Indian Journal of Public Health Research & Development, March 2020, Vol. 11, No.

03  2483

Association of Manganese Level in Drinking Water and

Other Factors with Hypertension in the Around Landfill
Population in Depok, Indonesia

Ukik Agustina1, Ema Hermawati1, Laila Fitria1, Febri Hardiyanti1, Septia Rini Rizki1
1
Department of Environmental Health, Faculty of Public Health, University of Indonesia

ABSTRACT
Background: Hypertension is a risk factor for cardiovascular disease, such as stroke and heart disease.
Hypertension is also a silent killer which has caused 9 million preventable deaths and 1.3 billion people have
hypertension worldwide. In Indonesia, cardiovascular disease is the second leading cause of death. One of
the hypertension factors still under study is excessive manganese intake. The landfill is a source of release of
manganese into the environment. This study aimed to determine the relationship and risk of manganese level
and other factors on hypertension in the people who live around the landfill in Cipayung, Depok.

Method: The study design was cross sectional with 107 respondents who consumed ground water as raw
material for drinking water. Measurement of manganese in water used the method (SNI) 6989.5: 2009 on
how to test manganese by Atomic Absorption Spectrophotometry (AAS).

Result: The results showed significant results on the variables of obesity (0.042, OR: 2,460) and age
(0,0001, OR: 10,675) on hypertension. The level of manganese in drinking water to hypertension did not
show significant results, but as a controlling variable (0.450, OR: 1.584). While other variables (blood sugar
levels, smoking, ethnicity, family history, socioeconomic and gender) did not show significant results, but
had an OR more than 1, which were respectively 2.05, 2.48, 3.19 (active smokers), 1.79 (passive smokers),
1.02, 1.12, 0.96 and 2.45.

Conclusion: The conclusion from this study is no relationship between manganese levels in drinking water
with hypertension, but obesity and age have a significant relationship to hypertension.

Keywords:  Manganese, drinking water, hypertension, landfill.

