Jagonob and Adam

EFFECTIVENESS OF HERBAL AND PRESCRIBED MEDICINE IN MANAGING
PATIENTS WITH HYPERTENSION
A Thesis Presented to the Faculty Cotabato Medical Foundation College Incorporated
Midsayap, Cotabato
In Partial Fulfillment of the Requirements for Nursing
By
Adam, Shaira A.
Jagonob, Glyndee Marr E.

COTABATO MEDICAL FOUNDATION COLLEGE
NURSING DEPARTMENT
Poblacion 8, Quezon Ave., Midsayap, Cotabato
APPROVAL SHEET
In partial fulfillment of the requirements for the degree of Bachelor of
Science in Nursing this THESIS entitled:
EFFECTIVENESS AMONG HERBAL MEDICINE, PRESCRIBED MEDICINE AND
COMBINATION OF HERBAL AND PRESCRIBED MEDICINE IN MANAGING PATIENTS
WITH HYPERTENSION IN BARANGAY BARONGIS, LIBUNGAN, COTABATO
has been prepared and submitted by Lorna E. Vallar who is recommended for the
corresponding ORAL EXAMINATION.
Ms. ……………………….
Adviser
APPROVED in partial fulfillment of the requirements for the degree of
BACHELOR OF SCIENCE IN NURSING
by the Oral Examination Committee:
Romulo M. Garcesa, EdD
Chairman
Imelda H. Mariano, RN Roque Ciasico, MIM
Member Member
Effie Magatao, BSEd
Member
ACCEPTED in partial fulfillment of the requirements for the degree of
BACHELOR OF SCIENCE IN NURSING
Lorna E. Vallar, RN, MAN

Dean
2024
Date
TABLE OF CONTENTS
TITLE Page
PAGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. i
APPROVAL SHEETS
1. RECOMMENDING ORAL DEFENSE . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii

2. ACCEPTANCE OF PAPER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii
ACKNOWLEDGEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .iv
ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v
TABLE OF CONTENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vi
1. LIST OF TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii
2. LIST OF FIGURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
CHAPTER I INTRODUCTION
Review of Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Theoretical Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Conceptual Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Statement of the Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Hypotheses (if applicable) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Significance of the study (for proposal include in
INTRODUCTION, for final paper, integrate in DISCUSSION)
CHAPTER II METHOD
Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . .. . . . . . . . . . . . . 33
Setting (if applicable) . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . 33
Participants (may include the sampling applied) . . . . . . . . . . . . . . . . . . . . . . . 33
Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . . . . . 34
Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Data Analysis (for proposal, include in METHOD; for final paper,
integrate in RESULTS)
Limitation of the Study (for proposal, include in METHOD; for
final paper, integrate in DISCUSSION)
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
APPENDICES
A. Letter of Permission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
B. Statistical Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
C. Research Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Effectiveness of Herbal and Prescribed Medicine in managing Hypertension

CHAPTER 1
INTRODUCTION
Hypertension does not cause symptoms on its own, but it slowly damages blood vessels,
and in the long-term, is a major risk for a variety of cardiovascular diseases such as stroke,
aneurysm, and heart attack; as well as end organ damage such as renal failure and vision loss.
For these reasons, hypertension is also known as silent killer. It can be classified as primary or
secondary hypertension. Primary hypertension has no apparent cause and may develop as a result
of old age, obesity, high-salt diet, lack of exercise, smoking and drinking. While secondary
hypertension is caused by underlying conditions, most notably, kidney problems and endocrine
disturbances (Benetos, et al., 2019).
South-East Asia is expected to have the highest male hypertension prevalence, whereas
Africa is expected to have the highest female hypertension prevalence. The prevalence of
hypertension in both sexes is expected to be highest in low-income countries. By 2040, the male
population is anticipated to have a higher prevalence of hypertension than the female population.
Globally, hypertension prevalence is expected to fall from 22.1% in 2015 to 20.3% (20.2 -
20.4%) in 2040 (Boateng et al., 2023).

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The purpose of studying herbal and prescribed medicine for the management of
hypertension can be useful for several reasons. Through learning about the different remedies
and treatments available, individuals can make informed decisions about their health and take
charge of their health management. Thus, knowing the effectiveness of compliance in herbal and
prescribed medicine can help individuals manage their condition more effectively, reduce the
risk of complications, and take a more active role in their healthcare.
Review of Related Literature
Management of Hypertension
Both pharmacologic and nonpharmacologic methods are used to treat hypertension.
Decisions on treatment are based on the presence or absence of diabetes mellitus, chronic renal
disease, or cardiovascular disease. One of the suggested approaches is limiting daily sodium
consumption to less than 1500 mg if the patient is fat or overweight, they should engage in
resistance or aerobic training for 90 to 150 minutes per week, moderate alcohol consumption (≤2
drinks per day for men and ≤1 drink per day for women), and increased consumption of foods
high in potassium. It is anticipated that each of these tactics will lower systolic pressure by 3 to 8
mm Hg and diastolic pressure by 1-4 mmHg (Taler, 2018).
Muntner, et al., (2020) stated that hypertension control rates remain unsatisfactorily low
among patients treated with effective antihypertensive therapy. Home blood pressure monitoring
(HBPM) is recommended by multiple international hypertension guidelines as an effective way

to assess blood pressure (BP) control in patients treated with antihypertensive medications.
Clinicians who recommend HBPM should educate patients on proper home BP measurement
techniques, as well as recommend validated automatic monitors which measure BP from the
upper arm. Available guidelines largely recommend a standardized HBPM schedule, including
measuring BP twice per day for seven days, should be used to assess BP control. Averaged home
BP values should be used to evaluate BP control, with prompt antihypertensive adjustment
recommended if average home BP readings are above 135/85 mmHg, and close follow-up
monitoring thereafter to ensure continued BP control.
Even among patients receiving effective antihypertensive medication, the rates of
hypertension control are still unsatisfactorily low. Several international hypertension
recommendations endorse HBPM as a useful tool for evaluating blood pressure control in
individuals receiving antihypertensive therapy. In addition to recommending validated automatic
monitors that take blood pressure from the upper arm, clinicians who offer HBPM should
instruct patients on appropriate home BP measurement practices. The majority of available
guidelines suggest that a standardized HBPM schedule be used to evaluate blood pressure
control, which includes taking blood pressure twice a day for seven days. The average home
blood pressure readings should be used to assess blood pressure control. If the readings are more
than 135/85 mmHg, immediate antihypertensive medication adjustment is advised, and close
follow-up monitoring is then advised to guarantee that blood pressure control is maintained
(Andraos, et al., 2021).
Umemura, et, al. (2019) stated that measuring blood pressure at home can help patients
adhere to their treatment plans better and avoid over- or under-medicating their hypertension.

