Giving Rosella (Hibiscus sabdariffa) Beverage to Overcome

Hypertension in Pregnant Women

Riris Sitorus, Diah Evawana Anuhgera, Dwi Handayani, Sriwulan, Ika Nur Saputri, Nikmah Jalilah

Ritonga

Institut Kesehatan Medistra Lubuk Pakam

Keywords: Rosella Beverage, blood pressure, pregnant women, hypertension

Abstract: Rosella flowers have been used as herbal food and beverage in the form of herbal beverage with hot and

cold serving as traditional medicine. The purpose of this study was to determine the effect of rosella

beverage on blood pressure changes in hypertensive pregnant women. This research is a quasi-experimental

study using a non probality sampling design using a control group. The number of samples is 30 people,

divided into two groups, 15 intervention groups and 15 control groups. To find out the difference in blood

pressure before and after the intervention in the treatment group and the control group, the analysis that used

was paired sample t-test and to determine the difference in blood pressure between the treatment group and

the control group using independent t-test. The results showed that there were differences in systolic blood

pressure of 39.67 mmHg and diastolic of 22.33 mmHg before and after intervention in the treatment

group..The results of the analysis about the differences of blood pressure between the control group and the

treatment group with a p-value of 0.00 <0.005 with a difference in healing time of 2 days in the

experimental group and 3-4 days in the control group. Giving rosella (hibiscus sabdarifa) beverage can be

used as an herbal beverage to reduce blood pressure in pregnant women with hypertension with an average

healing time of 2 days.

1 INTRODUCTION

Hypertension in pregnancy is defined as a blood

pressure of 140 mmHg or more after 20 weeks'

pregnancy in women who were previously

normotensive, or an increase in systolic pressure of

30 mmHg and a diastolic pressure of 15 mmHg

above normal values. Hypertension is a medical

problem, which often appears during pregnancy and

can also cause complications of 2-3% of

pregnancies. Besides hypertension in pregnancy is

also still a major source of death in mothers.

Maternal mortality in Indonesia is still dominated

by 3 main causes, namely bleeding, hypertension

and infection. Bleeding and infections tend to

decrease while hypertension is increasing in

proportion,> 25% of maternal deaths in Indonesia in

2014 due to hypertension.

AKI is one indicator of the health status of a

country that indicates the ability and quality of

health services, education and public knowledge,

environmental health, social culture, and barriers to

accessing health services. According to WHO

(2013) the MMR every year is estimated at 210 /

100,000 live births.

Research by Andika, Rompas and Mulyadi

(2014) showed a decrease in blood pressure after

hypertension sufferers with captopril therapy were

given rosella flowers, a decrease in average systolic

and diastolic blood pressure after 2 hours of

administration was 19.3333 mmHg and 10.00

mmHg.

Hypertension or better known as high blood

pressure is a condition where a person experiences

an increase in blood pressure above normal.

According to WHO hypertension is a condition that

shows a person's blood pressure ≥ 140 mmHg for

systolic pressure and ≥ 90 mmHg for diastolic

pressure. Stage 1 hypertension if systolic blood

pressure is 140 - 159 mmHg or diastolic 90 - 99

mmHg and stage 2 hypertensionif systolic blood

pressure is ≥160 mmHg and diastolic ≥ 100 mmHg.

Blood pressure is affected by cardiac output and

peripheral resistance, because blood pressure

requires blood flow which is determined by the

strength of the heart pump (cardiac output)

180

Sitorus, R., Anuhgera, D., Handayani, D., Sriwulan, ., Saputri, I. and Ritonga, N.

Giving Rosella (Hibiscus sabdariffa) Beverage to Overcome Hypertension in Pregnant Women.

DOI: 10.5220/0009469101800187

In Proceedings of the International Conference on Health Informatics and Medical Application Technology (ICHIMAT 2019), pages 180-187

ISBN: 978-989-758-460-2

Dried roselle calyx contains flavonoid

compounds consisting of anthocyanin, gassypetin

and glucoside hibiscin. Flavonoids work directly on

the smooth muscle of the arteries that stimulate or

activate endothelium drived relaxing factor (EDRF)

causing vasodilation and inhibiting angiotensin

converting enzyme (ACE). So that angiotension I

cannot be changed to angiotension II which

functions to increase the sympathetic nervous

system, vascular smooth muscle vasoconstriction

and increase water and sodium retention.

