How to cite:
Dina Indrati Dyah Sulistyowati (2022). Healing Acupressure Lr-3 on
Blood Pressure and Anxiety Levels in Pregnant Women with
Hypertension. Journal Eduvest. Vol 2(7): 1.397-1.405
E-ISSN:
2775-3727
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Eduvest – Journal of Universal Studies
Volume 2 Number 7, July, 2022
p- ISSN 2775-3735- e-ISSN 2775-3727
HEALING ACUPRESSURE LR-3 ON BLOOD PRESSURE
AND ANXIETY LEVELS IN PREGNANT WOMEN WITH
HYPERTENSION
Dina Indrati Dyah Sulistyowati
Poltekkes Kemenkes Semarang, Indonesia
Email: dinaindrati@gmail.com
ABSTRACT
Hypertension pregnancy disorders are one of the causes of
increased morbidity and mortality of maternal, fetal, and
neonates. The maternal mortality rate (MMR) in Indonesia is
still quite high. One of the causes of maternal death is
hypertension. Healing acupressure LR 3 is a combination of
self-healing and acupressure, where the massage process has
2 reactions, namely the strengthening reaction (yang) and the
lowering reaction (yin). Massages at a certain point in
acupressure therapy can stimulate nerve waves so that they
can launch blood flow, relax spasms, and lower blood pressure.
This study aims to determine the effectiveness of healing
acupressure LR-3 (healing-pressure) affects blood pressure and
anxiety levels in pregnant women with hypertension, compare
pre-test control groups and experiments, compare pre-and
post-test in control and experimental groups, and compare the
differences in pre-post tests between control groups and
experiments. Research including experiment, using the
randomized pre-test post-test control group design research
design. The analysis used a repeated ANOVA test with post
hoc Bonferroni.The results of this study are expected to be an
operational standard in helping to increase knowledge to
overcome pregnant women with hypertension in a non-
pharmacological manner that is safe for mothers and babies.
The results of the analyzed are found that there was a
significant difference in the average blood pressure and
anxiety level of pregnant women after being given intervention
in the intervention group before and after the intervention
Dina Indrati Dyah Sulistyowati
Healing Acupressure Lr-3 on Blood Pressure and Anxiety Levels in Pregnant Women
with Hypertension 1.398
period (p < 0.000), meaning that there was an effect of healing
acupressure LR-3 (healing-pressure) affecting blood pressure
and anxiety levels in pregnant women with hypertension.
KEYWORDS
Healing Acupressure, LR-3 (Healing-Pressure), Anxiety,
Hypertension, Pregnant Women
This work is licensed under a Creative Commons
Attribution-ShareAlike 4.0 International
INTRODUCTION
Hypertension and pregnancy disorders are one of the causes of increased morbidity
and mortality in maternal, fetal, and neonatal. According to the National Institute for Health
and Care Excellence (NICE) Guidelines, hypertensive disorders during pregnancy carry
risks to both mother and baby.
The Ministry of Health recorded that the Maternal Mortality Rate (MMR) in
Indonesia is currently still quite high, even though it has decreased. P in 2016 reached 305
cases per 100,000 live births, which is still below the achievement of the 2014 target of 118
k per 100,000 live births. Meanwhile, the program target the Sustainable Development
Goals (SDGs) by 2030 maternal mortality rate (MMR), or MMR on a global scale,
decreases by less than 70 per 100,000 live births. As for the cause of maternal death in
Indonesia in 2016, bleeding was 32%, 26% was caused by hypertension, 7.3% by infection,
and 40.8% of others such as heart disease, and diabetes mellitus.
In Central Java Province during January to May 2016 the number of MMR was 251
cases per 100,000 live births. The cause of maternal death in Central Java province in
2015, hypertension was 26.34%, bleeding 21.14%, circulatory disorders 9.27%, infection
2.76%, and others 40.49%5,3
According to the hypertension in Pregnancy Guideline from the American College
of Obstetricians and Gynecologists (ACOG) 2013 it is estimated that 10% of pregnancies
worldwide have hypertension during pregnancy. Based on the National High Blood
Pressure Education Program Working Group in Pregnancy, pregnancy hypertension is
divided into four categories namely chronic hypertension, hypertension, preeclampsia, and
preeclampsia superimposed (Gillon et al., 2014a)
Hypertension is hypertension without proteinuria that arises after 20 weeks of
pregnancy and disappears after delivery. Blood pressure in hypertension is ≥140/90 mmHg,
there is no history of hypertension before pregnancy, and in <12 weeks of gestation, blood
pressure is normal. There is no proteinuria (Gillon et al., 2014b) The American College
of Obstetricians and Gynecologists (ACOG) stated, that the entire prevalence of pregnant
hypertension 25% had preeclampsia.