Measuring the morning/evening or evening/monitoring ratio prior to taking a medication is very
helpful in determining how long the drug's effect will last. The diagnosis of resistant
hypertension, morning hypertension, masked hypertension, white coat hypertension, and
selecting a treatment plan can all be accomplished with the help of a home blood pressure
monitor. Home blood pressure is helpful for evaluating blood pressure variability over an
extended period of time, such as seasonal variations in blood pressure, because it can be
monitored often and for an extended length of time.
In the study entitled the relationships between self-reported dietary practices and food-
based dietary quality, adequate nutrient intakes, following the recommended diet guidelines with
BP management among Korean adults who have knowledge of high blood pressure. It
emphasized that a nutritious diet has a positive correlation with managed blood pressure, which
was only significant in males. Environmental factors including nutrition and exercise have a
continual impact on blood pressure. Significant consequences of the impact of nutrition on blood
pressure regulation using many clinical and epidemiologic attempts. A superior diet, such one
that a higher healthy eating index (HEI) score diet and a Mediterranean diet, can further reduce
blood pressure in those who are already hypertensive and can stop the development of
hypertension in normotensive people (Shim, et al., 2019).
Faisal, et al., (2018) stated that current research in the medical literature demonstrates
that high sodium chloride (salt) levels dramatically raise blood pressure. Conversely, it has been
demonstrated that consuming less salt can have a major the frequency and risk of high blood
pressure. Reducing salt consumption has also been shown to dramatically lower heart
morbidities in obese patients and improve under controlled hypertension in the elderly. Feeding

research called Dietary Approaches to Stop Hypertension (DASH)-Sodium reported in non-
hypertensive individuals, a reduced sodium consumption will result in a considerable reduction
in their risk of hypertension. Three categories of sodium intake were identified by the study: high
(about 143 mmol/d), which represents the consumption of most people), low (65 mmol/d) and
intermediate (about 106 mmol/d). they found that intermediate sodium intake can reduce
hypertension incidence and complications.
Given that endothelial dysfunction is linked to hypertension and is a precursor to vascular
disorders in humans, the adjustment of a healthy lifestyle, which includes regular exercise and
proper diet, is anticipated to be a significant and successful non-pharmacological therapy for the
management and treatment of hypertension and cardiovascular problems. Numerous
investigations involving individuals with normotension, and hypertension revealed of the
reduction in total peripheral resistance brought about by consistent, moderate physical activity.
Additionally, the release of various cytokines is linked to active muscles and diverse anti-
inflammatory peptides, which in turn boost the bio availability of NO by reducing the generation
of ROS. According to these findings, exercise-induced vasodilation was also connected to new
arterioles developing and sympathetic vasoconstrictor tone being decreased in the already-
existing containers. It appears from this that there is concrete proof that exercise reduces
sympathetic the reduction of blood pressure after training is supported by activity, which
suggests that neuronal cardiovascular control is involved (Laresen, et al., 2018).
Widiyanto, et al., (2021) stated that nicotine contains chemicals that can harm the lining
of the artery walls and increase the risk of plaque development in the arteries, smoking can raise
blood pressure (atherosclerosis). Nicotine is mostly to blame for this, as it can activate the

sympathetic nervous system, which makes the heartbeat faster and narrow blood vessels. Carbon
monoxide also plays a part, as it can replace oxygen in the blood, forcing the heart to beat faster
in order to fulfill the body's oxygen demands. Heart disease and hypertension are conditions that
smokers are two to four times more likely to have. When smoking, detrimental substances like
nicotine enter the body and particularly the heart. Nicotine has the ability to lower blood oxygen
levels when it enters the body. This addictive drug can also cause damage to heart blood arteries,
elevate blood pressure, quicken heartbeats, and increase the risk of blood clots that can
precipitate a heart attack.
Both hypertensive and normotensive subjects experience a dose-related effect on blood
pressure when consuming higher amounts of alcohol. Drinking alcohol excessively or
chronically can lead to a number of negative consequences. Heart failure, an elevated risk of
cancer, liver disease, inadvertent injuries, and neurological problems are among them. If people
are at risk, then alcohol consumption, even moderate amounts, must be forbidden. Aside from
this, drinking alcohol was linked to high blood pressure and blood pressure. Drinking alcohol
increases the release of sympathetic amines and the activation of the sympathetic nervous system
(SNS). Alcohol consumption may have an impact on the autonomic nervous system (ANS),
which may result in hypertension. Increased sympathetic flow may cause not only adrenoceptor-
mediated responses that may result in vasoconstriction and elevated heart rate) as well as
oxidative processes. It may also stimulate the adrenal glands, causing them to generate
adrenaline, which raises systolic blood pressure (SBP) and cardiac output. Alcohol can cause
harm via interacting with the receptors in the baro-reflex the stem of the brain (Wake, 2021).

Koliaki, et al., (2019) stated that the higher body mass brought on by obesity can raise
blood pressure. The quantity of nutrients and oxygen that the body's tissues require depends on
body mass. Blood circulating in the blood causes an increase in blood pressure. Artery blood
flow as a result of vascular expansion generating an elevation in blood pressure. Being fat causes
an individual's bodily tissue to require more oxygen and food, which raises blood pressure, heart
rate, and blood volume. It is possible for subcutaneous adipose tissue to become too small to
store excess energy when an individual is obese.
The current study evaluated various subgroups of hypertension patients' commitment to a
healthy lifestyle. The official guidelines for treating hypertension state that changing one's
lifestyle is the primary course of treatment for patients with the condition. It is anticipated that as
more people become aware of hypertension, their lifestyles will alter accordingly. However,
many hypertensive patients believe that controlling their condition with antihypertensive
medications is sufficient, and as a result, they do not perceive the need to change their way of
living. Lastly, because maintaining a healthy lifestyle necessitates the right interventions and
training, changing one's lifestyle is challenging (Akbapour, et al., 2018).
Choudhry, et al., (2021) stated that adherence to treatment regimens and healthy lifestyles
can be negatively impacted by the co-occurrence of various chronic illnesses in adults with
hypertension, such as depression, post-traumatic stress disorder, and other behavioral health
disorders like drug and alcohol misuse. Furthermore, memory changes in older people can lead
to missed doses and overdosing or ingesting more medication than is recommended which can
result in drug toxicity. Medication adherence can also be hindered by significant disabilities and

poor quality of life, particularly if the medications do not improve quality of life or lessen the
disability right away.
A healthy lifestyle can help reduce weight, improve sensitivity to antihypertensive drugs,
and have positive effects on cardiovascular risk factors on its own. The best way to stop the
harmful effects of the obesity-hypertension phenotype is to encourage maintaining a normal
body weight for the rest of one's life. A sizable section of the population would have a reduced
chance of getting hypertension if fat were eliminated from the picture. In order to prevent obesity
from occurring, multiple stakeholders must collaborate towards a shared objective through a
multifaceted approach. Encouragement of the adoption of a healthy lifestyle at all levels—from
the person to the population—is the main goal. Maintaining a normal body weight is mostly
dependent on leading a healthy lifestyle, which includes eating a diet rich in nutrients and
balanced in calories (Leggio, et al., 2018).
Carnagarin, et al., (2028) stated that in addition to lowering blood pressure, renin-
angiostensin system (RAS) blockage reduces inflammation, oxidative stress, and glucose levels
equilibrium. RAS inhibitors are thought to be the most suitable first-line pharmacotherapy in
ocular hypertension (OHT) due to their wide range of positive effects, as well as their superior
tolerability and demonstrated protection against cardiovascular disease and metabolism. When
ACE inhibitors and angiotensin receptor blockers (ARBs) were used in place of traditional
hypertension therapies like diuretics and β-blockers, lower rates of newly diagnosed type 2
diabetic mellitus (T2DM) were seen, suggesting a positive metabolic impact. Apart from its
efficacious lowering of blood pressure, RAS blockage has demonstrated benefits for

cardiovascular disease and chronic renal disease, delaying the advancement of diabetic
nephropathy, and having positive impacts on the lipid profile.
Effectiveness of Herbal Medicine in managing patients with Hypertension
Spinach is enriched with heart-friendly nutrients like folate and magnesium. The leafy
wonder is also a good source of lutein. Lutein is instrumental in preventing thickening of walls
of arteries, which helps reducing the risk of strokes and blood pressure. Spinach can help manage
hypertension, or high blood pressure, in a few ways. It contains potassium, which helps balance
sodium levels in the body and regulate blood pressure. Spinach has nitrates that can turn into
nitric oxide, a compound that relaxes blood vessels and improves blood flow. The antioxidants in
spinach, like vitamins C and E, help reduce inflammation and oxidative stress that can contribute
to high blood pressure. Spinach is a good source of magnesium, which plays a role in blood
pressure control. While spinach alone may not cure hypertension, including it in a healthy diet
can be beneficial for managing blood pressure (Leo, et al., 2018).
Carrot ( Daucus carota L.) has been used in traditional medicine as an anti-hypertensive
mediator. It improves endothelial function and regulates fluid balance. Carrot juice is rich in
antioxidants, which decrease oxidative stress and control the function and structure of blood
vessels. Carrots regulate BP because of the existence of potassium. Intravenous administration of
the bio-active components of the aerial parts of D. carota, including DC-2 and DC-3, triggered a
decrease in arterial BP in NMT rats. DC-2 and DC-3 can act by obstructing calcium channels
(Soleti, et al., 2021).

