SLOW STROKE BACK MASSAGE (SSBM)

THERAPY FOR REDUCING BLOOD

PRESSURE IN HYPERTENSION
PATIENTS: NARRATIVE
REVIEW
Normaliyanti1*, Rifa’atul Mahmudah1, Rian Tasalim2
1
Bachelor of Nursing Study Program, Faculty of Health, Sari Mulia University
Banjarmasin

Abstract

Background: Hypertension is a chronic condition when the blood pressure on the increase
the blood vessels. Righ know management only focus on pharmacological treatment, in
fact, non-pharmacological therapy is also needed in order to maximize the results to be
achieved, one of which is through Slow Stroke Back Massage (SBBM) therapy. SSBM is
a technique of giving back messages with oil or lotion which is done by rubbing slowly.
SSBM therapy can provide a relaxing effect for patients, improve blood circulation, reduce
the level of pain felt by patients, improve sleep quality, besides that SSBM can also be
useful for lowering blood pressure.

Objective: to determine Slow Stroke Back Massage therapy for reducing blood pressure
in Hypertension patients.

Methods: Narrative review research design. Narrative review sourced from Biomed
Central, Google Scholar, Elsevier, Garuda Portal and PubMed identified through the
Population, Interventions, Comparison, Outcomes and Study Design (PICOS) system
approach. The number of articles used for this research narrative is 11 journals. The
journal criteria used were filtered based on the title, abstract and keywords or keywords,
namely slow stroke back massage therapy, lowering blood pressure, hypertension.

Conclusion: Slow Stroke Back Massage therapy can be used in patients with hypertension
by doing a massage for 10 minutes for 3 consecutive days and reduce systolic blood
pressure by 15 mmHg and diastolic by 10 mmHg.

Keywords: Keywords: Hypertension, Lowering Blood Pressure, Slow Stroke Back Massage
Therapy, massage therapy

Introduction

The current development in the health sector does not only emphasize the control of infectious
diseases, but also seeks to overcome non-communicable diseases (PTM) (Rendy & Margareth, 2017).
One of the non-communicable diseases that is a priority in the world of health is hypertension (Ansar,
2019). Hypertension or high blood pressure is a chronic condition when the blood pressure on the
walls of the arteries (blood vessels) increases. Hypertension is a disease that always increases every
year in various countries around the world (Anies, 2018).
 World Health Organization (WHO) is estimated at 1.13 billion people with hypertension
worldwide, most of them (two thirds) are in low- and middle-income countries (WHO, 2021). Data
for Basic Health Research (Riskesdas) in 2018 the prevalence of hypertension by age 18 years is
34.1%. The estimated number of hypertension cases in Indonesia in 2018 was 63,309,620 people with
the lowest prevalence of hypertension sufferers of 22.2% coming from Papua Province while the
highest prevalence of hypertension sufferers came from South Kalimantan Province at 44.1%
(Kemenkes RI, 2018 ). The prevalence of hypertension sufferers in 2019 was 210,501 people. The
highest prevalence of hypertension sufferers in South Kalimantan came from Hulu Sungai Tengah
Regency as many as 18,581 people and the lowest came from Tanah Bumbu Regency as many as
2,896 people (Department of Communication and Information of South Kalimantan Province, 2020).

The risk factors for hypertension are divided into 2, namely hypertension that cannot be changed
and hypertension that can be changed. Risk factors for hypertension that cannot be changed include
age, gender, education, occupation and family history (Maulidina, 2019). Risk factors for
hypertension that can be changed include obesity, smoking, lack of activity, excessive salt
consumption, dyslipidemia, excessive alcohol consumption, psychosocial and stress (Supriyono,
2019). The causes of hypertension include caffeine, mono sodium glutamate (vetsin, soy sauce,
shrimp paste) and the use of estrogen (Purwono, 2020).

Continuously high blood pressure in the long term can cause complications (Roshifani, 2016).
Hypertension is an abnormal increase in blood pressure that can be the main cause of cardiovascular
disease (Ansar, 2019). Hypertension is a major risk factor for coronary heart disease, heart failure, and
stroke (Purwono, 2020).