Introduction income countries. Hypertension is a leading cause

Hypertension or high blood pressure is a serious
medical condition that can significantly increase the
risk of disease, such as heart, brain, kidney and other
diseases. Around 1.13 billion people worldwide suffer
from hypertension, most (2/3) living in low and middle
Corresponding Author:
Ema Hermawati
Department of Environmental Health, Faculty of Public
Health, University of Indonesia
e-mail: ema.hermawati1@gmail.com
of premature death worldwide1. In 2030, the United
Nations (UN) is committed to reducing 1/3 of premature
deaths from non-communicable diseases2.
In Indonesia, hypertension in the population aged ≥
18 years (measurement results) in 2018 has increased,
reaching 34.1%. While the province of West Java ranks
second as the province with the most hypertension
sufferers which exceeds the national figure3. In Depok,
in 2016 there were 34,244 cases of hypertension reported
out of 759,710 of patients taking blood measurements4.
Based on the sequence of disease patterns, most
outpatients (aged 45-75) in all Depok hospitals in
2017, hypertension ranks third (10.05%) after diabetes
2484  Indian Journal of Public Health Research & Development, March 2020, Vol. 11, No. 03
mellitus and Congestive Heart Failure (CHF) and
ranks sixth (19,590 patients, 6.61%) in all age groups
in general. In the primary health care, hypertensive
outpatients reached 141,084 (14.91%) and ranked the
second highest disease4.
High blood pressure is also called the “silent killer”
because it often has no signs or symptoms and many
people do not know that they suffer from hypertension5.
Hypertension, also known as high blood pressure which
is a condition in which blood vessel pressure is constantly
increasing1. Blood pressure is divided into 3 categories
namely, normal (≤120/80 mmHg), prehypertension
(systolic: 120-139 mmHg and diastolic 80-89 mmHg)
and hypertension ≥140 mmHg6. Risk factors for
hypertension include prehypertension, diabetes, kidney
disease, high sodium and low potassium diets, high
fat diets, low consumption of vegetables and fruits,
lack of physical activity, obesity, excessive alcohol
consumption, smoking, age over 65 years, history
family, sex, race or ethnicity5,1.
In addition to the above risks, one of the chemical
elements that can affect blood pressure is Manganese
(Mn) although the results of the study are still
controversial. Based on population studies in Korea,
that Mn levels in the blood are positively related to
increasing hypertension7. However, another study states
that manganese is negatively correlated with blood
pressure8. Most studies on the relationship between
manganese and blood pressure have been carried out
from the perspective of manganese toxicity. These
studies report that manganese levels in the blood are
high, because excessive manganese exposure increases
blood pressure8. Based on the study of Kostial et al
(1974) reported that manganese increases blood pressure
in animal studies. However, Šarić and Hrustić (1975)
report that low blood pressure in workers exposed to
manganese. In particular, it is difficult to explain the
mechanism behind the correlation between manganese
intake and blood pressure. However, it has been reported
in several studies that abnormal manganese levels
decrease manganese-SOD activation, which inhibits the
anti-oxidative function of this enzyme and decreases the
defense capacity of vascular endothelium dysfunction
and causes hypertension8.
Mn is a metal group element in the form of gray
solids9. Mn is an essential element needed by the body
to maintain health, but in excessive amounts can cause
various health problems10. Mn organ targets include
the respiratory system, central nervous system, blood
and kidneys9. Landfill is one of the main sources of
groundwater contamination in the area around the landfill
due to the presence of leachate flow. These contaminants
come from organic materials, inorganic macro
components, heavy metals, metalloids and Xenobiotic
Organic Compounds (XOCs)11. Leachate contains high
concentrations of anionic and inorganic cations (eg
bicarbonate, sulfate, iron, manganese, sodium, chloride)
and dissolved organic matter (eg aldehydes, alcohols,
short sugar chains)12.
Cipayung Depok Final Disposal Site has been
built since 1984 with an area of ± 10.8 hectares with
an area of 5.1 hectares of landfill consisting of pond
A (2.1 hectares), pool B (2.4 hectares) and ponds C
(off 0.6 hectares). In 2011 pool C was closed because
landfill conditions were too high and too dependent on
residents’ housing, so it only depends on zones A and
B. In 2015 Cipayung landfill Depok increased landslides
into the central area so zones A and B became one with
elevations reaching ± 30 meters13.
The purpose of this study was to study the
relationship of Mn content in soil air and other factors
(obesity, blood sugar levels, age, smoking, ethnicity,
family research, socioeconomic and sex) to hypertension
in the study community community living in the
area around Places Cipayung Depok Final Disposal
(Landfill). The population is in two kelurahan, namely
Cipayung Kelurahan and Pasir Putih Kelurahan.
Method
The research method used cross sectional. The
research sample consisted of 107 people who were
administratively scattered in 2 Kelurahan namely
Cipayung Kelurahan and Pasir Putih Kelurahan.
Sampling is done by cluster sampling. The inclusion
criteria of the research were, a minimum stay of 5 years,
used ground water as a source of drinking water, and had
a life span of 18-60 years. While the exclusion criteria
were, respondents who had a history of hypertension
before living in the area around the Cipayung Landfill
Depok and had a history of blood clots (hemophilia).
Testing of Mn content in ground water as a source
of drinking water used the Indonesian National Standard
(SNI) method 6989.5: 2009 on how to test Mn by Atomic
Absorption Spectrophotometry (AAS) in the range of
Mn levels of 0.1 mg/L to 10 mg/L with a wavelength of
279.5 nm. Blood pressure meter measurements used the
 Indian Journal of Public Health Research & Development, March 2020, Vol. 11, No. 03  2485
ABN series and blood sugar measurements when using but substantively the level of Mn in ground water was
the GCU easy touch. Obesity measurement was done considered necessary with regard to hypertension, so
through Body Mass Index (BMI) measurement which that the variable was still included in the modeling. The
was the result of weight distribution (kg) by height final results of the modeling obtained, that the variables
squared (meters) and other characteristic data through that were risk factors for hypertension in the community
questionnaires. living around landfills are obesity (0.042 OR: 2,460)
and age (0,0001, OR: 10,675), while the Mn variable
Results in ground water was a variable controller (OR: 1.584)
A significant relationship between risk factors (Table 2).
for hypertension and hypertension is indicated by the
Discussion
age variable (0,0001, OR 9.58). While other variables
(obesity, blood sugar levels, smoking, ethnicity, family Obesity has a significant relationship (0.042)
history, socioeconomic, Mn levels in groundwater and with hypertension and has a greater risk of 2,460 to
gender) did not show significant results, but had an OR experience hypertension. Obesity is a major risk of
of more than 1, which were 2.05, 2.48, respectively, 3.19 hypertension14,15. Based on Wang’s research (2014) that
(active smokers), 1.79 (passive smokers), 1.02, 1.12, obesity has a very strong relationship with the incidence
0.96, 1.31 and 2.45. of hypertension16. Being overweight, especially when
associated with increased visceral adiposity, is a major
Table 1. Prevalence of Hypertension Based on cause of hypertension, accounting for 65% to 75% of the
Cluster Sampling. risk of human primary (essential) hypertension17.
Cluster Hypertension In the study results found that blood sugar levels>
Total
Points No Yes 140 mg/dL have a greater risk of 2.482 experiencing
1 13 (24.5%) 13 (24.1%) 26 (24.3%) hypertension. This is consistent with other studies
2 18 (34.0%) 19 (35.2%) 37 (34.6%) that cystotic pressure has a significant relationship
3 14 (26.4%) 15 (27.8%) 29(27.1%) with plasma glucose and fasting blood glucose18,19.
4 8 (15.1%) 7 (13.0%) 15(14.0%) In etiology, diabetes and hypertension share common
pathways such as SNS (Sympathetic Nervous System),
Based on the sampling cluster, the most hypertension
RAAS (Renin Angiotennsin Aldosterone System),
occurred in cluster number 2, namely 19 people (35.2%).
oxidative stress, adipokines, insulin resistance, and
A total of 16 people consumed ground water with Mn>
PPAR (Peroxisome Proliferator Activated Receptor)20.
0.4 mg/L and 9 of them had blood pressure> 120/80
mmHg (Table 1). Age> 35 years has a greater risk of experiencing
10,675 hypertension. This is consistent with CDC data
Table 2. Final Multivariate Modeling
that the prevalence of hypertension increases according
Odds Ratio to age group, age group 18–39, 7.5%; 40–59, 33.2%; and
Variable Sig CI (95%) 60 and over, 63.1%21,22. People who smoke actively (OR
(OR)
Body Mass Index (BMI) 0.042 2.460 1.033-5.860 3,188) and passive (OR 1,786) have a risk of developing
Age 0.001 10.675 3.240-35.169 hypertension. This is in accordance with the research of
Mn concentration in Thuey et al (2009) that hypertension has a relationship
0.450 1.584 0.481-5.222
groundwater with smoking dose23,24.

