SELF-ACUPRESSURE TO LOWER BLOOD PRESSURE ON OLDER ADULTS WITH HYPERTENSION

Abstract

Hypertension is often suffered by older adults, which directly can impact their health and quality of life. One of the non-pharmacological management for patients with hypertension is through acupressure to accelerate blood-flow circulation and to reduce blood pressure. This study aims to determine the self-acupressure effect on the elderly with hypertension in Cilincing Health Center in North Jakarta. This research used a quasi-experimental involving control and intervention group. Thirty-six elderlies were involved in this study divided into two groups. Findings showed that there were significant differences in the intervention group between the results of systolic and diastolic measurements before and after acupressure (p-value=0,000). The findings suggest that families can apply self-acupressure as a support system for older adults with hypertension.

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Jurnal Riset Kesehatan, 8 (2), 2019, 1-4
DOI: 10.31983/jrk.v8i2.3879
Copyright © 2019, Jurnal Riset Kesehatan, e-ISSN 2461-1026
Jurnal Riset Kesehatan
http://ejournal.poltekkes-smg.ac.id/ojs/index.php/jrk
_____________________________________________________________
SELF-ACUPRESSURE TO LOWER BLOOD PRESSURE
ON OLDER ADULTS WITH HYPERTENSION
Agus Citra Dermawana; Santun Setiawatib; Raden Siti Maryamc*
aAkademi Keperawatan Bina Insan ; Kramat Raya 22 ; Jakarta Utara ; Indonesia
b,c Poltekkes Kemenkes Jakarta III ; Melati 2 ; Bekasi ; Indonesia
Abstract
Hypertension is often suffered by older adults, which directly can impact their health and quality
of life. One of the non-pharmacological management for patients with hypertension is through
acupressure to accelerate blood-flow circulation and to reduce blood pressure. This study aims to
determine the self-acupressure effect on the elderly with hypertension in Cilincing Health Center
in North Jakarta. This research used a quasi-experimental involving control and intervention
group. Thirty-six elderlies were involved in this study divided into two groups. Findings showed
that there were significant differences in the intervention group between the results of systolic and
diastolic measurements before and after acupressure (p-value= 0.000). The findings suggest that
families can apply self-acupressure as a support system for older adults with hypertension.
Keywords:
self-acupressure ; hypertension in older adults ; family
1. Introduction
Life expectancy among older adults
sometimes is being hampered by various health
problems. The top five diseases often suffered by
older adults are hypertension, arthritis, stroke,
chronic obstructive pulmonary disease (COPD),
and diabetes mellitus (DM) (Riskesdas, 2013).
Hypertension is considered to be the most
suffered disease among older adults, as
approximately around 16-31% of senior citizens
in Indonesia from various states or provinces
from hypertension (Riskesdas RI, 2013). The
elderly with hypertension have a higher chance
of getting a complication. The most often
occurred complication on the elderly with
hypertension is cardiovascular disease and
stroke. Untreated hypertension can cause daze,
throbbing pain on sub occipital, numbness series,
or paralysis on one entire side of the body. The
non-pharmacological treatments for
hypertension can be through some specific
techniques in reducing stress, techniques in
losing weight, alcohol, doing physical exercises,
relaxation, and acupressure (Rezky, Hasneli, &
Hasanah, 2015).
Acupressure or administering pressure
on specific points on the body is one of the
non-pharmacological interventions that are very
efficient and relatively safe because it does not
involve invasive actions or injuring the skin
(Saputra, 2002). The benefits of acupressure
include helping to manage stress, calm nervous
tension, and increase body relaxation. This
therapeutic technique uses fingers performed at
points associated with hypertension.
Administering massages on specific spots in
acupressure therapy can stimulate nerve waves
so that they can accelerate blood-flow circulation,
relax spasms, and lower blood pressure
(Hartono, 2012). Acupressure can be done with
the help of others or done independently. The
elderly with family assistance are expected to be
able to do acupressure independently.
Research by Widodo et al. (2014) shows that
*) Corresponding Author (Raden Siti Maryam)
E-mail: raden.maryam@poltekkesjakarta3.ac.id