Rosella is an annual herb that can reach heights

of 0.5 - 3 m, round, woody, and red stems. Single

leaf, egg-shaped, looping fingers, blunt edges,

jagged edges, and grooved base. The leaf length is 6

- 15 cm and the width is 5- 8 cm. round leaf stalks

green with a length of 4-7 cm. Roselle flower is a

single flower that comes out of the axillary leaves

that fall within 24 hours after blooming, on each

stem there is only one flower. Flowers have 8-11

strands of hairy petals.

figure1. rosella flower

figure2. Dried Rosella flower

The process of drying rosella flowers can be done

naturally or artificially. Naturally, rosella petals are

dried by being spread out on palm trees or bamboo

tkar, so they don't get sunburn which causes their

quality to decrease. Drying is done in the morning at

09.00 - 11.00 noon and afternoon at 14.00 - 16.00.

artificial drying using an oven with a temperature

not more than 60 - 70◦c.

2 METHODS

This research was done at the

GrandmedLubukPakam General Hospital.

Respondents in the study were divided into 2

groups: a control group of 15 people and a treatment

group of 15 people. The sampling technique in this

study is non-probability sampling with consecutive

sampling technique.

This research is a quantitative research with a

Quasi Experimental design in the design of the non-

equivalent control group Design. Blood pressure is

measured twice, at the beginning before the

intervention and after the intervention.

The instrument which used in this study was an

observation sheet measuring blood pressure before,

and after intervention in both groups

 Data collection tools

The data which was taken is primary and secondary

data. Secondary data consisted of the identity and

characteristics of the respondent, age, parity,

pregnancy rimayat, history of childbirth, past

childbirth history and family history obtained from

medical records. Primary data consisting of blood

pressure values before and after the intervention

were obtained through measurement of blood

pressure values using mercury blood pressure meters

and stethoscopes. The instrument that used for

primary data collection was a blood pressure

assessment sheet before and after the intervention.

 Assessment method

a. Administrative Procedure

- Submit research ethics to the ethics committee

after the proposal exam

- Submit a research permit application letter

issued by the head of the study program

b. Technical procedures, stage 1 selection of the

Enumerator

- To guide researchers in the research process,

researchers chose to be assisted by enumators

who were midwives / nurses on duty in the

midwifery room at Grandmed Public Hospital,

LubukPakam

- The enumators that researchers need are those

in the morning service, the number of

enumators in this research are 3 people per

hospital to anticipate shifts and holiday

schedules

- Enumerators who are selected and willing to

help researchers are then equated to

perceptions regarding the research process

Giving Rosella (Hibiscus sabdariffa) Beverage to Overcome Hypertension in Pregnant Women

181

- Activities carried out by the enumerator will be

included in the attendance sheet of the

enumerator

c. Case selection

- Conducted socialization by researchers or

enumerators to the study population in order to

obtain understanding and be willing to become

a sample in voluntary research. This is

supported by the signing of an informed

consent

- Determination of samples that fit the research

inclusion criteria is based on medical diagnosis

(sample treatment status)

- The sample is divided into two experimental

groups and a control group

d. Intervention Allocation

- Measurement of blood pressure values of the two

groups before being given an intervention (pre-

test). The procedure used was to explain to

both groups that blood pressure measurements

would be taken before intervention was given.

Measurement of blood pressure used mercury

blood pressure meters and stethoscopes

conducted by enumerator researchers. The

results of blood pressure measurements in both

groups were entered into the observation sheet

and blood pressure values before the

intervention.

- Provision of intervention, giving roselle drink

given to the experimental group. Previously,

researchers had provided a rosella flower drink

made from 10 grams of dried petals of rosella

flowers (hibiscus sabdariffa) brewed with 200

ml of hot water at 900C, allowed to stand for 5

minutes and filtered .

e. Procedure for giving rosella beverage to the

experimental group

- Respondents in the experimental group were

given a Rosella flower drink

- Interventions are given every day until blood

pressure returns to normal. Roselle drinks are

taken directly in front of researchers or

enumerators

- Observation of blood pressure values is carried

out after 6-8 hours of drinking rosella flowers

to assess the significant decrease in blood

pressure every day and recorded in the

observation sheet of blood pressure values after

the intervention.