Cinnamon (Cinnamomum zeylanicum) is another plant used for the treatment of
hypertension (HTN). Cinnamon has reduced BP in numerous rat models and in people with
prediabetes and type2 diabetes (T2D). The aqueous extract of its stem bark causes a reduction in
SBP and prevents contractions prompted by potassium chloride (also known as KCl), related to
the endothelium, NO, and ATP-sensitive K+ channel (K ATP channel). The methanolic extract
of the bark increases NO levels (Torbati, et al., 2021).
Cocoa bean powder (Theobroma cacao), augmented with flavonoid components, is used
for inhibiting CVDs by motivating the creation of NO, increasing vasodilation, and decreasing
endothelial dysfunction. Daily use of dark or milk chocolate (40 to 105 g) can decrease SBP by
about 5 mm Hg and DBP by about 3 mm Hg ( Fazlijou, et al., 2021).
Coffee weed (Cassasia occidentalis) also decreases BP. The leaf of this plant is used as an
antihypertensive agent. Coffee weed has been found to decrease BP levels, probably through the
suppression of external Ca2+ influx. Coffee weed leaves have diuretic effects along with anti-
inflammatory and anti-oxidant properties. They decrease lipid peroxide content and inhibit
phospholipase A2 activity (Kamyab, et al., 2021).
Garlic ( Allium sativum) supplements have revealed their effectiveness in the treatment
of HTN, decreasing BP by about 10 mm Hg systolic and 8 mm Hg diastolic, like standard BP
medication. This herb is recognized for its antibacterial, antioxidant, anti-inflammatory, anti-
cancer, and hypocholesteremic effects. One study displayed that garlic had an approximately
80% effectiveness in the treatment of HTN. Aged garlic extract (AGE) induces a constant drop
in BP compared to with other forms of garlic. Furthermore, garlic supplements prompt a major

decrease in both SBP and DBP by 3.75 and 3.39 mm Hg, respectively. In another study, patients
with HTN who ingested garlic tablets (300–1500 mg/d) for 24 weeks described a considerable
reduction in SBP by 9.2 mm Hg and DBP by 6.27 mm Hg. Moreover, age has super-oxide
scavenging abilities in human neutrophils, and daily use of 150 or 400 mg/kg of garlic extract
prompted an increase in eNOS activity and a decline in nicotinamide adenine dinucleotide
phosphate (NADPH)-oxidase in the aortas of fructose-fed rats. The components of garlic inhibit
ACE activity, diminish Ang II-induced vasoconstrictor responses, prevent VSMCs proliferation
in smooth muscles, antagonize endothelin-1 prompted vasoconstriction, and inhibit the
stimulation of NF-κB. Some B vitamins are important co-factors in the mechanisms of action
through which sulphur components in garlic are transformed into H2S, serving as signaling
molecules for smooth muscle cell relaxation and vasodilation, leading to a reduction in blood
pressure (Ried, 2020).
Ginger (Zingiber officinale), generally recognized as ginger, has been broadly used in the
daily diet and for different therapeutic purposes. Ginger contains a large amount of potassium,
which plays a role in the regulation of BP and heartbeat. Administration of two bioactive
components of ginger, (6)-gingerol and (6)-shogaol, orally (70– 140 mg/kg) or intravenously
(1.75–3.5 mg/kg) creates tri-phasic BP profiles: first a rapid drop, then an intermediate increase,
and lastly, a delayed decline in BP. Currently, (6)-gingerol is considered to be a new Ang II type
1 receptor antagonist. Recently, it has been found that ginger decreases levels of total
cholesterol, triglycerides, low-density lipoprotein (LDL), and very low-density lipoproteins
(VLDL). It also inhibits ACE-1 activity (Kamyab, et al., 2021).

Lemongrass (Cymbopogon citratus) is a plant whose leaves and oil are used to make
medicine. Lemongrass is widely used in Southern Asia, China, and Brazil. Its antihypertensive
effects have been ascribed to Citral, its active phytochemical compound. Citralor crude extracts
cause dose-dependent vasorelaxation through the activation of NO and the suppression of
calcium channels. Lemongrass exerts modest antioxidant activity by suppressing ROS molecules
and is involved in anti-inflammatory pathways by preventing NF-κB and iNOS activity
(Namdar, et al., 2021).
Onion (Allium cepa) was shown to decrease BP in fructose-fed and anesthetized
normotensive rats. Organo-sulfur compounds have been correlated with reducing BP by
sustaining the elasticity of the major arteries accompanied by lowering the blood viscosity,
thereby preventing blood clotting. Quercetin, the composite most usually related to onions, can
decrease BP an average of 5 mm Hg by decreasing oxidative stress through its reaction with free
radicals and progressing vascular function. Aqueous extracts of onion (400 mg/kg/d) increased
eNOS expression but decreased that of VCAM-1. The antioxidant effects of onion seem to be the
result of the inhibition of NADPH oxidase activity together with a simultaneous rise in
antioxidant kinetics of glutathione peroxidase (GPX) enzymes and SOD (Araj-khodaei, et al.,
2021).
Tomato (Lycopersicon esculentum) is the edible part of the plant Solanum lycopersicum.
Tomato extract contains carotenoids which are recognized as operative antioxidants. The extract
of tomato (Lyc-O-Mato) moderately decreased BP in patients with HTN. Tomato extract has a
clinically substantial capacity to decrease SBP by more than 10 mm Hg and DBP by more than 5
mm Hg. The root extract of tomato reduced BP levels in hypertensive rats. The antioxidant-rich

extract of tomato has been revealed to decrease both SBP and DBP in hypertensive patients
(Ghojazadeh, et al., 2021).
Turmeric (Curcuma longa) originates from Southeast India and is widely cultivated in the
tropical areas of South Asia. Turmeric, also called curcumin, has anti-inflammatory and anti-
cancer properties. Curcumin exerts advantageous effects on CVDs, such as HTN. Curcumin
decreases AT1R expression in arteries by disturbing SP1/AT1R DNA binding, thereby
decreasing AT1R-mediated vasoconstriction and then inhibiting the progress of HTN (Namadar,
et al., 2020).
According to Ramolundi, et al., (2018) although the use of herbal medicines is generally
considered “safe” because they are “natural,” the intake of such herbal preparations may
negatively affect hypertension, particularly in older patients treated with polypharmacy. Herbal
medicine may affect the drug absorption and metabolism or excretion of concomitantly
administered cardiovascular drugs. For example, when garlic (Alium sativum L.) is taken with
anticoagulant, anti-platelet and non-steroidal anti-inflammatory drugs, it increases the risk of
bleeding.
In addition, danshen can regulate the cAMP signaling pathway, cGMP-PKG signaling
pathway, mTOR signaling pathway, Ras signaling pathway, and Rap1 signaling pathway to
mediate cell proliferation and differentiation. On the other hand, baizhu and qianshi can
participate in the metabolism of amino acids such as glycine, serine, threonine, alanine, aspartate,
and glutamate to regulate the cellular processes. Huangqi shows the most extensive regulation
cellular life processes, including the regulation of DNA transcription factors and a variety of

