The Lapise Juice as an Alternative Drink to Reduce Blood Pressure of

Pregnant Women with Pre-eclampsia

Muji Hartinah

, Suharti

and Fidyah Aminin

Nursing, Poltekkes Kemenkes Tanjungpinang, Arif Rahman Hakim Street No 1, Tanjungpinang, Riau Island, Indonesia

Midwifery, Poltekkes Kemenkes Tanjungpinang, Arif Rahman Hakim Street No 1, Tanjungpinang, Riau island, Indonesia

Keywords: LaPiSe Juice, Blood Pressure, Pregnant Women, Pre Eclampsia.

Abstract: Objective: to determine the difference of blood pressure in pre-eclampsia pregnant women who were given

LaPiSe juice and who were not given LaPiSe juice. Method: This study used Quasi experimental with pre

and post-test design, held in Tanjungpinang, between 12 June 2017 and 20 August 2017. Samples were 76

pre-eclampsia pregnant women selected with using purposive sampling method who received Pre-

Eclampsia treatment, that divided into 2 groups of treatment and control group (38 respondents in each

group). Treatment group were given pre-eclampsia treatment and also LaPiSe Juice for 10 days then the

blood pressure measurement was carried out before and after being given LaPiSe juice. The control group

was given pre-eclampsia treatment only. Researcher and enumerator team visited pregnant woman’s home

and gave LaPiSe Juice every day, once a day for 10 days then recorded it on the observation sheet. They

also measured blood pressure on 10

day. The data was analyzed with wilcoxon. Result: There was a

significant difference in pregnant women blood pressure which was given LaPise juice (systole’s mean

128,42 ± 12,597 diastole’s mean 82,89 ±6,939) and not given LaPiSe juice (systole’s mean 134,0 ± 7,97,

diastole’s mean 84,74 ±7,618) with p value 0.000. Conclusion: LaPiSe juice could be used as an alternative

healthy drink to lower blood pressure.

1 INTRODUCTION

Hypertension in pregnancy is estimated to be the

cause of death of around 7.1 million people

worldwide, and it is the top three cause of death for

pregnant women in Tanjungpinang City.

Preeclampsia is a systemic disease that affects the

function and health of multiple organs and leads to

pathophysiology during pregnancy that affects both

the mother and baby. While there is no cure for PE,

except for early delivery of the feto-placental

unit.(Harmon et al., 2017). Because of it, special

treatment is needed. Fruit and vegetables tend to rich

in natural antioksidants and increased consumtion at

these dietary component has been proposed as an

alternative strategy for health improvement for

pregnant women with pre eklamsia.

The use of medicinal plants and herbal

formulations is a consideration to reduce toxic

effects and have minimal side effects compared to

synthetic drugs (Mulyani, Rosa and Huriah, 2015).

Herbal treatments for hypertension are fruits,

vegetables, leaves and roots. However, herbal

treatments take from fruits and vegetables which can

lower blood pressure are not available yet.

Processing and converting fruits and vegetables into

different product are needed in order to make

pregnant women able to consume fruits and

vegetables. So, it's important to provide herbal

treatment to lower blood pressure from fruits and

vegetables such as chayote, banana and watermelon.

Chayote or namely Sechium edule Sw contain of

the tannin which are antimicrobial, and alkoloid

which is able to facilitate blood circulation so as to

prevent disease and open clogged blood vessels. The

results of phytochemical screening and gastric layer

chromatography analysis The chemical components

of chayote (Sechium edule) found alkaloids,

saponins, kardenolines or bufadienols and

flavonoids (Marliana and Suryanti, 2005).One of the

active compounds in chayote (Sechium edule) is

flavonoids. Flavonoids have antihypertensive

potential by damaging ACE and as a diuretic.

Therefore, the last extract of chayote (Sechium

edule) as an antihypertensive.(Nadila,

2014).Watermelon contain of flavonoid named

Hartinah, M., Suharti, . and Aminin, F.

The Lapise Juice as an Alternative Drink to Reduce Blood Pressure of Pregnant Women with Pre-eclampsia.