Jurnal Riset Kesehatan, 8 (2), 2019, 2-4
DOI: 10.31983/jrk.v8i2.3879
Copyright © 2019, Jurnal Riset Kesehatan, e-ISSN 2461-1026
acupressure performed in hypertensive patients
can lower blood pressure. Rezky, Hasneli, and
Hasanah (2015) explain that reflexology can
reduce blood pressure. Treating hypertension is
not only using medical drugs but can use Benson
relaxation therapy regularly (Purwati, Suryani &
Supriyono, 2011).
Acupressure is one of the
non-pharmacological treatments with methods,
tools, or materials applied in medical care, which
can be administered as an alternative or
complementary to specific medical treatments
(Kozier, Erb, Berman, & Snyder, 2010). The right
alternative to reduce blood pressure without
drug dependence and side effects is to use
non-pharmacological treatments (Kowalski,
2010). Therefore, this study aims to determine
the effect of independent acupressure on elderly
blood pressure in the community.
2. Method
The study design used quasi-experimental
with intervention and control groups. The
intervention group received acupressure;
meanwhile, the control group did not receive
it.The sampling technique used was consecutive
sampling done by selecting all individuals who
had met the selection criteria until the desired
number of samples meet the requirement. The
number of samples in this study was 36 elderly
(18 elderly in the intervention group and 18
elderly in the control group). Data collection was
carried out with respondents filling out
questionnaire sheets, conducting blood pressure
checks (pre) done by researchers, administering
acupressure guided by researchers once for 30
minutes, and finally conducting blood pressure
re-checks (post).
This study used ethical considerations with
the intention that respondents get protection on
rights and privacy during data collection. The
researchers proposed informed consent, which
aimed at maintaining the privacy of respondents,
respecting the autonomy of respondents,
maintaining the comfort of respondents. This
study had been approved by the Ethics
Commission of the Polytechnic of the Ministry of
Health Jakarta III No. KEPK-PKKJ3 / 050 / XII /
2017. In bivariate analysis, a dependent test was
used to determine the effect of independent
acupressure on elderly blood pressure.
3. Result and Discussion
Fifteen elderlies in the intervention group
are aged between 60-70 years old, while there are
twelve in the control group. Women are
dominating the intervention group in which
there are 14 people (77.8%); meanwhile, the
control group is dominated by men in which
there are ten elderlies (55.6%). The educational
background of the elderly is mostly graduated
from elementary school in which there are eight
people for each group, and most of the elderly
are unemployed.
Table 1. Characteristics of elderlies blood
pressure before intervention between the two
groups.
Variable
Intervention
Group
Control Group
Blood
Pressure
N
%
N
%
Systolic
140-159
160-179
11
5
61.1
27.8
8
7
44.5
38.9
180-209
≥210
Diastolic
70-80
90-99
100-109
110-119
≥120
2
-
4
6
7
1
-
11.1
-
22.2
33.4
38.9
5.5
-
2
1
4
9
3
1
1
11.1
5.5
22.2
50.0
16.8
5.5
5.5
Table 1 shows that the highest proportion of
systolic in the intervention group was 140-159
mmHg of 11 people (61.1%) and in the control
group of 8 people (44.5%); while the highest
proportion of diastolic in the intervention
group was between 100-109 mmHg by 7 people
(38.9%) and in the control group between 90-99
mmHg by 9 people (50%).
Table 2. Mean differences of blood pressure on
the intervention group.
Measurement
Variable
N
Mean
(mmHg)
SD
P-value
Before
Siastole
18
153.61
13.91
0.000
After
18
135.56
13.38
Before
Diastole
18
92.78
8.95
0.000
After
18
83.89
6.78
Table 2 shows that the average systolic
measurement at the first measurement is 153.61
mmHg, and the second measurement is 135.56
mmHg. There is a significant difference between