amino acid metabolic pathways, and it shows a variety of regulatory effects on the function of
the kidney and heart. It is suggested that these herbs can produce synergistic and complementary
effects in the treatment of HN. The therapeutic effects of these herbs on HN are mainly the
deceleration of the renal damage caused by hypertension, protection of nephrons and podocytes,
reduction in blood pressure and the amount of protein in urine, and slowing renal interstitial
fibrosis and maintaining nephron function, but the effect of a single herbal medicine is often
limited. To achieve the expected therapeutic effects, these herbs need to be combined. These
herbs are often used in the clinic. This finding is consistent with the results in this study, showing
that these herbs fall under the important compatibility rules identified by the apriori algorithm
(Huan, et al., 2021).
Blood pressure levels in the 130-139 SBP, and DBP 85–89 mmHg range are related with
a more than two-fold increase in relative risk of cardiovascular disease when compared to blood
pressure levels below 120/80 mmHg, also the benefits of lowering BP, which was associated
with reductions in stroke incidence by 35-40%, myocardial infarction by 20-25%, and heart
failure by 50%. Systematic review provides evidence that the integrated CHM with WM could
improve the clinical effectiveness, SBP, and DBP in patients with PHTN better than using WM
alone. In treatment duration less than 7 weeks, combination therapy CHM with WM improves
SBP and DBP better than WM alone, but there is no significant difference in more than 7 weeks.
Moreover, no patient stopped treatment or withdrawal due to severe adverse effects, indicating
that combining CHM with WM could be safe in treating hypertension (Mohammed, et al., 2023).
The antihypertensive effects of Nigella sativa may be due to many active compounds,
each with distinct mechanisms of action. There are several possible mechanisms involved in BP

reduction, which include cardiac depressant effect, calcium channels blocking properly, and
diuretics effects. Black cumin seed is believed to have a relaxant effect on smooth muscle and
may act like a calcium channel blocker to dilate blood vessels. Other researcher suggest black
seed extracts may help the heart pump more efficiently, or that black seed has a diuretics action.
Therefore, this prophetic remedy can be considered a safe and effective alternative to modern
medicine for the prevention and treatment of hypertension. It is imperative that the alternative
cure should be effective, free from side effects, easily usable and affordable ( Musharraf, 2018).
Bahha, et al., (2022) stated that natural goods are a valuable supplementary and
complementary therapies that are able to handle several health conditions including
cardiovascular disease and hypertension diseases, dyslipidemia, and diabetes mellitus. Medicinal
medicine is described as pharmaceuticals that come from plants through heating, filtration, or
extraction steeping or using any other tangible techniques. The application of the use of herbs as
the main treatment for various ailments is growing appeal across the globe because of the
simplicity of access, natural origin, the impression of extreme safety, and suitable effectiveness.
Traditionally, traditional medicine refers to a broad range of antiquated, culturally
specific medical procedures that were in use for centuries prior to the application of science to
health issues. Patients with cardiovascular diseases—which can be brought on by conditions
affecting the heart and blood vessels and include heart attacks, cerebrovascular illnesses,
hypertension, and heart failure—are treated using medicinal herbs. In addition to contributing to
atherosclerosis, which increases the risk of heart attack and stroke, hypertension impairs heart
function. There are numerous medications available to treat these conditions, yet popular
antihypertensive medications typically have a number of negative effects. Many active

ingredients found in medicinal herbs have pharmacological and preventive qualities, making
them useful for treating hypertension (Kamyab, et al., 2021).
Effectiveness of Prescribed Medicine in Managing Hypertension
According to Saseen (2018), central α-agonists stimulate α2-receptors in the brain and
result in decreased sympathetic nervous outflow and decreased peripheral arterial resistance.55
They lower BP effectively and quickly but can also cause rebound hypertension when stopped
abruptly after chronic use. Central α-agonists often result in sodium and water retention; thus, it
may be desirable to use these drugs in combination with a diuretic. Clonidine is the most
commonly prescribed central α-agonist. It is limited by dose-dependent anticholinergic side
effects such as drowsiness, dry mouth, and constipation. Transdermal clonidine is particularly
useful in the management of the labile hypertensive patient who requires multiple medications,
the hospitalized patient who cannot take medications by mouth, and the patient prone to early-
morning surges in BP. Clonidine overdose can produce paradoxical hypertension when the
depressor effects of central α2-adrenergic–receptor stimulation are exceeded by the pressor
effects of peripheral α2-adrenergic–receptor stimulation, resulting in a predominantly
vasoconstrictive response.
Centrally acting antihypertensive compounds remain an important therapy in the
management of hypertension. A significant number of patients have their hypertension linked to
the SNS so significantly that drugs in this class can be readily viewed as first‐step therapies;
however, centrally acting antihypertensive compounds are used most regularly in an add‐on
capacity for general control of hypertension, whatever its primary origin. The prototype

compounds in this class—α‐methyldopa and clonidine—are now used less regularly because of a
fairly oppressive side effect profile. There are several choices within the centrally acting
antihypertensive medication class, however, which improves the chances of finding a well‐
tolerated compound. Centrally acting antihypertensive compounds are diversified in their
actions, both reducing BP and favorably influencing a number of nonhypertensive circumstances
coupled with SNS overactivity. The onset of action varies among the compounds in this class,
with clonidine showing meaningful activity within 15 to 30 minutes of intake (Sica, 2018).
Additive blood pressure (BP) lowering effects have been demonstrated when ARBs are
combined with thiazide diuretics or dihydropyridine calcium channel blockers, augmenting
hypertension control. Furthermore, therapeutic use of ARBs goes beyond their antihypertensive
effects with evidence-based benefits in heart failure and diabetic renal disease particularly among
ACE inhibitor intolerant patients. On the other hand, combining renin-angiotensin system
blocking agents, a formerly common practice among medical subspecialists focusing on the
management of hypertension, have ceased to do so as there is not only evidence of
cardiovascular benefit, but modest evidence of harm, particularly with regard to renal
dysfunction. Inhibition of angiotensin converting enzyme only partially inhibits the formation of
angiotensin II. Angiotensin II activates two types of angiotensin II receptors (ATR) – ATR1 and
ATR2. The ATR1 receptors are abundant in the vessels, brain, heart, kidney, adrenal gland, and
nerves while ATR2 are prominently expressed in the fetus but decrease in number during the
postnatal period where they are only available in small amounts in the adult kidney, adrenal
gland, heart, brain, uterus, and ovary. Activation of ATR1 increases inositol triphosphate and
various arachidonic acid metabolites and decreases cyclic adenosine monophosphate. This

causes generalized vasoconstriction from contraction of vascular smooth muscle, increases in
aldosterone resulting in increased sodium reabsorption in the proximal tubule and cell growth in
the arteries and heart (White, et al., 2019).
These beta‐blocker effects are inferior to those of other antihypertensive drugs. The
effectiveness and safety of these pharmacological agents when used as first-line treatment for
hypertension. These effects of beta-blockers were similar to those of thiazide diuretics, but
patients were more likely to withdraw from a beta-blocker due to the side effects than a diuretic.
Scientific evidence rapidly accumulated to show that the cardiovascular protection and safety
profile of beta-blockers was inferior to that of newer antihypertensive agents such as calcium
channel blockers and inhibitors of the renin-angiotensin system. The incidence of stroke was
significantly higher for patients whose antihypertensive treatment was commenced with a beta-
blocker than for those who received a renin-angiotensin system inhibitor. In theory, third-
generation beta-blockers should reduce central blood pressure more than conventional beta-
blockers because vasodilatation by the former may alter the pattern of the pressure wave
reflecting back from the periphery.beta-blockers are effective in preventing cardiovascular
disease but are no longer suitable for routine initial treatment of hypertension because their
cardiovascular protection and metabolic effects are worse than those of other antihypertensive
drugs ( Bradley, et al., 2018).
Angiotensin-converting enzyme inhibitors effectively lower the mean arterial blood
pressure as well as systolic and diastolic blood pressure both in hypertensive and normotensive
subjects. Recommend ACE inhibitors as first-line antihypertensive therapy, especially in patients
with diabetes mellitus and cardiovascular diseases. Although ACE inhibitors are generally very