- Measurement of blood pressure values in the

experimental group after the intervention was

given (posttest).

a. Data processing

Data processing is carried out with the SPSS

(Statistical Product and Service) program through

the stages of editing, coding, data entry, data

cleaning.

b. Data analysis

 Univariate

This analysis describes the data in the form of a

categorical table. The data that has been processed

will be presented in the form of tables or graphs and

narrated

 Bivariate

If the Shapiro Wilks test is normally distributed then

a bivariate analysis is performed for comparative

analysis of paired numerics, two groups of pairs and

not pairs. Bivariate analysis aims to look at two

variables that are thought to be related or correlated.

Bivariate analysis was carried out to identify the

relationship between the two variables, namely to

identify the relationship between the administration

of dried rosella flower petals (Hibiscus Sabdariffa)

with these changes in blood pressure in pregnant

women with hypertension. Paired t-tests were

performed to compare blood pressure in each group

before and after the intervention and unpaired t-tests

to compare differences in blood pressure changes

between the control group and the experimental

group. If the data are not normally distributed the

value of Shapiro wilks is significant (p, 0.05), the

median is used as a measure of concentration and the

minimum and maximum values as a measure of

spread. The Wilcoxon parametric test was used

instead of the paired t test and the Mann-Whitney

nonparametric test as a substitute for the unpaired t-

test. The p value is considered significant if the p

value <0.05 and 95% CI.

3 RESULTS AND DISCUSSION

3.1 Paired Sample t Test Analysis in

Case Groups

Table 1 shows that the systolic blood pressure

normality test results before and after the

intervention obtained significantly greater than the

alpha value (0.05), namely 0.237 and 0.191, and then

Ho was accepted. Then it can be concluded that the

data obtained are normally distributed.

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

182

Table .1: normality test results for systolic and diastolic blood pressure before and after the intervention

Group I Mean SD Sig.

Systolic

Before intervention

After intervention

Systolic Difference

Diastolic

Before intervention

After intervention

Diastolic Difference

158,67

119

39,67

73,33

21,67

14,573

6,036

11,255

7,071

7,715

9,759

0,375

0,140

0,978

0,237

0,191

0,698

Table 2 shows that the difference in systolic

and diastolic blood pressure is greater than the alpha

level (0.05), which is 0.698. Based on the results of

normality analysis, systolic and diastolic blood

pressure data before and after the intervention and

the difference are normally distributed and both are

interrelated, so the analysis uses a parametric test

paired sample t test and obtained a significant value

of systolic blood pressure before and after the

intervention P = 0,000 (<0 , 05) and t = 13,650 and

the significance of diastolic blood pressure before

and after the intervention P = 0,000 (<0.05) and t =

8,599. From this analysis it can be concluded that

there are differences in systolic and diastolic blood

pressure values before and after the dry roselle

flower petals are given in group I (case).

Table 2: results of analysis of differences in systolic and diastolic blood pressure before and after the intervention

Paired Differences t df Sig.

(2-

tailed)

ean

Std.

Deviation

Std.

Error

Mean

95% Confidence

Interval of the

Difference

Lower Upper

air 1

Systolic

Before intervention

Case group –

Systolic

afterinterventionca

se group

11.25

2.906 33.434 45.899

.650

14 .000

air 2

DiastolicBefor

e intervention Case

group -

Diastolicafterinterv

entioncase group

9.759 2.520 16.262 27.071

599

14 .000

3.2 Paired Sample t Test Analysis in

the Control Group

Table 3 shows that the results of systolic and

diastolic blood pressure normality tests before and

after the intervention obtained significance values

greater than alpha (0.05) ie0.219 and 0.171 then Ho

was accepted. Then it can be concluded that the data

obtained are normally distributed.

Giving Rosella (Hibiscus sabdariffa) Beverage to Overcome Hypertension in Pregnant Women

183

Table 3: normality test results for systolic and diastolic blood pressure before and after the intervention.

Kelompok II Mean SD Sig.

