Utilization of celery leaf extract (Apium Graveolens) as alternative f

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Elma M et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-72 2019 605-611 605 IJAMSCR |Volume 7 | Issue 2 | Apr- June - 2019 www.ijamscr.com Research article Medical research Utilization of celery leaf extract Apium Graveolens as alternative for recovery blood pressure of postpartum hypertension Elma Marsita 1 Ari Suwondo 2 Suryati Kumorowulan 3 1 Poltekkes Kemenkes Semarang Indonesia 2 Poltekkes Kemenkes Semarang Indonesia 3 Balai Penelitian dan Pengembangan Kesehatan Magelang Indonesia Corresponding Author: Elma Marsita Email id: elmamarsita93gmail.com ABSTRACT Background Postpartum hypertension is a condition blood pressure ≥ 140 / 90 mmHg with or not accompanied by proteinuria or edema in postpartum occurring 5-10 of other cases postpartum pathology. Nifedipine which usually be used has side effects flatulence constipation nausea cough headache can be transferred to breast milk and ineffective for patients with severe hypertension. Celery leaves contain potassium and flavonoid which can help lower blood pressure. Aim Prove that celery leaf extract as an alternative change blood pressure in postpartum hypertension. Methods Quasi experimental with pre and post test control group design through 16 treatment group and 16 control group for postpartum hypertension mothers. Blood pressure were measured everyday for 7 days. Data analysis using paired t- test independent t-test wilcoxon mann whitney. Results Systolic blood pressure before and after treatment in intervention group 154 + 11.6 and 129 + 8.5 with p0000 the control group 153 + 10.9 and 141 + 9.3 with p0000. Diastolic blood pressure before and after treatment in the intervention group 99 + 8.2 and 83 + 5.7 with p0.000 the control group 103 + 6.1 and 93 + 5.3 with p0.000. The treatment group significant changes in systolic blood pressure p-value 0.003 and diastolic blood pressure p-value 0.049 compared with control group. Conclusion Celery leaf extract with dose 213 mg everyday for 7 days effectively reduced blood pressure of postpartum mothers with hypertension. Keywords: Celery Leaf Extract Blood Pressure Postpartum Women Hypertension. ISSN:2347-6567 International Journal of Allied Medical Sciences and Clinical Research IJAMSCR

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Elma M et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-72 2019 605-611 606 INTRODUCTION Postpartum hypertension is an increase in blood pressure ≥ 140 / 90mmHg with or not accompanied by proteinuria or edema in postpartum.1 According to WHO the maternal mortality rate is 216 per 100000 live births in 2015 and 18 are caused by hypertension. 2 Puspitas research on 2012 explain that the causes of postpartum maternal mortality are preeclampsia/eclampsia and labor complication mothers with preeclampsia / eclampsia 37.27 times greater risk of maternal death during puerperal than mothers who have not preeclampsia / eclampsia. 3 Giving pharmacological drugs that often be used by health workers is nifedipine 10 mg. However nifedipine has side effects including flatulence constipation nausea cough and headache. 4 5 Futhermore nifedipine has a concentration in breast milk. Nifedipine doses of 90 mg everyday can be transferred to breast milk by 10ng / ml although nifedipine has data that supports its safety for use in pregnancy and lactation. 6 7 Nifedipine be used in mild to moderate hypertension whereas drug administration in patients with severe hypertension is not effective. 8 Considering this problem there is a need complementary therapy for nifedipine which can help lower blood pressure by using celery leaf extract. Celery leaves Apium graveolens are native Indonesian spices that has not side effects for the human body very easy to obtain and the price is also affordable for all people. empirically this plant be believed by the community for traditional medicine that has anti-hypertensive effects mild diuretics and antiseptics in the urinary tract and antirheumatism. 9 Celery leaf contain flavonoid 2471mg/100 gram which useful as antihypertensive and antioxidants. 10 Celery is agent hypotensive that function to prevent narrowing of blood vessels and high blood pressure. 11 Celery leaves also contain potassium 260 mg / 100gram which works with 3 roles they are as diuresis inhibits the kidneys to secrete renin so that angiotensin II is not formed and as vasodilation. This herb also contains magnesium and vitamin C which play a role in preventing cholesterolemia and amino acid arginine which can help lower blood pressure. 12 Based on this background the researchers were interested in conducting a study entitled "utilization of celery leaf extract apium graveolens as alternative for recovery blood pressure of postpartum hypertension” MATERIALS AND METHODS This research used quasi experimental with pre and post test control group design. The population is postpartum women with hypertension who treated in Bhakti Wira Tamtama Hospital Semarang and Ungaran Hospital Semarang. The sample consist of 32 respondents 16 treatment group and 16 control group for postpartum hypertension mothers. Each group was given the intervention for 7 days. The intervention group was given celery leaf extract a daily dose of 213mg plus nifedipine a daily dose of 10 mg while the control group was only given nifedipine with a daily dose of 10 mg. Blood pressure were measured everyday from pretest until postest. Data analysis using paired t-test independent t-test wilcoxon mann whitney. This study identified the effect of giving celery leaf extract to changes in blood pressure in postpartum mothers with hypertension. RESULTS Univariate Analysis Table 1. Distribution of Characteristics of Respondents by Age Education Profession Parity Type of Labor History Hypertension in Pregnancy and Family History Characteristics Intervention Group n16 Control Group n16 p N N Age 21-35 35 9 7 563 438 9 7 563 438 1000