effective antihypertensive drugs, they have been proven to be less effective in hypertensive
Black race individuals than in whites in clinical practice. ACE inhibitors block an angiotensin-
converting enzyme that converts angiotensin I to angiotensin II. Decreased production of
angiotensin II enhances natriuresis, lowers blood pressure, and prevents remodeling of smooth
muscle and cardiac myocytes. Lowered arterial and venous pressure reduces preload and
afterload. Also, the hypothesis is that ACE inhibitors interfere with the degradation of
bradykinin, a peptide that causes vasodilation. Angiotensin-converting enzyme regulates the
balance between the vasodilatory and natriuretic properties of bradykinin and the
vasoconstrictive and salt-retentive properties of Angiotensin II. ACE inhibitors alter this balance
by decreasing the formation of Angiotensin II and the degradation of bradykinin. ACE inhibitors
also alter the formation and degradation of several other vasoactive substances, such as substance
P, but the contribution of these compounds to the therapeutic or adverse effects of ACE
inhibitors is uncertain (Herman, et al., 2023).
Thiazide diuretics are superior to any other diuretic agent for hypertension treatment and
subdivide into two subcategories, i.e., thiazide-type and thiazide-like diuretics. Thiazide-like
diuretics are so-called because they lack the benzothiadiazine backbone (thus the chemical
properties associated with it), which is characteristic of Thiazide-type agents. Among the
thiazides, thiazide-like drugs are exceptional and better than thiazide-type diuretics in handling
high BP with the least adverse effects such as metabolic or electrolyte disturbances. In the DCTs,
the most abundant Na+ reabsorption occurs through the NCC channels, which are the lone
targets of thiazide diuretics. Thiazides exert their action by competitively binding to the chloride
binding site of the NCC’s transmembrane domain and inhibiting the Na+ reabsorption. The

important role of NCC channels is well-established as in patients with loss-of-mutation of this
channel causes gitelman syndrome manifesting with hypokalemic metabolic alkalosis,
hypomagnesemia, hypocalciuria, and lower systemic BP. Low-dose thiazide-like agents are
considered the best antihypertensive agent as it lowers BP on chronic use irrespective of volume
depletion. Though the exact mechanism is still unclear, it is theorized to occur through direct
endothelial or vascular smooth muscle-mediated vasodilation (probably by altering Ca2+
regulation), reverse whole body regulation, and/or renal autoregulation. All thiazides are
sulfonamide derivatives that are readily absorbed from the gastrointestinal (GI) tract after oral
administration. With a half-life of approximately 42 hours, chlorthalidone has a larger volume of
distribution than its thiazide-type counterpart hydrochlorothiazide because they bind to red blood
cell (RBC) carbonic anhydrase and are sequestered in these cells, reaching a concentration 7 to
10 times more than that of plasma. Thus, RBCs act as a reservoir, and the drug is released into
the plasma gradually, which can be utilized clinically by a once-daily dosing regimen (Shahin, et
al., 2023).
Calcium channel blocker (CCB)-based combination strategies are effective and well
tolerated when used with other classes of antihypertensive drugs, and should be considered a
first-line option in hypertensive patients, particularly in those at high cardiovascular risk.
Calcium channel blockers are used extensively in clinical practice and data from several clinical
studies show that CCBs effectively and safely lower BP and reduce long-term CV risk in a wide
range of patient populations. CCB and ACE inhibitor combination therapy with amlodipine and
benazepril was significantly more effective in reducing SBP and pulse pressure in patients with
severe systolic hypertension than either monotherapy. Combination therapy with

antihypertensive agents that have different but complementary mechanisms of action not only
avoids unnecessary drug interactions and adverse events, but also maximizes the benefits of
agents that have additional effects beyond BP lowering. For example, there is evidence to show
that the combination of CCBs and ARBs provides end-organ protection through synergistic
mechanisms. CCBs are effective with all other antihypertensive agents, and this flexibility makes
them ideal as part of a first-line combination strategy to achieve target BP and provide additional
CV benefits, without compromising safety in patients at increased CV risk (Haller, 2018).
On the other hand, the sympathetic nervous system plays a pivotal role in the long-term
regulation of arterial blood pressure through the ability of the central nervous system to integrate
neurohumoral signals and differentially regulate sympathetic neural input to specific end organs.
Recent evidence suggests that autonomic circuits can be sensitized by prior exposures to stimuli
that subsequently alter future cardiovascular responses Sympathetic hyperactivity in human
hypertension has been revealed through elevated norepinephrine spillover, increased muscle
sympathetic nerve activity via microneurography, surgical sympathectomy, and greater depressor
responses to acute ganglionic blockade Notably, some antihypertensive pharmacotherapies lower
ABP by targeting the sympathetic nervous system (DeLalio, et al., 2020).
Currently, this class of agents consists of angiotensin converting enzyme inhibitors
(ACEIs) and ARBs; however, trials are under way to investigate the treatment benefits of renin
inhibitors. The mechanism of blood pressure reduction in ACEIs is largely through blockade of
the formation of angiotensin II; however, there is some effect due to bradykinin upregulation.
The mechanism of blood pressure reduction with ARBs is primarily through blockade of the
AT1 receptor. In addition, there are benefits through binding at the AT2 receptor. ARBs are safe,

well tolerated, and efficacious in blood pressure reduction across the spectrum of blood pressure
elevation. This class of antihypertensives offers protection from renal disease progression,
cardiovascular disease, and stroke, and delays progression to hypertension from prehypertension.
There is evidence supporting beneficial effects that extend beyond blood pressure reduction
alone. Thus, ARBs are an excellent choice as initial or add-on therapy in the treatment of
hypertension (Nesbitt, 2023).
The calcium antagonists are effective and safe agents for the treatment of arterial
hypertension. They can be combined with diuretics, beta-blockers, and angiotensin-converting
enzyme (ACE) inhibitors. They can be safely prescribed to patients with hypertension. Dietary
sodium restriction during antihypertensive therapy with calcium antagonists is not required for
optimal antihypertensive efficacy. The second generation of calcium antagonists, especially the
dihydropyridine analogues that have greater potency and vascular selectivity, and a longer
duration of action, will optimize the treatment of hypertension. However, beta blocker and ACE
inhibitors calcium antagonists appear to be markedly effective in older patients because of an
increase sensitivity of vascular alpha-adrenoceptors mediated by the increase in free intracellular
calcium concentration. The principal mechanism underlying the antihypertensive action of the
calcium antagonists is the vasodilatation that results from interference with the excitation
contraction coupling in peripheral vessels. Initially, the vasodilatory effect of a calcium
antagonists evokes a baroreflex-mediated activation of the sympathetic and renin-angiotensin
system. Calcium antagonists selectively interfere with adrenoceptor-alpha-mediated, but also
angiotensin ll mediated, vasodilatation, a phenomenon that is demonstrated in human forearm
(Man, 2018).