Blood pressure control is broadly divided into 2 types, namely non-drug treatment (non-
pharmacological) and treatment with drugs (pharmacological) (Herlambang, 2013). In general, the
classes of antihypertensive drugs used are diuretics, ACE inhibitors (ACEI), Angiotensin-Receptor
Blockers (ARBs), Calcium channel Blockers (CCB) and Beta blockers (Fadhilla, 2020). Other blood
pressure control that can be done is by non-pharmacological treatment (Herlambang, 2013). Non-
pharmacological therapy is treatment therapy without the use of drugs which is divided into
approaches with ingredients (aromatherapy, sinshe), spiritual and supernatural approaches
(meditation, yoga, reiki) and massage therapy (Pratiwi, 2017).

Massage therapy is one of the non-pharmacological treatments to lower blood pressure (Luqman,
2017). Massage therapy is not only useful for lowering blood pressure but in general it can also be
useful for reducing pain, rehabilitation in sports accidents, reducing stress, depression, anxiety,
increasing relaxation and improving health (Luqman, 2017). Massage therapy that has the benefit of
lowering blood pressure includes Slow Stroke Back Massage (Ardiansyah, 2019).
 Slow Stroke Back Massage (SSBM) is one of the relaxation therapies in the form of massage
(massage) which can be useful for lowering blood pressure (Pinasthika, 2018). SSBM is a touch
movement in the back area that causes a relaxing effect of muscles, tendons and ligaments which will
increase parasympathetic nerve activity and stimulate the release of the neurotransmitter acetylcholine
then the neurotransmitter acetylcholine inhibits sympathetic nerve activity resulting in systemic
vasodilation and decreased contractility of the heart muscle which manifests in a decrease in heart
rate, cardiac output and stroke volume which in turn causes a decrease in blood pressure (Pinasthika,
2018).

The results of Silaban's research (2018) showed that SBBM therapy had a significant effect on
reducing the patient's blood pressure, both systolic by 21,848 mmHg, while the average diastolic
blood pressure decreased by 10.758 mmHg. Based on the results of the study, it showed that there was
a change or decrease in blood pressure in patients who were given SBBM interventions, besides that
SSBM therapy could be done easily, cheaply and simply and could even be done without cost. SSBM
therapy techniques can be carried out by health workers and can be taught to families of hypertensive
patients so that they can carry out the therapy at home.

A person who has hypertension so far has often only focused on pharmacological treatment,
namely only consuming drugs given by health workers, in fact, in addition to pharmacological
treatment, non-pharmacological therapy is also needed in order to maximize the results to be
achieved, one of which is through SBBM therapy.

Based on the above background, the researchers are interested in conducting a study entitled
"Slow Stroke Back Massage Therapy for Lowering Blood Pressure in Hypertensive Patients"

Materials and Methods

Narrative review research design. The search strategy for narrative review in this research is to
use an electronic based that is accredited/indexed by sinta such as Biomed Central, Portal Garuda,
Google Scholar, Elsevier, PubMed and other database sources using the keywords "Slow Stroke Back
Massage" "Blood Pressure" and "Hypertension " The search was carried out in November 2020. The
journal criteria used were filtered based on the title of the literature, full paper and a minimum issue of
2016.

Results and Discussion

The results showed that from 11 journals that had been reviewed, all (100%) stated that slow
stroke back messages could lower blood pressure. These studies include research by Kusumongtyas
(2018), Pratiwi (2019), Febriani (2019), Yuniarti (2019), Ramadhan (2019), Kardiana (2018),
Trisnadewi (2018), Wibowo (2017), Jayawardhana (2017). ), Septiari (2017) and Antari research
(2019).

The research of Kusumoningtyas (2018), Pratiwi (2019), Yuniarti (2019), Kardiana (2018),
Wibowo (2017), Jayawardhana (2017) and Antari research (2019) stated that there is an effect of slow
stroke back massage in lowering blood pressure in patients hypertension (p value = 0.000). The
Febriari Research (2019) Slow Stroke Back Massage that has been carried out on the three
participants has decreased blood pressure. Ramadhan (2019) stated that blood pressure decreased in
subjects 1 and 2 after being given a slow stroke back message intervention in hypertensive patients.
Trisnadewi (2018) stated that there was a difference in the decrease in diastolic blood pressure after
being given a slow stroke back massage intervention using ylang and lavender essential oils (p <
0.05). Septiari's research (2017) shows that slow stroke back massage reduces blood pressure in
hypertensive patients with a maximum value of 4.75 mmHg and 4.5 mmHg systolic and diastolic
decreases, respectively.