In multivariate modeling, of the 10 variables analyzed
6 of them could be entered into the model because the
significance is less than 0.25, including obesity (0.066),
blood sugar levels (0.189), age (0.0001), active smoking
(0.140), passive smoking (0.144) and gender (0.144).
While the ethnicity, family history and socioeconomic
variables were not included in the modeling because
the significance exceeded 0.25. The level of Mn in
ground water had a significance of more than 0.25,
People with a family history of hypertension had
a greater risk of 1,122 to develop hypertension. This
is in accordance with the research of Liu et al (2015)
that family history has a significant relationship with
hypertension25. Higher prevalence in family history with
hypertension is also associated with the prevalence of
obesity, central obesity and metabolic syndrome26.
Mn concentration> 0.4 mg/L in ground water used
2486  Indian Journal of Public Health Research & Development, March 2020, Vol. 11, No. 03
as a source of drinking water has a risk of 1,314 to cause
hypertension, although several studies have different
results. The results of this study are similar to those of Lee
and Kim (2011) that the concentration of Mn in the blood
is associated with an increased risk of hypertension in a
representative sample of the adult population in Korea7.
While the study of Wu et al (2017) the concentration of
Mn in urine has a negative correlation (p <0.01) with
systolic pressure and diastolic27. Based on the results
of this study, found a greater risk of hypertension
in men than woman is OR 2,450. These results are
in accordance with research of Choi et al (2017) the
prevalence of hypertension was higher in men (34.6%)
than in women (30.8%)28. However, after the age of 60
years, hypertension was more prevalent in females than
in males. Based on the research of Alhawari et al (2017)
significant gender differences in systolic pressure (=
0.003) with mean differences = 18.08 mmHg (CI: 16.13
to 19.9) and diastolic pressure (= 0.011) with differences
in mean mean = 3.6 mmHg (CI: 2.06 to 5.14), higher in
men than in women29.
Conclusions
There is no relationship between manganese levels
in drinking water with hypertension, but obesity and age
have a significant relationship with hypertension. The
variables of obesity (0.042, OR: 2,460) and age (0,0001,
OR: 10,675) showed significant with hypertension. The
level of manganese in drinking water to hypertension
did not show significant results as a controlling variable
(0.450, OR: 1.584). The variables, blood sugar levels,
smoking, ethnicity, family history, socioeconomic and
gender did not show significant results, but had an OR
more than 1, which were respectively 2.05, 2.48, 3.19
(active smokers), 1.79 (passive smokers), 1.02, 1.12,
0.96 and 2.45.
Ethical Considerations: This study was approved
by The Research and Community Engagement Ethical
Committee Faculty of Public Health Universitas
Indonesia (Ket-698/UN2.F10/PPM.00.02/2019).
Competing Interests: The authors declared that no
competing interests exist.
Acknowledgements: Acknowledgments from the
researchers were conveyed to the Universitas Indonesia
for funding all of this research. Expressing thanks to the
Jakarta Center for Environmental Health Engineering,
which has been pleased to test water samples, the
National Unity and Politics Agency (Kesbangpol Kota
Depok), Cipayung and Pasir Putih Village Governments
who have allowed researchers.
Source of Funding: This research was fully funded
by Hibah Publikasi Internasional Terindeks Tugas
Akhir (Hibah PITTA B) No: NKB-0591/UN2.R3.1/
HKP.05.00/2019.
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