EFFECTIVENESS OF PROGRESSIVE MUSCLE RELAXATION WITH A DECREASE OF

BLOOD PRESSURE Recitation AND REDUCE STRESS LEVEL IN PATIENTS WITH

HYPERTENSION

Niken Setyaningrum1, Atik Badi'ah2

1
Nursing Study Program, Global Solar STIKES, Yogyakarta
2
Nursing Study Program, Ministry of Health POLTEKES, Yogyakarta
Email: nikensetyaningrum7@gmail.com

ABSTRACT
Background: Hypertension is one of the deadliest diseases in the world and is currently listed
as the third killer disease after heart disease and cancer. Based on the 2014 survey sample
registration hypertension is the fifth leading cause of death in Indonesia. Based on WHO
estimated in 2025 the incidence rate of hypertension increased by 29.2%. Hypertension is
associated with the quality of sleep and stress levels as they relate to the sympathetic nerve
response. If not identified properly it can worsen the condition of patients with hypertension.
Hypertension can be controlled by non-pharmacological therapy using progressive muscle
relaxation technique relaxation with remembrance.
Purpose: This study was to determine the effectiveness of progressive muscle relaxation with
the remembrance of the decrease in blood pressure and a decrease in stress levels.
Method: The design of this study using Quasi-experimental design with
Comparison Group, Sample was taken using purposive sampling. The study was conducted in
the region 2 Yogyakarta Gamping Puskesmas. The sample size in this study were 40
respondents to the division of each sample of 20 respondents in the intervention group and the
control group.
Results: There are significant differences between the intervention group (PMR and dhikr) with
the control group (PMR) to decrease systolic blood pressure (p <0.01), diastolic blood pressure
(p <0.01) and a decrease in stress levels (p <0, 05).
Conclusion: Progressive muscle relaxation techniques with remembrance performed
simultaneously can be used to lower blood pressure and reduce stress levels.

Keywords: Hypertension, Stress Levels, Progressive Muscle Relaxation, Remembrance

This prediction is based on the number of

PRELIMINARY
Hypertension is a disease that can
affect anyone, young and old, rich and poor.
Hypertension is one of the deadliest diseases
in the world and is currently listed as the third
killer disease after heart disease and cancer
(Adib, 2009). Currently the number
hypertensive patients is increasing every
year. Approximately 80% increase in cases of
hypertension that occurs mainly in developing
countries, is expected to rise to 1.15 billion
cases in 2025 from 639 million cases in 2000.
hypertensive patients and population growth
today (Armilawati et al, 2007) ,
The relationship between stress and
hypertension occurs through the sympathetic
nerve activity can increase blood pressure
gradually (Yundini, 2008). The response to
of stress stimulates the adrenal glands to
produce hormones cortisol and epinephrine
(adrenaline), which affect the endocrine
system, the nervous and immune (Blauer-
Wu, 2002 cit Lorentz, 2006). Endorphins
serves to inhibit the production of cortisol and