Effectiveness of Combined Herbal and Prescribed Medicine
When there are noticeable changes in the pharmacokinetic characteristics of medications
used along with herbal therapy, herbal-drug interactions become clinically significant. Changes
in drug metabolism and protein transport, particularly cytochrome and P-glycoprotein
isoenzymes, which can be enhanced or inhibited by synthetic or herbal medications, are
frequently the cause of the interactions (Azizah, et al., 2022).
According to Reid, et al., (2018), there were numerous advantages to using garlic to treat
cardiovascular conditions. Among them is the reduction of blood pressure, which can be induced
by the bioactive component of garlic's antioxidant activity, which in turn causes smooth muscle
cell relaxation and vasodilation. It revealed that among Jamaican hypertension patients, garlic is
frequently taken in addition to an antihypertensive medication, especially hydrochlorothiazide
(HCT). Additionally, it is used in conjunction with hydralazine, nifedipine, reserpine, HCT, β-
blockers, and the leaves of pears and breadfruits.
In China, people with primary hypertension (PHTN) have been treated with an integrated
approach combining western medicine (WM) and chinese herbal medicine (CHM). When CHM
and WM are used together, the therapeutic efficacy of treating hypertension is much higher than
when WM is used alone. Furthermore, in those with PHTN, CHM with WM may effectively and
safely reduce both systolic and diastolic blood pressure (Nawi, et al., 2021).
Liwa, et al., (2018), stated that herb-drug interactions could potentially intensify the
toxicological effects of cardiovascular medications. Examples of such interactions are ginseng
and digoxin or garlic and warfarin. Herbal aquaretics that lower sodium levels, like dandelion,

have the potential to counteract the hypotensive effects of thiazide diuretics. Digoxin toxicity and
elevated blood digoxin concentrations are linked to ginseng use in conjunction with digoxin. It is
obvious that African adults with hypertension who use herbs need counseling regarding potential
drug interactions between their herbal supplements and cardiovascular medications, in addition
to advice not to substitute herbal remedies for allopathic ones.
Utilizing nutritional supplements and herbal remedies (herein known as herbal remedies)
inside the United States has significantly increased during the past ten years. Ginkgo has been
linked to numerous possible negative interactions, however there has only been one documented
negative herb-drug interaction, with hydrochlorothiazide leading to heightened BP levels. Fruits
and seeds of ginkgo have been utilized for a number of conditions, such as intermittent
claudication and dementia. Anticoagulants and non-steroidal anti-inflammatory medications can
make bleeding more likely via having an impact on the aggregation of platelets. Furthermore, it
has been claimed to obstruct the anti-hypertensive action of Chlorothiazide (Nagawa, et al.,
2021).
Ren, et al., (2020), stated that herbal traditional Chinese medicine (TCM) formulations
have long been advised as alternative and complementary therapies for hypertension in China
and additional nations. Some mild to moderate hypertension individuals who are unwilling to
take antihypertensive medicines would prefer CHM, either administered alone or in combination
with antihypertensive therapies, due to worries about long-term medication and adverse
responses of antihypertensive drugs. They believed that TCM was effective in enhancing
symptoms, decreasing blood pressure swings, and enhancing vascular endothelial function linked
to hypertension, as well as cutting back on Western medicine despite its rather sweet and bitter

flavor. Furthermore, given that CHM has been in use for thousands of years, it appears to be
rather safe.
Because of their corresponding targets in herbal products, beta blockers have the
potential to produce several human development index (HDIs) during metabolism. Since nadolol
is excreted in its unaltered form, patients who regularly use herbal remedies would benefit most
from this type of beta blocker when treating hypertension. While carvedilol interacted with
potentially all herbal drugs, atenolol showed the lowest likelihood of interacting with herbs
among the beta blockers. The majority of interactions with this class have the potential to be
hazardous, while a small percentage can raise metabolic rate and result in ineffective treatment
(Garcia, et al., 2023).
Thangsuk, et al., (20211) stated that herbs have been utilized as an alternative medicine
for a variety of illnesses, including hypertension, all over the world. The study found that
patients who take herbal medicines typically had lower medication adherence in the relationship
between herb use and medication adherence. The adherence to medicine was shown to be poorer
in patients with hypertension who consumed medicinal herbs. This effect was found to be
dependent on the dosage and adherence of the herb used. Patients were driven to choose
alternative medicine and have poor medication adherence because they believed that
conventional medicine had harmful effects on the body, caused side effects or complications
from medical mistreatment, and was inconvenient and expensive. Blood pressure regulation is
impacted by low medication adherence, and using herbs has been linked to low adherence. As a
result, people who use herbs may need to improve their drug adherence.

Theoretical Framework
The Health Belief Model (HBM) is a psychological model that aims to explain how
individuals make decisions about their health-related behaviors. The HBM proposes that an
individual's health behavior is influenced by four main factors: perceived susceptibility,
perceived severity, perceived benefits, perceived barrier. The effectiveness of home remedies
and medicine maintenance in managing high blood pressure can be improved by addressing the
underlying beliefs and attitudes that influence an individual's behavior. Healthcare providers and
public health professionals can use the HBM to identify the specific factors that are most
influential in shaping an individual's behavior and tailor their interventions accordingly. This can
help to increase adherence to these behaviors and ultimately improve health outcomes for
individuals with high blood pressure.
Another Nursing Theory applicable for this topic is the Health Promotion Theory by Nola
Pender. It highlights that every individual has distinct personal traits and experiences that
influence their actions in the future. Nursing interventions have the potential to alter these
variables. The endpoint of the health promotion model is health-promoting behavior, which is
the intended behavioral consequence. At every developmental stage, engaging in health-
promoting practices ought to lead to better health, increased functional capacity, and a higher
quality of life. Intentional health-promoting activities may be thwarted by the immediate
competing demand and preferences, which also impact the final behavioral demand.
Conceptual Framework
Effectiveness of Herbal and Prescribed Medicine in managing HypertensionDependent Variables
Effectiveness of Herbal and Prescribed Medicine in

Independent Variables
Management of Hypertension
Demographic data of the respondents in terms of;
2.1 age
2.2. gender
2.3 marital status
2.4 religion
2.5 tribe
Figure 1. Schematic diagram showing the relationship between the independent variable,
dependent variable and its intervening variable.
To visualize the expected cause and effect relationship, the researchers used basic
components of boxes and arrow. Each variable appears in a box. Independent variables consist of
management of hypertension, and point to the dependent variable which consists of effectiveness
of herbal and prescribed medicine in managing patient with hypertension which are: absence of
adverse effects, prevents complications, and desired blood pressure at normal range.
Statement of the Problem

The investigators aim to compare the effectiveness among herbal, prescribed
maintenance and combination of herbal and prescribed maintenance in patients with high blood
pressure in Barangay-Barongis, Libungan Cotabato.
Specifically, the investigators sought to understand the following questions:
1. What is the demographic profile of the respondent in terms of:
1.1 age
1.2 sex
1.3 monthly income
1.4 religion
1.5 tribe and
1.6 marital status?
2. What is the level of effectiveness of herbal medicine in terms of;
2.1 desired BP result at normal range
2.2 absence of adverse effects
2.3 prevents complications
3. What is the level of effectiveness of prescribed medicine in terms of;

4. What is the effectiveness of combination of herbal and prescribed medicine in managing
patient with hypertension, in terms of;
5. Is there any significant difference between herbal and prescribed medicine in managing
patient with hypertension?
6. Is there any significant difference between herbal medicine and combination of herbal
and prescribed medicine in managing patient with hypertension?
7. Is there any significant difference between prescribed medicine and combination of
herbal and prescribed medicine in managing patient with hypertension?
8. Is there significant difference among prescribed, herbal, and combination of herbal and
prescribed medicine in managing patient with hypertension?
Hypothesis
HO There is no significant difference between herbal and prescribed medicine in managing
patient with hypertension.

H1 There is a significant difference between herbal and prescribed medicine in managing patient
with hypertension.
H2 There is a significant difference between herbal medicine and combination of herbal and
prescribed medicine in managing patient with hypertension.
H3 There is a significant difference between prescribed medicine and combination of herbal and
prescribed medicine in managing patient with high blood pressure.
H4 There is significant difference among prescribed, herbal, and combination of herbal and
prescribed medicine in managing patient with hypertension.
Significance of the Study
This study is significant to the nursing students for this can be a guide for them to get
information with regards to determining the effectiveness of herbal and prescribed medicine and
combination of herbal and prescribed medicine in managing patient with hypertension.
To the Indigenous People, this will serve as a choice for preference in the management of
hypertension of each diagnosed clients.
To the Barangay Health Workers, this will provide information to further understand the
importance of traditional and non-traditional approach for patients diagnosed with hypertension
that could be crucial in order to provide proper treatment.