DOI: 10.5220/0008206901710175

In Proceedings of the 1st International Conference of Indonesian National Nurses Association (ICINNA 2018), pages 171-175

ISBN: 978-989-758-406-0

171

Rutin. One of Flavonoid named Rutin is a flavonol

glycoside and in vitro and in vivo studies showed the

antioxidant and anti-inflammatory properties of rutin

and its role in the metabolism of glucose and

lipids(Abu-hiamed, 2017) The high antioxidant

activity of watermelon can be ascribed either to

presence of high phenols or flavonoids or lycopene

or other reducing agents which may also reduce the

oxidized state of antioxidant compounds

(Choudhary, 2015). Similar observation has been

recorded in watermelon (Choo and Sin, 2012; Nagal,

Kaur and Singh, 2012) Five flavonoids were

detected in both banana varieties at all fruit

developmental stages (Dong et al., 2016) These

fruits contain anti-oxidants which allow it to help

lowering blood pressure and suitable for pregnant

woman,easy to find, cheap and easy to serve. We

can combine these three ingredients into a juice to

lower blood pressure because they has antioxidant

content.

Based on preliminary studies is conducted by

researchers at the Tanujungpinang City in 2015 there

were 113 cases with Pre Eclamsia, there were 11

cases of pregnant women with Pre-eclampsia, and

one person died because of it. In 2016 there were 94

cases pre-eclampsia and 4 cases with eclampsia,

there were no mortality rates for pregnant women

with eclampsia. Based on the results of interviews

with 30 pre-eclampsia pregnant women in

Tanjungpinang City, it was found that there was no

herbal treatment as a support for medical treatment

while undergoing pre-eclampsia treatment. So we

need for juice made from herbal ingredients that can

reduce blood pressure in pregnant woment with pre

eclamsia. This juice can be mixture of chayotes,

bananas and watermelon namely LaPiSe Juice. The

aim of the study was to determine the differences of

blood pressure of pre-eclampsia pregnant women

who were given LaPiSe juice and who were not

given LaPiSe juice.

2 METHOD

The study held in Tanjungpinang Tanjungpinang,

between 12 June 2017 and 20 August 2017. LaPiSe

Juice contain of each 200 mg of chayotes, bananas

and watermelons. Prepare watermelons, bananas and

chayote each 200 grams of Chayote, 200 grams of

banana and 200 grams of watermelon. Put the fruits

to the blender and mix it with 250 ml of water.

Blend it for 1 minute. After that, put the Lapise

juice into a glass and it ready to serve. The methods

used in this study was Quasi experimental with pre

and posttest design. The sample was pre-eclampsia

pregnant women (blood pressure of a pregnant

woman reaches ≥ 140/90 mmhg) who receive Pre-

Eclampsia treatment receive antihypertensive drugs.

Seventy-six (76) pregnant woman with pre

eclampsia (38 treatment group and 38 control group)

were selected with using purposive sampling

method. The treatment group was given pre-

eclampsia treatment and also LaPiSe Juice for 10

days, a glass every morning (250 ml), then the blood

pressure measured with Digital Omron HEM 7130

Automatic Blood Pressure Monitor From Japan that

was carried out before and after the respondent drink

LaPiSe juice. The control group was given pre-

eclampsia treatment only. Researcher and

enumerator team visited pregnant woman’s home

and gave LaPiSe Juice everyday, and then recorded

it on the observation sheet. The team also measured

blood pressure in the last day of research. The blood

pressure examination is carried out in a sitting

position with the elbows bent on the table and the

palms facing up. Cufflinks approximately 3 cm from

the elbow, turn on the blood pressure meter and the

measurement results could be seen. Data was

analysed with Wilcoxon. This study has received

ethical approval from Jakarta Three health ministry

polytechnic ethics committee.

3 RESULTS

Table 1: Characteristics of respondent.

Indicator

Group

p value

Lapise Control

Percen-

tage (%)

Percen-

tage (%)

Gestational

age:

≤ 24 week 16 42 20 41

0.806*

≥25 week 22 58 18 59

Mother’s

Age:

≤ 20 years 0 0 0 0

0.584* 21 – 35 years 21 55 34 89

> 35 years 17 45 4 11

Parity:

Primigravi

1 4 5 14

0.709*

Multygra

vida

37 96 33 86

*One way Annova

From table 1, it was found that the gestational age in

the Lapise group and the control group were mostly

at gestational age more than 25 weeks. The age of

the mother in the Lapise group and control group

ICINNA 2018 - The 1st International Conference of Indonesian National Nurses Association

172

was mostly aged 21 to 35 years. Respondent in both

group were mostly in multigravida status.