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N Setyaningrum, A Badi'ah │ Effectiveness of Progressive Muscle Relaxation with Recitation of the
decrease in blood pressure and Decrease Stress Levels in Patients with Hypertension
epinephin. According to Saleh (2010) states
that to increase the production of endorphins
can be done with excersice, meditation,
prayer or remembrance to get some peace.
Pharmacologic treatment takes a long
time and give side effects to the body, this
condition can be relatively inexpensive, long
time and can improve the boredom resulting
incompliance to therapy. Non-
pharmacological therapy is a factor that plays
a major role in lowering blood pressure since
the last five years. This type of therapy
includes lifestyle changes consisting of
quitting smoking, losing excess weight,
lowering excessive alcohol consumption,
physical exercise, reduced salt intake and
increasing fruit and vegetable consumption
and lowering fat intake (Medicine, 2006; Adib,
2009).
Based on the above research and the
tendency of some additions incidence of
hypertension each year, the healing
properties of a long illness and complications
arising can lead to the development of human
resources is becoming less socially and
economically. Good cost burden borne by
people, communities and governments will
grow, while the effectiveness and efficiency of
declining so we need a disease management
of hypertension is well to achieve the goal of
health development is more successful (Perry
& Potter, 2005).
Results of a preliminary study on the
working area of Puskesmas limestone 2
obtained the data that 10 patients with
hypertension have all said that if they feel
dizzy and blood pressure to rise directly to
the clinic, patients taking the drug provided by
MEDISAINS: Scientific Journal of Health Sciences, Vol 18 No. 1, APRIL 2018 | Page 9
the clinic, until now there has been exercised
non-pharmacological to lose blood pressure.
Therefore, it should be considered to use
non-pharmacological approaches that are
natural for controlling high blood pressure
and control stress levels.
METHOD
The design used in
This study is the "Quasi-experimental Design
with Comparison Group". In this study
compared changes in blood pressure and
stress levels in hypertensive patients is in the
intervention group of progressive muscle
relaxation with remembrance while the
control group received the intervention of
progressive muscle relaxation.
The population in this study were all
patients with primary hypertension who
control routine in the clinic Limestone 2
Yogyakarta, the captured data is data in
January 2016 amounted to 121 people.
Researchers avoid the drop out by adding
10% of the estimated sample size was 1.8
rounded to 2 so that a sample size of each -
a total of 20 respondents in each group. The
samples in this study to determine the
respondents' purposive sampling will be used
in research. Research conducted Gamping
Puskesmas working area 2 Yogyakarta. This
study was conducted over five months, from
July to September, 2016.
A univariate analysis performed to
describe all the variables studied. Bivariate
analysis to determine differences in the
intervention group and the control of blood
pressure decline analysis using Mann
Whitney test, whereas to determine
N Setyaningrum, A Badi'ah │ Effectiveness of Progressive Muscle Relaxation with Recitation of the
decrease in blood pressure and Decrease Stress Levels in Patients with Hypertension

differences in the intervention group and the DISCUSSION

control group on the level of stress using
Indeependen sample t test
(Paired t-test).
RESULTS
In response karakteristrik showed most
respondents were women as much as 65%.
Age at most are between the ages of 50 to 69
years, with 70%. The education level of
42.5% of respondents sebayak junior high
school. Berdasarka most respondents work is
work as private employees as much as
57.5%.
The majority of respondents have a
family history of hypertension 70%, while for
a history of smoking 70% of respondents did
not smoke. All the respondents did not have a
history of drinking alcohol, while for the
duration of diagnosed hypertension as much
as 42.5% were in the range of more than 3
years (Table 1).
Wilcoxon analysis results of the intervention
group and control group to variable blood
pressure showed p <0.05, which means that
there are significant differences between the
two groups to lower systolic and diastolic
blood pressure. Independent sample t test
analysis in the intervention group and control
group to variable levels of stress showed p
<0.05 means that there are significant
differences between PMR and remembrance
group (intervention) with PMR group alone
(control) the level of stress in hypertensive
patients (Table 2).
The results found that both groups
were given PMR and remembrance as well
as the group given PMR course, equally
decreased blood pressure and stress levels.
The results of the analysis of the study found
no significant difference in blood pressure
and deterioration in stress levels in the group
that performed PMR and zikr with the group
given PMR alone with values of p <0.05.
When viewed from the mean score decrease
blood pressure in both systole and diastole
and score tingkt stress reduction, conducted
PMR group, be more effective than the group
given PMR with remembrance
simultaneously.
Progressive muscle relaxation aimed at
decreasing anxiety, stress, muscle tension
and sleeplessness. When the body and mind
relax, automatically tension that often makes
the muscles will tighten ignored (Ramdhani,
2009).