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Elma M et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-72 2019 605-611 607 Education Primary School Junior High School Senior High School College 3 3 9 1 188 188 563 63 4 1 7 4 250 63 43.8 250 0334 Profession Housewife Provate employees Entrepreneur 8 7 1 500 438 63 8 8 - 500 500 - 0309 Parity Primipara Multipara 3 13 188 813 3 13 188 813 1000 Type of Labor Normal Birth SC 6 10 375 625 7 9 438 563 0510 History in Pregnancy There Nothing 14 2 875 125 15 1 938 63 0237 Family History There Nothing 8 8 500 500 7 9 438 563 0629 Homogeneity Table 1 show frequency distribution of respondents. The age variable illustrates that the highest age at the age of 21-35 is 9 respondents 56 3 each group. The education level variable shows that the highest education is senior high school of 9 respondents 563 in intervention group and 7 respondents 438 in control group. The profession level variable shows that the highest profession is housewife of 8 respondents 50 each group. The parity level variable shows that the highest parity is multipara of 13 respondents 81 3 each group. The type of labor level variable shows that the highest type is SC of 10 respondents 625 in intervention group and 9 respondents 563 in control group. The pregnancy history variable shows that the highest respondents have history hypertention of pregnancy namely 14 respondents 87 5 in intervention group and 15 respondents 93 8 in control group. The family history level variable shows that the highest respondents haven’t hypertension in their family namely 8 respondents 50 in intervention group and 9 respondents 56 3 in control group.

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Elma M et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-72 2019 605-611 608 Figures 1: Changes in mean systolic blood pressure in the intervention and control groups Figure 1 above shows that changes in the average systolic blood pressure on the first day to day 7 for the intervention group and the control group both experienced a decrease in the average value of blood pressure. It can be seen also graphically that the decrease in blood pressure in the intervention group was more than the decrease in the average value of blood pressure in the control group. Figure 2 Changes in mean diastolic blood pressure in the intervention and control groups Figure 2 above shows that the decrease in the average diastolic blood pressure on the first day to day 7 for the intervention group and the control group both experienced a decrease in the average value of blood pressure. 103.75 102 100.25 98.81 97.94 97 94.75 93.38 93.38 99.69 98.19 96.5 94.44 92.81 91.13 88.56 84.81 83.38 0 20 40 60 80 100 120 Control Intervention