Table 2 shown that there were very significant

differences in systole before and after the treatment

of LaPiSe in LaPiSe group with a value of p <0.05

(0,000), as well as the control group with a value of

p <0.05 (0,000). Further data showed that the mean

decreased in the LaPiSe group was higher then the

control group (15.71> 7.95).

Table 3 shown

that there were very significant

differences in diastole before and after the treatment

of LaPiSe in LaPiSe group with a p value <0.05

(0,000), and there was no significant difference in

the diastole of the control group before and after the

p value> 0, 05 (0.087). The next data showed that

there was a decreased in the mean in the treatment

group (6,27) was higher than the control group

(0,42).

Table 2: The Differences of systole value in pre and post

test between the intervention group and control group

Sistole

Group

Lapise

(n= 38)

Control

(n=38)

Pre Test:

Mean (SD) 144,53(11,825) 142,95(8,091)

Median 140,0 140,0

Range 130,0-170,0 140,0-170,0

Post Test:

Mean (SD) 128,42(12,597) 134,0(7,97)

Median 120,0 140,0

Range 120,0-170,0 120,0-150,00

Decrease in Mean 15,71 7,95

P value 0,000* 0,000*

* Wilcoxon

Table 3: The Differences of diastole value in pre and post

test between the intervention group and control group.

Diastole

Group

Lapise

(n= 38)

Control

(n=38)

Pre Test:

Mean (SD) 89,16(8,397) 85,16(7,758)

Median 90,0 90,0

Range 70,00-100,00 70,0-100,0

Post Test:

Mean (SD) 82,89(6,939) 84,74(7,618)

Median 80,0 90,0

Range 70,00-100,00 70,00-100,00

Decrease in

Mean

6,27 0,42

P value 0,000* 0,087*

* Wilcoxon

4 DISCUSSION

Lapise juice given to pregnant women with pre

eclamsia has lowered the blood pressure of sitole

and diastole better than pregnant women who are not

given lapise juice. LaPiSe Juice contain of 200 mg

chayotes, bananas and watermelons. This Juice

contain of flavonoid. Based on laboratorium test in

2017, the flavonoid content in 200 grams of LaPiSe

juice was 0.14. This flavonoid could reduce pregnant

woman’s blood pressure.

The chemical components of chayote (Sechium

edule) in ethanol extract showed that the squash

ethanol extract found flavonoids (Marliana and

Suryanti, 2005).One of the active compounds in

chayote (Sechium edule) is flavonoids. Flavonoids

have antihypertensive potential by damaging ACE

and as a diuretic. Therefore, extract of chayote

(Sechium edule) as an antihypertensive (Nadila,

2014).

Watermelon contain of flavonoid named Rutin.

Antioxidants commonly One of Flavonoid

named Rutin is a flavonol glycoside and in vitro and

in vivo studies showed the antioxidant and anti-

inflammatory properties of rutin and its role in the

metabolism of glucose and lipids (Abu-hiamed,

2017). The high antioxidant activity of watermelon

can be ascribed either to presence of high phenols or

flavonoids or lycopene or other reducing agents

which may also reduce the oxidized state of

antioxidant compounds (Choudhary, 2015) Similar

observation has been recorded by Nagal et al. (2012)

and Choo and Sin (2012) in watermelon. (Choo and

Sin, 2012; Nagal, Kaur and Singh, 2012).Five

flavonoids were detected in both banana varieties at

all fruit developmental stages. (Dong et al., 2016)

Plant compounds such as flavonoids have been

reported to exert beneficial effects in cardiovascular

disease, including hypertension. Information on the

effects of isolated individual flavonoids for

management of high blood pressure. Flavonoids, as

isolated outside of the food matrix, from the 5 main

subgroups consumed in the Western diet (flavones,

flavonols, flavanones, flavan-3-ols, and

anthocyanins), along with their effects on

hypertension, including the potential mechanisms

for regulating blood pressure (Clark, Zahradka and

Taylor, 2015)

Flavonoids from all 5 subgroups have been

shown to attenuate a rise in or to reduce blood

pressure during several pathological conditions

(hypertension, metabolic syndrome, and diabetes

mellitus). Flavones, flavonols, flavanones, and

flavanols were able to modulate blood pressure by

restoring endothelial function, either directly, by

affecting nitric oxide levels, or indirectly, through

other pathways. Quercetin had the most consistent

The Lapise Juice as an Alternative Drink to Reduce Blood Pressure of Pregnant Women with Pre-eclampsia

173

blood pressure–lowering effect in animal and human

studies, irrespective of dose, duration, or disease

status (Clark, Zahradka and Taylor, 2015).