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N Setyaningrum, A Badi'ah │ Effectiveness of Progressive Muscle Relaxation with Recitation of the
decrease in blood pressure and Decrease Stress Levels in Patients with Hypertension

characteristics Intervention (n = 20) Controls (n = 20)

Frequency Percentage Frequency Percentage

Gender
Male 7 35% 7 35%
woman 13 65% 13 65%
Age
40-49 3 15% 2 10%
50-59 7 35% 7 35%
60-69 6 30% 8 40%
70-79 4 20% 3 15%
Education No
school - - - -
SD 3 15% 3 15%
JSS 7 35% 10 50%
SLTA 7 35% 5 25%
College 3 15% 2 10%
Profession
Does not 5 25% 4 20%
work
PNS / TNI / Police - - 1 5%
General employees 12 60% 11 55%
entrepreneur 2 10% 4 20%
farmer 1 5% - -
Family History There
is 14 70% 14 70%
No 6 30% 6 30%
history of smoking
Yes 5 25% 7 35%
No 15 75% 13 65%
History of Alcohol
Yes - - - -
No 20 100% 20 100%
Terdiagnoa
Hypertension <1 2 10% 5 25%
year
13 years old 8 40% 8 40%
> 3 years 10 50% 7 35%

Table 2. Differences drop in blood pressure and a decrease in the level of

intervention (PMR and remembrance) and the control group (PMR) stress between groups
Group n The mean p-value
variables decrease
Systole Blood Pressure (mmHg) PMR and remembrance 20 14.60 0,001 *
PMR 20 26.40
Diastolic blood pressure (mmHg) PMR and remembrance 20 15.63 0,006 *
PMR 20 25.38
Stress level PMR and remembrance 20 12.10 0,034 **
PMR 20 15.85

Table 1. Characteristics of Respondents

Note: * Wilcoxon Test, ** Independent sample
t test

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N Setyaningrum, A Badi'ah │ Effectiveness of Progressive Muscle Relaxation with Recitation of the
decrease in blood pressure and Decrease Stress Levels in Patients with Hypertension

When muscles in a relaxed state, lactic

At the time of relaxed condition is acid will be removed through the
achieved then the action hypothalamus bloodstream, but when muscles contract in
will adjust and decreased activity of the long term, the blood circulation becomes
sympathetic and parasympathetic nervous blocked and fatigue formed rapidly, which will
systems. The sequence of physiological lead to tension and produces pain in the neck
effects and symptoms and sign will be muscles , shoulders and so on. Research
disconnected and psychological stress will Sutherland et al, showed that certain
be reduced. Relaxation techniques behaviors may more frequently occur during
commonly used muscle relaxation, periods of stress, this can be reduced by
relaxation with guided imagery and doing relaxation, as well as with research
relaxation response from Benson Oktavianis (2010) states that the progressive
(Smeltzer and Bare, 2002). muscle relaxation significantly able to reduce
Subandi (2002), states that in the work stress on caregivers of elderly in nursing
human body there are 620 skeletal muscles, Elderly.
these muscles can be trained to consciously Based on the research of
composed of bonding parallel fibers, and remembrance with the setting of breath and
each fiber is made of a number of slim relaxation can increase the activity of
filaments which can shrink and extends baroreceptors as the process gives impulses
(dilated). When thousands of slim filament afferent reaches the heart center, further
working in coordination, the muscles will increasing the activity of the parasympathetic
contract, in the form of glycogen sugar nervous system and releases the hormone
decomposes into force and lactic acid that acetylcholine, which increases the
can cause fatigue. permeability of potassium ions in the SA node
thereby reducing pulsation in the SA node, a
decrease in the transmission of impulses will
decreased heart rate, stroke volume and
cardiac output. Deep breathing relaxation
therapy (deep breathing) can increase
oxygen saturation, improve the state of
oxygenation in the blood, and create a state
of relaxation in the body (Muttaqin, 2009).
Increased oxygen can indirectly lower
the lactic acid by increasing the supply of
oxygen and lower the oxygen needs of the
brain, so it is expected that the balance of
brain oxygen. Slow, deep breathing can
stimulate the autonomic nervous response