The results of the studies in the article above, in general, show that by giving a slow stroke back
message intervention to hypertensive patients, it can be useful for lowering the patient's blood
pressure. This is in accordance with what was stated by researchers in reviewed journals that SSBM
therapy can provide a relaxing effect for patients, improve blood circulation, reduce the level of pain
felt by patients, improve sleep quality, besides that SSBM can also be useful for lowering blood
pressure (Septiari, 2010). 2017). The massage technique in the form of a gentle gentle back massage
intervention (SSBM) causes relaxation and decreases sympathetic nerve activity and increases
parasympathetic nerve activity resulting in vasodilation of arteriolar diameter, in addition to
vasodilation of arteriolar diameter, nursing implications of SSBM can reduce blood pressure, body
temperature and heart rate (Kusomoningtyas, 2018).

A person who is diagnosed with hypertension feels more anxious and stressed with the condition
of the disease he is suffering from because this disease is a lifelong disease that cannot be cured and
must take medication continuously and make various healthy lifestyle changes (Padila, 2013). The
anxiety and stress will make the patient's sympathetic nervous system active so that the patient's blood
vessels become constricted and narrowed which in the end the blood that should flow smoothly to the
heart is reduced so that it requires increased blood pressure to flow throughout the body, with massage
intervention. Soft on the back (slow stroke back message) then the patient becomes calmer and more
relaxed because the sympathetic nervous system will also be calmer (inactive) so that the blood
vessels will be more open which of course will facilitate blood flow to return to normal (Pinasthika,
2018).
 The results of the review of all articles state that the slow stroke back message intervention can
reduce blood pressure. Hypertension or high blood pressure is often the main factor causing various
cardiovascular diseases so that hypertensive patients need to control blood pressure so as not to
experience various complications of the disease, including by doing a gentle massage on the back
(Ardiansyah, 2019).

The results of the research of Septiari (2017), Wibowo (2017), Kardiana (2018),
Kusumaningtyas (2018), Antari (2019) and Yuniarti's research (2019) have succeeded in reducing
respondents' systolic blood pressure after giving an average slow stroke back message of 4 ,5 - 10
mmHg while diastolic blood pressure is 3,75 - 10 mmHg.

Trisnadewi's research (2018) shows that respondents who were given a slow stroke back massage
intervention with ylang oil had an average decrease in systolic blood pressure of 12.66 mmHg and
diastolic an average of 9 mmHg while in the group of respondents who were given slow stroke back
intervention. message using lavender oil has an average decrease in systolic blood pressure of 1.34
mmHg and an average increase in diastolic blood pressure of 0.66 mmHg.

Febriani's research (2019) has succeeded in reducing respondents' systolic blood pressure after
giving a slow stroke back message by an average of 15 mmHg but does not explain the results of a
decrease in diastolic blood pressure.

Pratiwi's research (2019) does not include the average size of the decline, but shows data that
respondents after being given the slow stroke back message intervention decreased by 70%.
Jayawardhana's research (2019) did not explain the amount of blood pressure before and after the
slow stroke back message intervention.

Based on data from the journal, it shows that the research that has succeeded in reducing the
blood pressure of hypertensive patients after being given a slow stroke back message intervention is a
study from Febriani (2019). This could be because the sample of the study was postpartum women
who experienced an increase in high blood pressure during delivery, which could only be a temporary
increase in blood pressure so that postpartum women were not too worried about their condition so
that after the slow stroke intervention, respondents of this study could more relaxed than other
research respondents, besides that the number of samples in the study was less so that researchers in
providing slow stroke back message interventions could be maximized.