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Elma M et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-72 2019 605-611 609 Bivariate Analysis Systolic Table 2. Differences in Systolic Blood Pressure Values Between The Intervention and Control Group Variable p Systolic Blood Pressure Groups Mean+SD Pretest Intervention Control 15406+11619 15338+10948 0864 Day-1 Intervention Control 15181+11280 15269+10333 0821 Day-2 Intervention Control 14906+11096 15150+9866 0516 Day -3 Intervention Control 14544+10099 15006+8782 0177 Day-4 Intervention Control 14213+9584 14894+9637 0540 Day-5 Intervention Control 13900+9026 14656+8648 0022 Day-6 Intervention Control 13563+8891 14413+8709 0010 Day-7 Intervention Control 13050+9209 14181+9028 0001 Postest Intervention Control 12900+8563 14125+9342 0001 Difference Postest-Pretest Intervention Control -2506+12672 -1212+9273 0003 independent t-test Based on the results of the Independent t-test in table 2 above it shows that the value of p 0.003 0.05 which means that there is a significant difference of decrease between the systolic blood pressure in the intervention group and the control group. The measurement of systolic blood pressure from pretest to posttest between the intervention group and the control group showed a p-value 0.05 starting at the 5th day measurement meaning that on the 5th day there was a significant difference of decrease in systolic blood pressure between the intervention groups and control group. Likewise clinically the results showed a decrease in systolic blood pressure in the intervention group began effective on day 5 because the systolic blood pressure was at a value of 140mmHg. Bivariate Analysis Diastolic Table 3. Differences In Diastolic Blood Pressure Values Between The Intervention and Control Group Variable p Systolic Blood Pressure Groups Mean+SD Pretest Intervention Control 9969+8228 10375+6191 0061 Day-1 Intervention Control 9819+7635 10200+5831 0082 Day-2 Intervention Control 9650+6947 10025+5939 0108 Day -3 Intervention Control 9444+6088 9881+4806 0049

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Elma M et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-72 2019 605-611 610 Day-4 Intervention Control 9294+5698 9794+5092 0016 Day-5 Intervention Control 9113+5464 9700+5367 0005 Day-6 Intervention Control 8856+5887 9475+4344 0003 Day-7 Intervention Control 8481+6058 9338+4870 0000 Postest Intervention Control 8338+5726 9338+5353 0000 Difference Postest-Pretest Intervention Control -1631+6650 -1037+6907 0049 Mann Whitney Mann Whitney analysis in table 3 above shows that the p-value 0.049 0.05 which means there is a significant difference between changes in diastolic blood pressure in the intervention group and the control group. The results showed that diastolic measurements from pretest to posttest began to have a p-value 0.05 in the measurement of the third day p-value 0.049 0.05 meaning that there was a significant difference of decrease in diastolic blood pressure between the intervention group and the control group was on day 3 but clinically the diastolic blood pressure in the intervention group was effective on day 6 because blood pressure was starting at 90mmHg. DISCUSSION The process of postpartum hypertension is decreased blood flow and uterine perfusion stimulating excessive renin release will flow with blood to the liver. Renin reacts with angiotensinogen to convert it to angiotensin I. Angiotensin I transforms into angiotensin II in the lungs with thromboxane causing vasopasms to develop the anterior lumen narrows and increases anterol pressure. Angiotensin II also stimulates the adrenal cortex to secrete nitric oxide causing sodium retention increasing blood volume and pressure. 13 14 Celery leaves have a flavonoid content of 24.71 mg / 100 grams which is useful as an antihypertensive and antioxidant. 10 Celery is a hypotensive agent by flavonoids which serves to prevent narrowing of blood vessels and high blood pressure. 21 Celery leaves also contain potassium 260 mg / 100grams that work with 3 roles namely as diuresis inhibits the kidney from secreting renin so that angiotensin II does not form and as vasodilation. This herb also contains magnesium and vitamin C which play a role in preventing cholesterolemia and amino acid arginine which can help lower blood pressure. 12 The results of blood pressure analysis obtained were supported by research conducted by Sri Sakinah in 2018 that there were differences in mean values of systolic and diastolic blood pressure before and after intervention in respondents given celery leaf decoction with systolic mean before intervention of 148.68 mmHg and after intervention to 139.33mmHg. This also happened to diastolic blood pressure with a mean before intervention 95.33 mmHg to 90.33 mmHg after intervention. The results of paired t-test analysis showed that the p- value 0.00 0.05 in systolic and diastolic pressures meant that there were significant differences in the values of systolic and diastolic blood pressure before and after the intervention of celery leaves decoction.15 CONCLUSIONS The administration of celery leaves Apium graveolens with a dose of 213 mg and antihypertensive drugs nifedipine 10 mg everyday for 7 days had an effective effect in reducing postpartum maternal systolic and diastolic blood pressure with hypertension. The effect of giving celery leaf extract and nifedipine antihypertensive drugs has a potentiating effect which means that some drugs are given together with different actions but have a greater effect on the patient if both are given together.