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N Setyaningrum, A Badi'ah │ Effectiveness of Progressive Muscle Relaxation with Recitation of the
decrease in blood pressure and Decrease Stress Levels in Patients with Hypertension

through spending endorphin vasodilation of brain blood vessels allowing

neurotransmitters that affect a decrease in more brain oxygen supply to brain tissue
sympathetic nerve responses and enhancing perfusion is expected to be adequate
the parasympathetic response. (Denise, 2007; Downey, 2009).
Sympathetic nerve stimulation
increases the activity of the body, while the CONCLUSIONS AND
RECOMMENDATIONS
parasympathetic response is much lower
Coupled with remembrance PMR or
ativitas body or relaxation so as to lower the
PMR alone can lower blood pressure and
metabolic activity (Velkumary &
lower levels of stress in hypertensive
Madanmohan, 2004). Parasympathetic nerve
patients. For patients with hypertension need
stimulation and inhibition of sympathetic
to make a PMR or PMR coupled with
nerve stimulation to relaxation also result in
remembrance to control their blood pressure.
Breathing Exercise on Autonomic

REFERENCES
Adib, M. (2009). Easy Ways to Understand and.
Avoid Hypertension, Heart, and Yundini
Yogyakarta: Dianloka Hypertension.
February 2, 2015.
Armilawaty. (2007). The risk of hypertension and
Napier: FKM UNHAS. Internal medicine
textbook. Ed 4. (2006). Jakarta:
Denise, ML (2007). Sympathetic Storning After
Severe Traumatic Brain
Injury.Critical Care Nurse Journal, 27 (1),
30-37.
Downey, LV (2009). The Effects of Deep Breathing
Training on Pain Management in the
Emergency Department. Southern Medical
Journal, 102 (7): 688-692.
Lorentz, Madeline. (2006). Stress and
Psychoneuroimmunology Revisited:
Using Mind Body Interventions to
Reduce Stress. Alternative Journal of
Nursing
Muttaqin, Arif. (2009). Textbook Care
Nursing Clients with System Disorders
Cardiovascular and hematology.Jakarta.
Salemba Medika.
Oktavianis, D. (2010). The effectiveness of
progressive muscle relaxation to
reduce stress levels in caregivers of
elderly in Elderly Nursing X.
Accessed June 10
2015 from
http://www.distrodoc.com/268127

MEDISAINS: Scientific Journal of Health Sciences, Vol 18 No. 1, APRIL 2018 | Page 13
N Setyaningrum, A Badi'ah │ Effectiveness of Progressive Muscle Relaxation with Recitation of the
decrease in blood pressure and Decrease Stress Levels in Patients with Hypertension

Potter, AP, & Perry, A. (2005). Fundamentals

of Nursing. (6 th Edition). St.Louis
Missouri: Mosby-Year Book, Inc.
Ramdhani, N., & Sons, AA (2009). Multimedia
Development Relaxation. accessed on 4
September 2015 of http://neila.staff.ugm.ac.id/wordpress/
wp-content / uploads / 2009/08 / for relax
iotot.pdf,
Saleh, LM (2010). Remembrance for Health
Neuroscience. Jakarta: Zaman
Smeltzer, CS, & Bare, GB (2002). Textbook of
Medical Surgical Nursing
Brunner & Suddarth, (Ed 8). Jakarta: EGC.
Subandi, MA (2002). Psychotherapy:
conventional and contemporary
approach. Yogyakarta: Student
Library
Velkumary, GKPS, and Madanmohan. (2004).
Effect of Short-term Practice of

MEDISAINS: Scientific Journal of Health Sciences, Vol 18 No. 1, APRIL 2018 | Page 14