Jurnal Riset Kesehatan, 8 (2), 2019, 3-4
DOI: 10.31983/jrk.v8i2.3879
Copyright © 2019, Jurnal Riset Kesehatan, e-ISSN 2461-1026
the results of the first and second systolic
measurements (p-value= 0.000 and α= 0.05). The
average diastolic measurement in the first
measurement is 92.78 mmHg, and the second
measurement was 83.89 mmHg. There is a
significant difference between the results of the
first and second diastolic measurements
(p-value= 0.000 and α= 0.05).
Most respondents are approximately aged
70-79 years old. Older adults tend to have a
higher blood pressure than younger people
because physiological function decreases due to
the aging process so that many
non-communicable diseases occur in old age.
The elderly are also susceptible to infectious
diseases due to weakened immunity (Ministry of
Health, 2013).
Patients with hypertension in this study are
mostly women. These are because after turning
55, around 60% of older adults who suffer from
hypertension are women due to the decrease of
estrogen hormone (Pratiwi & Mumpuni, 2017).
Women who are not yet facing menopause, their
estrogen plays a role in increasing High-Density
Lipoprotein (HDL) that protects blood vessels
from damage. As we age, the hormone estrogen
decreases so that women are prone to
hypertension after menopause. Supported by
research where as significant relation between
hormonal contraception usage with hypertension
incidence (Suryanda, 2017).
Based on the results of blood pressure
measurements conducted before the intervention,
the average systolic is 140-159 mmHg, and the
diastolic is 90-99 mmHg. After administering
self-acupressure intervention, there is a decrease
in systolic to 110-130 mmHg and diastolic to
70-80 mmHg. There is a significant difference
between the results of the first and second
systolic measurements (p-value 0.000), and there
are significant differences between the results of
the first and second diastolic measurements
(p-value 0.000) in the elderly group acquire the
intervention. Acupressure is done by involving
the elderly independently accompanied by
family. A decrease in both systolic and diastolic
blood pressure occurs after acupressure. This is
also in line with research conducted by Majid
(2016) explaining that there is a decrease in
average systolic and diastolic blood pressure
with a p-value (0.001) after administering
acupressure for three times. Mustapha's research
(2017) states that acupressure interventions can
help improve circulation in post-stroke patients.
The results of Afrila, Pristiana, and Erwin
(2015) research prove that the administration of
a combination of slow stroke back massage and
acupressure therapy is proven effective in
reducing blood pressure in patients with
hypertension. Relaxation is an action that must
be performed on every anti-hypertensive
therapy. If the blood pressure increases, the
relaxed blood vessels will become vasodilation
so that it will cause the blood pressure to drop
and will slowly return to normal (Muttaqin,
2009). The results of this study are in line with
Adam's (2011) study that stimulation to
acupressure points can stimulate mast cells to
release histamine as a mediator of vasodilation
of blood vessels, resulting in increased blood
circulation that causes the body to relax and
ultimately reduce blood pressure. The existence
of various interventions carried out on the
decline experienced by the elderly is expected
to influence and to give meaningful changes.
Inline to the results of research conducted by
Prasetyo (2015) that there are significant
differences between the cognitive functions of
the elderly after taking action memory training.
4. Conclusion and Suggestion
Independent acupressure that can be done
by the elderly alone with family can significantly
reduce systolic blood pressure by 18.05 mmHg.
Acupressure or emphasis on specific points on
the body is one of the non-pharmacological
interventions that are efficient and relatively safe
because they do not carry out invasive actions.
It is expected that nursing education can be
used as learning material in the laboratory and
become one of the alternatives or complementary
therapies in the community in the management of
hypertension in the elderly. For nurses in the
community who handle the elderly program can
motivate the elderly and families to be able to
carry out independent acupressure on the elderly
regularly. As a reference material for further
research on family experience doing acupressure.
The limitation of this study is it only takes one
blood pressure measurement for intervention and
control group.
5. Acknowledgements
This work is supported by Akper Bina Insan
Director who gave the golden opportunity doing
a lot of research.

Jurnal Riset Kesehatan, 8 (2), 2019, 4-4
DOI: 10.31983/jrk.v8i2.3879
Copyright © 2019, Jurnal Riset Kesehatan, e-ISSN 2461-1026
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