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Elma M et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-72 2019 605-611 611 REFERENCES 1. Kang E Sugarman R Ramadan H Mueller A Shahul S Perdigao JL et al. Prevalence risk factors and associated complications of postpartum hypertension in rural Haiti. Pregnancy Hypertension. 10 2017 135- 42. 2. Organization WH. World Health Statistics 2017: Monitoring health for the SDGs 2017. 3. Puspita R Santi M Chatarina Umbul W. Analisis Determinan Kematian Maternal pada Masa Nifas di Kabupaten Sidoarjo Tahun 2012. Jurnal Berkala Epidemiologi. 21 2014 105-17. 4. Burnier M. Drug adherence in hypertension. Pharmacological research. 2017. 5. Al Disi SS Anwar MA Eid AH. Anti-hypertensive herbs and their mechanisms of action: part I. Frontiers in pharmacology. 6 2016 323. 6. Ghuman N Rheiner J Tendler BE White WB. Hypertension in the postpartum woman: clinical update for the hypertension specialist. The journal of clinical hypertension. 1112 2009 726-33. 7. Anadón A Martínez-Larrañaga MR Ares I Castellano V Martínez MA. Drugs and Chemical Contaminants in Human Breast Milk. Reproductive and Developmental Toxicology Elsevier 2 2017 67-98. 8. Benedicta I Rumagit JAP. Studi Deskriptif Pemberian Obat Pada Pasien Hipertensi Di Puskesmas Sario. Jurnal ilmiah Farmasi Poltekkes Manado. 2012. 9. Asyik N. Kajian Pembuatan Pangan Fungsional dalam Bentuk Sirup dari Ekstrak Daun Seledri Apium graveolens L.. Jurnal Sains dan Teknologi Pangan. 33 2018. 10. Kusnadi K Devi ET. Isolasi dan Identifikasi Senyawa Flavonoid Pada Ekstrak Daun Seledri Apium graveolens L. dengan Metode Refluks. PSEJ Pancasakti Science Education Journal. 21 2017. 11. Asmawati N Purwati P Handayani RS. Efektivitas Rebusan Seledri dalam Menurunkan Tekanan Darah pada Lansia Penderita Hipertensi di Posyandu Lansia Kelurahan Pajar Bulan Kecamatan Way Tenong Lampung Barat. Jurnal Kesehatan. 62 2016. 12. Houston MC. The role of nutrition nutraceuticals vitamins antioxidants and minerals in the prevention and treatment of hypertension. Alternative therapies in health and medicine. 19 2013 32. 13. Sibai BM. Etiology and management of postpartum hypertension-preeclampsia. American journal of obstetrics and gynecology. 2066 2012 470-5. 14. Hendarti HF. Evaluasi Ketepatan Obat dan Dosis Obat Antihipertensi pada Pasien Hipertensi Rawat Jalan di Puskesmas Ciputat Januari-Maret 2015: FKIK UIN Jakarta 2016. Sakinah S Ashari HK. Pengaruh Rebusan Daun Seledri Terhadap Penurunan Tekanan Darah Pada Pasien Hipertensi Di Wilayah Kerja Puskesmas Pangkajene Kabupaten Sidrap Jurnal Ilmiah Kesehatan Diagnosis. 123 2018 261-6. How to cite this article: Elma Marsita Ari Suwondo Suryati Kumorowulan. Utilization of celery leaf extract Apium Graveolens as alternative for recovery blood pressure of postpartum hypertension. Int J of Allied Med Sci and Clin Res 2019 72: 605-611. Source of Support: Nil. Conflict of Interest: None declared.

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