To the Food and Drugs Administration, this study will help ensure that prescribed drugs
and effective herbal medicines may be given fairly in people who needed them and ensure that
these are safe.
To the Pharmacist, this study will increase the options that they can give to patients with
hypertension when dispensing medicines and in providing patient counseling, advice and
guidance to patients on how to take medications and what side effects to expect.
To the Future Researchers, this will serve as reference in conducting related study on the
effectiveness between herbal and prescribed medicine and combination of herbal and prescribed
medicine in managing patient with hypertension.
Definition of Terms
Adverse reactions- also known as an adverse event or adverse effect, refers to an unintended and
negative response or side effect that occurs after the use of a medication, medical treatment, or
exposure to a substance. These reactions can occur due to individual differences in how the
body processes or responds to a specific treatment or substance.
Complications- refer to additional medical problems or adverse events that arise as a result of a
primary disease, condition, or medical intervention. Complications can occur during the course
of an illness, after a medical procedure or surgery, or as a result of underlying health conditions.
They may involve a worsening of the original condition, the development of new symptoms or
problems, or the occurrence of unintended consequences.

Desired result- refers to the specific outcome or goal that someone aims to achieve. It represents
the desired or expected outcome of a particular action, plan, or endeavor. The desired result can
vary depending on the context and can be related to various aspects of life, such as personal
goals, professional objectives, academic achievements, or health outcomes. It is important to
have a clear understanding of the desired result in order to set goals, make plans, and take
appropriate actions to work towards achieving it.
Effectiveness- refers to the degree to which something is successful in producing a desired result
or outcome. If something is effective, it means it accomplishes its intended purpose, produces the
expected results, or solves a problem efficiently. Effectiveness can be measured in various ways,
depending on the context, such as by assessing the outcomes achieved, the time taken, or the
resources used.
Herbal medicine- also known as herbalism or botanical medicine, is a type of alternative
treatment that uses plants or plant extracts to treat, prevent, or alleviate various health conditions
or promote health and well-being.
Hypertension- is also known as high or raised blood pressure, is a condition in which the blood
vessels have persistently raised pressure. Blood is carried from the heart to all parts of the body
in the vessels. Each time the heart beats, it pumps blood into the vessels. Blood pressure is
created by the force of blood pushing against the walls of blood vessels (arteries) as it is pumped
by the heart. The higher the pressure, the harder the heart has to pump.
Patients- is any person with experience of a health condition or receiving health care, including
informal caregivers such as family and friends.

Prescribed medicine- often simply referred to as a "prescription," is a type of medication that a
licensed healthcare professional, such as a doctor, nurse practitioner, or psychiatrist, orders for a
patient. These medications are used to treat, prevent, or manage various health conditions.
CHAPTER II
METHOD
This chapter presents the research design, setting, sampling technique, participants,
measures, procedures, data analysis, and limitation.
Design

The researcher utilized descriptive-comparative research design to determine which of
the management of hypertension is the most effective in patient with hypertension in Barangay
Barongis, Libungan, Cotabato.
Setting
The researchers will conduct the study at Barangay-Barongis, Libungsn, Cotabato.
Barongis is a barangay in the municipality of Libungan, in the province of Cotabato. Its
population as determined by the 2020 Census was 2,921. This represented 5.19% of the total
population of Libungan.
Participants
The participants of this research will be the indigenous people who are diagnosed with
high blood pressure. The participants are consisted of selected male and female participants, 40
males and 40 females who are already diagnosed with high blood pressure, with a total of 80
participants; living in Barangay Barongis Libungan Cotabato.
The investigators will use survey methods which will involve purposive sampling in
which the participants will be chosen from a specific group to represents the target population.
Measures
The tool will be a researcher made-questionnaire with following parts: the first part is the
demographic profile of the respondents which ask about the age, sex, monthly income, religion,
tribe, and marital status. The second part of the questionnaire will determine the effectiveness of

herbal medicine in managing with hypertension in Barangay-Barongis, Libungan, Cotabato. The
third part of the questionnaire will determine the effectiveness of prescribed medicine in
managing patients with hypertension in Barangay-Barongis, Libungan, Cotabato. Part IV will
determine the effectiveness of combined herbal and prescribed medicines in the management of
hypertension.
Procedures
The investigators will utilize a researcher-made survey questionnaire that will undergo
validity and reliability testing. The indigenous people will be asked to answer the questionnaire
regarding the effectiveness among herbal, prescribed medicine and combination of both in
managing patients with hypertension.
The conduct of the study will follow the step-by-step procedure; first, researchers will ask
permission from the Dean of College of Nursing of the Cotabato Medical Foundation College,
Incorporated to conduct the study. Upon approval, the researchers will submit the questionnaire
to experts for validation of the questions. a pilot. The investigators will then proceed to the
Barangay Barongis Libungan Cotabato with a letter requesting authorization to carry out
research. The letter of permission from the Dean of College of Nursing will be included as a
document for veracity and validity of the study to be conducted. After receiving the consent, the
researchers will select participants of specific group for pilot testing will be conducted since it is
a researcher-made questionnaire for testing its reliability.
Following validation of the questionnaire's validity and reliability, the actual survey will
be carried out. Participants' consent will be requested prior to answering the survey instrument.

The survey forms will be given out to the participants and collected an hour later. The data
information will be gathered, tallied, and analyzed using proper statistical treatment.
Limitation of the Study
This study will focus on the effectiveness among Herbal Medicine, Prescribed Medicine
and combination of Herbal and Prescribed Medicine in managing patients with hypetension in
Baranggay Barongis. The result of the study will be solely based on the responses of the persons
diagnosed with high blood pressure who regularly use home remedies and person who regularly
take the prescribed medication.
Data Analysis
The researchers will utilize descriptive-comparative tools in describing the data gathered
from the respondents. Frequency count and percentage distribution will be used to analyze the
demographic characteristic of the participants. Weighted mean distribution will be used to elicit
the effectiveness among herbal medicine, prescribed medicine, and combination of herbal and
prescribed medicine in managing patients with hypertension in Barangay Barongis, Libungan,
Cotabato. To test the significant differences on the effectiveness among herbal remedies and
medicine maintenance, herbal medicine alone and combinination of herbal and prescribed t-test
will be used. To determine the significant difference among herbal, prescribed, and combination
of herbal and prescribed medicines, f-test or Analysis of Variance will be used.
Table of Parameters to Interpret the Weighted Mean for the Effectiveness of Herbal and
Prescribed Medicine

Scale Parameter ranges Description Interpretation
5 4.21-5.00 Strongly agree Very effective
4 3.41-4.20 Agree Effective
3 2.61-3.40 Neither agree or Effective enough
disagree
Strongly disagree
2 1.81-2.60 Very ineffective
Disagree
1 1.0-1.80 Ineffective
The table above showed the scales and their corresponding parameters to interpret the
result of the effectiveness of home medicine.
Table of Parameters to Interpret the Weighted Mean for the Effectiveness of Prescribed
Medicine
disagree

2 1.81-2.60 Strongly disagree Very ineffective
1 1.0-1.80 Disagree Ineffective
The table above showed the scales and their corresponding parameters to interpret the
result of the effectiveness of prescribed medicine.
Table of Parameters to Interpret the Weighted Mean between the Effectiveness of Home
Medicine, Prescribed Medicine, and the Combination of Home and Prescribed Medicine in
Managing Hypertension.
disagree
2 1.81-2.60 Very ineffective
Strongly disagree
1 1.0-1.80 Ineffective
Disagree

The table above showed the scales and their corresponding parameters to interpret the result of
the effectiveness among of home medicine, prescribed medicine, and the combination of home
and prescribed medicine in managing hypertension.
APPENDIX A
Letter of Permission

FEBRAURY, 2024
Mrs. Lorna E. Vallar, RN, MAN

Dean, College of Nursing
Cotabayo Medical Foundation College, Inc.
Poblacion 8, MIdsayap, Cotabato
Dear Dean Vallar,
Greetings!
The undersigned are currently conducting research entitled “EFFECTIVENESS OF HERBAL

