood pressure was caused by the citrulline and arginine content of watermelon, which has been shown to lower blood pressure. Watermelon's vitamin C and potassium content also help to maintain blood vessel flexibility and increase sodium excretion, lowering blood volume and pressure (Manno et al., 2016). Potassium in watermelon can also lower blood pressure by increasing intracellular fluid concentration, which draws fluids from the extracellular part of the cell (Suharman et al., 2021).
In diastolic pressure, there was no significant difference in the blood pressure of the watermelon intervention group; this is in line with Nurleli's study (2019), It discovered there was no difference in the respondent's diastolic blood pressure falling after receiving watermelon juice. However, it contradicts the findings of Agustin et al. (2021) and Hutasoit and Edy (2018), who found a difference or effect on diastolic pressure between pretest and post-test when giving a watermelon juice intervention to research participants using statistical tests using the Wilcoxon test.
Statistically, this study did not show a significant effect on reducing diastolic blood pressure with the intervention of watermelon juice. However, blood pressure measurements taken before and after the administration of watermelon juice revealed a decrease, even though the respondent still had hypertension clinically.
It was said in a study that the flesh of a watermelon contained only 40% citrulline, while the rind contained 60% citrulline (Suharman et al., 2021). In this study, watermelon juice was made using both parts
Effectiveness of Citrullus vulgaris rubrum …
147 of the watermelon, using the rind and the flesh parts of the watermelon, so that this research can support the results of the intervention that was given to the watermelon juice intervention group. Intervention with watermelon juice can positively reduce blood pressure in hypertensive patients, even though the diastolic blood pressure given watermelon juice is not very different between before and after the intervention.
Table 2.The Results of The Analysis of Differences in Blood Pressure Before and
After The Intervention in Intervention Group 2 (tomato juice)
The P-value for systolic blood pressure in the tomato juice intervention group was 0.046, and for diastolic pressure, the p-value was 0.019. Statistically, it can be concluded that systolic and diastolic pressures have changed between before and after the intervention was given.
Table 2 shows a change and decrease in blood pressure in the tomato juice intervention group, which is in line with the research by Cholifah & Dewi (2021), with the results of the study saying there were changes in blood pressure before and after giving tomato juice to the intervention group (Cholifah & Dewi, 2021). Changes in the respondent's blood pressure response may be caused by other factors that affect blood pressure, namely diet, exercise habits, salt consumption, coffee, alcohol, and stress (Ananda, 2020). An unbalanced diet in terms of the amount, frequency, and type of food, such as high-fat foods, consuming less vegetables and fruit, and high-sodium foods, can be closely related to blood pressure.
Several sources of saturated fat are obtained from animal protein, which, if consumed
excessively, tends to increase cholesterol levels (Harun, 2019).
Most respondents admitted that their diet was sometimes excessive, and they consumed much salt because they liked to eat salted fish and pickled or candied fruit. Most respondents also stated that their eating and resting patterns remained the same during the study and that nothing had changed.
According to Table 2, there were changes in the tomato juice group's systolic and diastolic blood pressure, which is in line with the findings of Nugraha and Suwanti (2018) and Cholifah & Dewi (2021); they examined hypertension patients' blood pressure before and after receiving tomato juice and discovered a substantial difference (Nugraha & Suwanti, 2018). Because tomatoes have a relatively high potassium content, drinking tomato juice for five days can cause a drop in blood pressure. Tomatoes have 360 mg of potassium per 100 grams. Potassium helps the body excrete sodium, which leads to a drop in the respondent's blood pressure.
Potassium in tomato juice, which lowers blood pressure, can cause a drop in blood pressure.
Aside from potassium, lycopene in tomatoes lowers the respondent's blood pressure.
According to the theory that lycopene can help regulate blood pressure by preventing the thickening and hardening of the artery walls, namely by controlling the tone of the smooth muscle of the blood vessels (Mu'min et al., 2017), the intervention was given in the form of juice, which is consistent with the theory that giving tomatoes in the form of juice can maximize the absorption of substances in tomatoes. Tomato nutrients can be absorbed by the body in 95% of cases if consumed in the form of juice rather than whole tomatoes (Handari et al., 2020).