Another reason that allows this study to lower blood pressure is because it was carried out in a
hospital, which could be a special room that has been provided for massage which allows the room to
be more comfortable than other research places, including elderly social homes, although many
journals others who did not mention in detail the place/room the research was carried out.
 Trisnadewi's research (2018) shows that the most successful research in reducing blood pressure
in chronic hypertension patients, because in this study using ylang ylang essential oil which contains
eugenol which can function to regulate the flow of adrenaline in the nervous system so that it can
cause calm and pleasure

The slow stroke back message intervention in each study also has differences in carrying out the
implementation procedures of this therapy. It is also possible to produce differences in the
achievement of reducing blood pressure for each respondent. The implementation of slow stroke back
message in general, most journals do it for 10 minutes for each massage but with different frequency
and number of days.

Antari's research (2019) stated that the time for the slow stroke back message intervention was
carried out 3 times a week for 4 weeks with 10 minutes reducing systolic blood pressure 4.95 mmHg
and diastolic 5.42 mmHg, while Febriani's research (2019) stated that the time the implementation of
the slow stroke back message intervention was carried out for 3 consecutive days to reduce systolic
blood pressure by 15 mmHg.

One of the more detailed journals explaining the procedure and frequency of implementation of
the slow stroke back message intervention includes the Kusumaningtyas research (2019) which
explains that his research on the slow stroke back massage intervention was carried out with a time of
10 minutes for 1 meeting, for 3 weeks with 12 meetings. .

The slow stroke back massage relaxation technique procedure that he has done consists of the
first movement to the sixth movement, each movement is carried out 10 times in 1 minute 40 seconds

1. Massage using the palms of the hands and fingers alternately

2. Massage by squeezing and rubbing the shoulder muscles

3. Massage by swiping your thumb outwards

4. Massage with efflux. Both hands pressing the buttocks to the shoulders

5. Press the back horizontally (petrization).

6. Massage with fingertips using brushing technique

The results of the journal review also found that each researcher had differences in performing
slow stroke back message interventions. This difference can be seen from the use of additional
materials as lubricants for massage, this may affect the comfort of the respondents and of course will
also affect the magnitude of the resulting decrease in blood pressure. However, not all journals
mention the type of lubricant used.

Several journals that mention lubricants in massage include the research of Ramadhan (2019)
which states that the slow stroke back message intervention was carried out with olive oil. Yuniarti's
research (2019) conducted a slow stroke back message intervention with baby oil. Trisnadewi's
research (2018) divides 2 groups in performing slow stroke back massage interventions, namely the
group that uses ylang ylang essential oil and lavender essential oil.

Based on the data from the three journals, the research from Trisnadewi (2018), which reduced
blood pressure the most, was conducting a slow stroke back message intervention using ylang ylang
essential oil. The slow stroke back message intervention using ylang ylang essential oil lowers blood
pressure more than using other oils due to the presence of ylang flower in the form of eugenol, which
functions to regulate the adrenaline glands in the nervous system, which can eventually lead to calm
and pleasure in respondents.

This is in accordance with what researchers stated in the journal that eugenol contained in ylang
ylang essential oil has a better effect than lavender essential oil. The decrease in blood pressure is due
to decreased sympathetic nerve activity thereby increasing the parasympathetic nerves and
vasodilation occurs due to stimulation of slow stroke back massage and relaxation which will
stimulate endorphins in the pituitary gland due to the essential effects of ylang ylang. The effects of
slow stroke back massage and ylang ylang essential oil can increase the relaxed response of
respondents and can have the effect of lowering blood pressure.

Conclusion
Based on the results of discussions and journal searches, it can be concluded that there was a decrease
in blood pressure after the Slow Stroke Back Massage intervention by doing massage for 10 minutes
for 3 consecutive days and could reduce systolic blood pressure by 15 mmHg and diastolic by 10
mmHg.

Acknowledgements
Thanks to Sari Mulia University for allowing me to conduct research using the journal review method
and thanks also to supervisors 1 and 2 Rifa'atul Maheasy, Ns., MSN and Rian Tasalim, Ns., M.Kep.
who has guided in conducting this journal review research.
Declaration of Interest Statement
The authors declare that they have no conflict of interests.
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