Flavonoids are scavengers of free radicals such

as superoxide anions and lipid proxy radicals and by

preventing oxidation of LDL-C, because oxidized

LDL is believed to be atherogenic. Therefore,

flavonoids may decrease the formation of

atherosclerotic plaques and reduce arterial stiffness,

arteries more responsive to the endogenous stimuli

of vasodilation. Studies have shown that

consumption of fruit, vegetable and tea (black and

green) containing high amount of flavonoid may

lead to lower blood pressure and may provide

protection against coronary heart disease and stroke.

It is possible that their antioxidant effect is

responsible (Kooshki and Hoseini, 2014).

Oxidative stress contributes to increase blood

pressure by acting on eNOS uncoupling and

decrease bioavailability of nitric oxide. The result is

a predominant on factors vasoconstrictors and low

action of vasodilators in vascular bed (Mink et al.,

2007). In the cardiovascular system, the reactive

oxygen species (ROSs) are produced in vascular

cells by a number of oxidases, including NADPH

oxidase, xanthine oxidase, lipoxygenase, and

cytochrome P450 (Mink et al., 2007; Kizhakekuttu

and Windlasky, 2010) Furthermore, clinical data

have suggested that there is increased endogenous

antioxidant, introducing exogenous antioxidants

present in food. In fact, the reduction of oxidative

stress has been accompanied by decreasing

cardiovascular risk and blood pressure in humans

used include vitamins A, C, and E, L-arginine,

flavonoids, coenzyme Q10, and alpha-lipoic acid

(Cherubini, 2008). Of these, flavonoids have gained

attention for their higher antioxidant power than the

others. In fact, the selected studies that used

supplements based on flavonoids, all demonstrated

significant reductions in blood pressure in

hypertensive , and hypercholesterolemic individuals.

The reductions were more pronounced for systolic

blood pressure, with a reduction of around 3 mmHg.

For diastolic blood pressure, only the study by Ward

et al (Ward et al., 2005) identified a significant

reduction (3 mmHg). Although these reductions are

relatively discreet, these are clinically significant, so

that hypotension afforded by the flavonoid is

equivalent to the use of a class of antihypertensive

medication (Baster, 2014).

These are some of the changes that can occur

during pregnancy, especially in pre eclamsia.

Oxidative stress seems to play an important role in

preeclampsia. Increased levels of reactive oxygen

species (ROS) might be the result of ischemia-

reperfusion injury from deficient conversion of the

medial segment of the spiral arteries. Increased ROS

exposure leads to protein, lipid and DNA oxidation

all of which have been found in placentas from

patients with preeclampsia. Other mechanisms

involved in preeclampsia include enhanced

sensitivity to angiotensin II (Mustafa et al., 2012) .

A subset of women with pre-eclampsia have

detectable autoantibodies against type-1 angiotensin

II receptor (AT1) in the serum, which can activate

AT1 in endothelial cells, vascular smooth muscle

cells, and mesangial cells from the kidney

glomerulus. AT1 autoantobodies have been shown

to induce hypertension, proteinuria, glomerulus

capillary endotheliosis, increased production of

sVEGFR-1 (soluble Vascular Endothelial Growth

Factor Receptor) and to stimulate the synthesis of

NADPH oxidase (Wallukat et al., 1999; Peres,

Mariana and Cairrão, 2018). So it is suitable to use

LaPiSe juice that contain of flavonoid to help

pregnant women that suffering pre eclamsia.

Limitation of this study was the absence of another

component measurement of LaPiSe juice that might

be can help reduced blood pressure.

5 CONCLUSION

There was a significant difference in pregnant

women blood pressure which was given LaPise juice

and not given LaPiSe juice. LaPiSe juice can be

used as an alternative healthy drink to lower blood

pressure.

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