With a p-value of 0.102 for systolic pressure and a p-value of 0.464 for diastolic pressure, Table 5 compares the watermelon group to the tomato group. In terms of statistics, both tomato juice and watermelon juice are equally successful at lowering respondents' blood pressure in the two intervention groups.
Effectiveness of Citrullus vulgaris rubrum …
148 Table 3. The results of the comparative
analysis of the effectiveness of watermelon juice and tomato juice in
lowering blood pressure
According to Table 5, the effectiveness of tomato juice and watermelon juice was identical. This conflicts with research by Agustin et al. (2021), who found that tomato juice and watermelon juice had varying degrees of success in decreasing blood pressure in hypertensive patients.
Statistically, there was no difference between watermelon juice and tomato juice in lowering post-test systolic and post-test diastolic blood pressure in hypertensive patients. This means that both watermelon juice and tomato juice are equally effective. Watermelon juice, like tomato juice, is effective in lowering blood pressure in hypertensive people.
Watermelon juice was found to be effective in lowering blood pressure in this study, which is consistent with the findings of Melanie et al. (2022) and Nurjannah (2020), who researched watermelon juice interventions. The intervention group received antihypertensive medications as well as watermelon juice, whereas the control group received only antihypertensive medications. Per his findings, the intervention group had lower average blood pressure than the control group (Melanie et al., 2022). As a result, watermelon juice lowers blood pressure and is recommended for people with hypertension (Nurjannah, 2020).
Similarly, tomato juice effectively lowered blood pressure, as studied by Mu'min et al. (2017), which discovered variations in systolic and diastolic blood pressure in the tomato juice study between the intervention and control groups. Systolic and diastolic blood pressure levels fell in the intervention group while remaining constant (fixed) in the control group. The control group only had
pretest and post-test blood pressure checks, whereas the intervention group also had pretest and post-test blood pressure checks (Mu'min et al., 2017). Then, in research, Nurrofawansri, Assyfa, Par'i, et al. (2019) used two groups: a control group and an intervention group. The control group received only counselling about the hypertension diet, whereas the intervention group received both counselling and tomato juice as treatment. The results showed that the intervention group's blood pressure differed statistically significantly from the control group's, but not the other way around (Nurrofawansri et al., 2019).
This study's blood pressure reduction is also supported by the DASH (Dietary Approaches to Stop Hypertension) theory, which focuses on increasing the intake of essential nutrients, namely minerals like potassium, calcium, and magnesium (Nurjannah, 2020). The DASH diet includes fruits, protein, and fibre, which can be obtained from vegetables, fruits, low-fat milk (soy milk), seeds, nuts (green bean porridge), and animal ingredients such as fish, poultry, red meat, and low-salt, low-sugar foods. The DASH diet includes foods with 30 grams of dietary fibre daily and minerals such as calcium, magnesium, and potassium; salt intake is always limited (Laili et al., 2022).
Conclusion
Watermelon and tomato juices obviously lower blood pressure levels in the two groups. Only the systolic blood pressure changed significantly in the watermelon juice group. The participants' systolic and diastolic blood pressures significantly changed in the tomato juice group. In terms of statistics, there was no distinction between the ability of tomato juice and watermelon juice to lower systolic and diastolic blood pressure in participants with hypertension. This means that watermelon juice and tomato juice have the same effectiveness in lowering the respondent's blood pressure.
Suggestions for the general public include raising awareness of the potential complications of hypertension and encouraging regular blood pressure checks. It is recommended that Puskesmas nurses conduct routine checks to screen residents for
Effectiveness of Citrullus vulgaris rubrum …
149 high blood pressure and treat residents diagnosed with hypertension immediately.
The findings of this study will be used as a reference for future researchers when it comes to providing interventions in the form of watermelon juice or tomato juice to hypertension patients.
Limitations of the study
Watermelon and tomato juice interventions were almost always given at different times of the day. However, based on previous research, the juices can be consumed in the morning or evening without any particular time limits, with a frequency of once or twice a day and a predetermined dose.
Acknowledgement
Thanks to all parties involved in the research process, especially the very enthusiastic respondents who took their time to help smooth the research process.
Conflict of Interest
There was no conflict of interest in this research.
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