AND PRESCRIBED MEDICINE IN MANAGING PATIENTS WITH HYPERTENSION”, as
requirement for the completion of the degree of Bachelor of Science in Nursing in Cotabato
Medical Foundation College, Inc.
In this regard, may we solicit your assistance by granting us permission to allow us to conduct a
study among the selected participants. All data and information coming from the survey shall be
used for educational purposes only.
Your approval regarding this matter will be very much appreciated.
Thank you and more power to you.
Respecfully yours,
Shaira A. Adam
Glyndee Marr E. Jagonob
Researchers
APPENDIX B
QUESTIONNAIRE

FEBRAURY, 2024
Dear Participants;
Greetings!
We, the BSN 3 students, are going to conduct a study. The purpose of this study is to compare
the effectiveness of herbal and prescribed medicine in managing high blood pressure. We are
asking a few minutes of your time to answer our survey questionnaire.
The researchers would like to know your level of satisfaction on herbal and prescribed medicine.
Furthermore, we would like to know your comment , suggestions/recommendations. This survey
will provide us feedback on how to determine which intervention is most effective in high blood
pressure and improve our service in the field of nursing profession in terms of caring for patients.
Your honest responses will be highly appreciated. Rest assured that your responses shall be held
in strict confidentiality.
Sincerely yours,
SHAIRA A. ADAM
GLYNDEE MARR E. JAGONOB
Researchers
INSTRUCTION: Place a check (/) in the option that corresponds to your answer. Please answer
the question honestly. Do not leave each item unanswered.
Name (optional):________________________
Age: ( ) Maguindanao

( )60 and above ( ) Others (specify):
( ) 50-59 Religion:
( ) 40-49 ( ) Roman Catholic
( ) 30-39 ( ) Iglesia Ni Kristo
( ) 20-29 ( ) Islam
Sex: ( ) Protestant
( ) Male ( ) Jehovah’s Witnesses
( ) Female ( ) UCCP
Marital status: ( ) Born Again
( ) Single ( ) Seventh Day Adventist
( ) Married
( ) Separated
( ) Widowed
Tribes:
( ) Cebuano
( ) Illonggo
( ) Ilocano
Direction: Read and put a check (/) in the box that correspond to your answer using the
following:
1- disagree 4- agree
2- strongly disagree 5- strongly agree

3- neither agree or disagree
Therapeutic effects
5 4 3 2 1
1. Taking antihypertensive medication made me feel less lightheaded right away.
2. Drinking garlic soaked with water every morning reduces my blood pressure.
3. Taking my prescribed medications on time helps me manage my blood pressure.
4. Every time I took my prescribed medication, I felt relief.
5. Using herbal medicine has allowed me to save money on medical expenses.
Side effects
5 4 3 2 1
1. I often feel dizzy after taking my antihypertensive medicine.
2. Changes in appetite or weight occur when prescribed medication and herbal remedies are
used together.
3. Regular consumption of combined herbal and prescribed medicine can cause skin reactions
such as rashes and itching.
4. I often experienced gastrointestinal symptoms such as nausea, vomiting, or diarrhea when
using a combination of herbal and prescribed medicine.
5. The combination of herbal and prescribed medicine has led to several side effects.
Complications
5 4 3 2 1
1. Long-term used of antihypertensive medicine may cause kidney failure.
2. I would consider stopping taking combination of herbal and prescribed medicine if

complications became too severe.
3. The potential complications of using the combination of herbal and prescribed medicine
outweigh the benefits.
4. Long-term used of herbal medicine may arises another illness.
5. I have experienced complications that required medical intervention or hospitalization since

starting the combination of herbal and prescribed medicine.
REFERENCES

Andraos, et al., (2021). Home blood pressure monitoring to improve hypertension control: A
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EFFECTIVENESS OF HERBAL AND PRESCRIBED MEDICINE IN MANAGING

PATIENTS WITH HYPERTENSION

A Thesis Presented to the Faculty Cotabato Medical Foundation College Incorporated

In Partial Fulfillment of the Requirements for Nursing

Jagonob, Glyndee Marr E.

Poblacion 8, Quezon Ave., Midsayap, Cotabato

In partial fulfillment of the requirements for the degree of Bachelor of

Science in Nursing this THESIS entitled:

EFFECTIVENESS AMONG HERBAL MEDICINE, PRESCRIBED MEDICINE AND

COMBINATION OF HERBAL AND PRESCRIBED MEDICINE IN MANAGING PATIENTS

WITH HYPERTENSION IN BARANGAY BARONGIS, LIBUNGAN, COTABATO

BACHELOR OF SCIENCE IN NURSING

Lorna E. Vallar, RN, MAN

1. RECOMMENDING ORAL DEFENSE . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii

Effectiveness of Herbal and Prescribed Medicine in managing Hypertension

disturbances (Benetos, et al., 2019).

20.4%) in 2040 (Boateng et al., 2023).

Effectiveness of Herbal and Prescribed Medicine in managing Hypertension

risk of complications, and take a more active role in their healthcare.

Review of Related Literature

Both pharmacologic and nonpharmacologic methods are used to treat hypertension.

mm Hg and diastolic pressure by 1-4 mmHg (Taler, 2018).

(HBPM) is recommended by multiple international hypertension guidelines as an effective way

Effectiveness of Herbal and Prescribed Medicine in managing Hypertension

BP values should be used to evaluate BP control, with prompt antihypertensive adjustment

monitoring thereafter to ensure continued BP control.

Even among patients receiving effective antihypertensive medication, the rates of

hypertension control are still unsatisfactorily low. Several international hypertension

individuals receiving antihypertensive therapy. In addition to recommending validated automatic

instruct patients on appropriate home BP measurement practices. The majority of available

(Andraos, et al., 2021).

Effectiveness of Herbal and Prescribed Medicine in managing Hypertension

Measuring the morning/evening or evening/monitoring ratio prior to taking a medication is very

hypertension, morning hypertension, masked hypertension, white coat hypertension, and

monitored often and for an extended length of time.

hypertension in normotensive people (Shim, et al., 2019).

Effectiveness of Herbal and Prescribed Medicine in managing Hypertension

research called Dietary Approaches to Stop Hypertension (DASH)-Sodium reported in non-

hypertensive individuals, a reduced sodium consumption will result in a considerable reduction

hypertension incidence and complications.

Given that endothelial dysfunction is linked to hypertension and is a precursor to vascular

management and treatment of hypertension and cardiovascular problems. Numerous

investigations involving individuals with normotension, and hypertension revealed of the

suggests that neuronal cardiovascular control is involved (Laresen, et al., 2018).

Effectiveness of Herbal and Prescribed Medicine in managing Hypertension

precipitate a heart attack.

Both hypertensive and normotensive subjects experience a dose-related effect on blood

pressure when consuming higher amounts of alcohol. Drinking alcohol excessively or

Effectiveness of Herbal and Prescribed Medicine in managing Hypertension

store excess energy when an individual is obese.

The current study evaluated various subgroups of hypertension patients' commitment to a

training, changing one's lifestyle is challenging (Akbapour, et al., 2018).

Effectiveness of Herbal and Prescribed Medicine in managing Hypertension

disability right away.

harmful effects of the obesity-hypertension phenotype is to encourage maintaining a normal

multifaceted approach. Encouragement of the adoption of a healthy lifestyle at all levels—from

balanced in calories (Leggio, et al., 2018).

Effectiveness of Herbal and Prescribed Medicine in managing Hypertension

nephropathy, and having positive impacts on the lipid profile.

Effectiveness of Herbal Medicine in managing patients with Hypertension

can be beneficial for managing blood pressure (Leo, et al., 2018).

vessels. Carrots regulate BP because of the existence of potassium. Intravenous administration of