Systolic

Before intervention

After intervention

Systolic difference

Diastolic

Before intervention

After intervention

Diastolic difference

155,67

120

35,33

92,33

75,33

17,00

12,743

5,669

8,756

5,627

5,164

6,761

0,219

0,171

0,694

0,113

0,293

0,038

In table 4 the results of parametric analysis

of paired sample t test and obtained significant

values of systolic blood pressure before and after the

intervention P = 0,000 (<0.05) and t = 16,102, and

the significance of diastolic blood pressure before

and after the intervention P = 0,000 (<0 , 05) and t =

9,738. From this analysis it can be concluded that

there are differences in systolic and diastolic blood

pressure values before and after the intervention in

the control group.

Table 4: The Results of analysis about differences in systolic and diastolic blood pressure before and after the intervention

in the control group.

Paired Differences t

Sig.

(2-

tailed)

ean

Std.

Deviatio

Std.

Error

Mean

95%

Confidence

Interval of the

Difference

wer

Upper

air 1

Systolic Before

intervention Case

group – Systolic

afterinterventioncase

group

4.67

8.338 2.153

30.

049

39.284

16.

102

.000

air 2

DiastolicBefore

intervention Case

group -

Diastolicafterinterventi

oncase group

7.00

6.761 1.746

13.

256

20.744

9.7

.000

In table 5: before analysing the difference in systolic and

diastolic blood pressure values between the case and

control groups, the normality of the systolic and diastolic

pressure values before and after the intervention in the two

groups was done using Shapiro Wilk to determine the

distribution of the data obtained and determine test to be

used. The data shows that the significant value of systolic

blood pressure before and after the intervention in both

groups <0.05 namely 0.047 and 0.019 then Ho is rejected,

and significant diastolic blood pressure before intervention

in both groups <0.005 namely 0.037 then Ho is rejected,

while the significance of diastolic blood pressure after

intervention in both groups> 0.05, Ho was accepted. So it

can be concluded that the systolic blood pressure before

and after the intervention and diastolic blood pressure

before the intervention is not normally distributed and the

two groups are not interconnected so that the statistical

analysis used is the Mann-Withney nonparametric test,

whereas the diastolic blood pressure data after the

intervention is normally distributed and the two groups not

interconnected, the statistical analysis used is the

parametric independent sample test.

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

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Table 5: Normality systolic and diastolic blood pressure test results of the control and intervention groups.

KelompokIdan II Mean SD Sig.

Systolic

Before intervention

After intervention

Diastolic

Before intervention

After intervention

156,67

119,50

93,67

74,33

13,604

5,776

6,424

6,530

0,047

0,019

0.037

0,079

Table 6 shows that the systolic blood pressure pre-

test and post-test were significantly greater than the

alpha value (0.05, 0.450 and 0.762, then Ho was

accepted, meaning that there was no difference in

average systolic blood pressure before and after the

intervention between the case and control groups.

Significant diastolic blood pressure pre-test and

post-test is greater than alpha (0.05), that is 0.280

and 0.411 then Ho is accepted, meaning that there is

no difference in average diastolic blood pressure

before and after intervention between the case and

control groups..

Table 6: The results of analysis about differences in systolic and diastolic blood pressure before and after the intervention

between the control group and the treatment group.

Variable

Group I

(n=15)

Group II

(n=15)

P value

Systolic

Pre test

Post test

Diastolic

Pre test

Post test

158,67

119

73,33

154,67

120

92,33

75,33

0,450

0,762

0,280

0,411

Before analysing the differences in healing time

between case and control groups, the normality of

the data based on the duration of healing was done

using Shapiro wilk to determine the distribution of

data and determine the test to be used. The results of

normality test data on healing time in both groups.

The data shows that the significant value of healing

time in the case and control group is smaller than the

alpha value (0.05) which is 0.005 then Ho is

rejected, meaning that the data based on healing time

is not normally distributed and the two groups are

not interconnected, then the analysis used is the non-

parametric Mann-Withney test. The results of

analysis about difference in healing time are

between the case and control groups

4 CONCLUSION

The provision of rosella beverage is effective for

overcoming hypertension in pregnant women with

an average healing time of 2 days faster than

hypertensive pregnant women who do not take

rosella which is an average healing time of 3-4 days.

Giving Rosella (Hibiscus sabdariffa) Beverage to Overcome Hypertension in Pregnant Women

185

Table 7: Results of analysis of healing time between the treatment and control groups.

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