Until recently, pregnancy hypertension of its exact etiology was not known. There
are several hypotheses regarding the etiology of pregnancy hypertension, including
ischemic placenta, immune maladaptation, and genetic factors. Ischemia placenta occurs
due to the invasion of incompetent trophoblasts so that the decidua vessels will be wiped
by endovascular trophoblasts. Based on WHO, the management of pregnant women with
hypertension or arising after gestational age ≥ 20 weeks with routine antenatal
examinations without being given antihypertensive therapy, unless blood pressure shows
an increase, then the patient is referred and given blood pressure-lowering drugs.
Antihypertensive therapy should be careful given the negative impact on infants.
Eduvest – Journal of Universal Studies
Volume 2 Number 7, July 2022
1.399 http://eduvest.greenvest.co.id
Administration of antihypertensive drugs risks reducing the perfusion of uteroplacental,
resulting in low birth weight (Brown et al., n.d.)
Indonesian people have long applied nonpharmacological and herbal therapies in
overcoming their health. Several nonpharmacological methods have been applied in clinics
or hospitals to help solve problems in pregnant women. Nonpharmacological therapy has
become part of the practice of nursing, in the form of modality therapy that can be used by
nurses as part of a comprehensive nursing plan, in providing women support during the
pregnancy process (Bello et al., 2021).
Hypertensive treatment can be done in a pharmacological and non-pharmacological
manner. Pharmacological treatment is treatment using drugs that can help lower and
stabilize blood pressure (Sulistyowati et al., 2011). Meanwhile, non-pharmacological
treatment is a form of treatment service that uses methods, tools, or materials used as
alternatives or complements to certain medical treatments. The number of pregnant women
in Banyumas Regency reaches 30,095 people, more than 6,000 of whom have a high risk.
The results of studies show that pregnant women with hypertension have not been
combined with non-pharmacological therapy. The nonpharmacological approach is a new
trend that can be developed and is an alternative method that can be offered to the mother
because of its not too great effect on both the mother and the fetus. One of the non-
pharmacological therapies that can be used to reduce hypertension is acupressure healing
therapy.
Human beings can heal themselves. This belief is applied in the self-healing
technique so that harmony and balance are achieved between the body, mind, and mind.
In self-healing exercises, there are several aspects involved, namely breath, motion, silence,
and touch/massage. The touch or massage given is in the form of acupressure.
Acupressure is to provide massage and stimulation at certain points in the body that
are used to improve health and overcome pain and reduce tension, fatigue, and various
diseases with the intention of re-circulating the circulation of energy vital and chi (Indrati
& Prasetyo, 2011) benefits of acupressure include helping in stress management, calming
nerve tension, and increasing body relaxation. This therapeutic technique uses fingers that
are carried out at points associated with hypertensive disease. Massages at certain points in
acupressure therapy can stimulate nerve waves so that they can launch blood flow, relax
spasms, and lower blood pressure (Samadi et al., 2018). As a result of research,
Randomized Clinical Trial, Acupressure on Taichong Acupoint with general hypertension
subjects, was shown to be able to lower blood pressure (p < 0.05), while the study with
hypertension in pregnant women, it has never been studied (Sulianti et al., 2018)
Healing acupressure is a combination of self-healing and acupressure, where the
massage process has 2 reactions, namely the strengthening reaction (yang) and the lowering
reaction (yin). The massage is performed for 30 pressures or turns clockwise. Yin massage
is performed for 40 pressures or round and counterclockwise. Massage can be started after
finding the right massage point, that is, the onset of a reaction at the massage point in the
form of pain or soreness. Point LR- 3 Taichong is a heart point, used to relieve headaches,
vertigo, emotional stress, and blurred vision (Song et al., 2015). Such as the results of the
research of a descriptive qualitative study The research Nursing Care Group conducted on
pregnant women in the first trimester, with inclusion criteria, especially in pregnant women
at risk, shows that Yongquan point acupressure (R1), Taichong (F3), Chengshan (B57) can
provide a sense of comfort during pregnancy and lower anxiety, fatigue, dizziness during
pregnancy (Sehhatie-Shafaie et al., 2013)
During pregnancy, the woman experiences both physical as well as emotional
changes. The anxiety and depression that appear during pregnancy affect negative
Dina Indrati Dyah Sulistyowati
Healing Acupressure Lr-3 on Blood Pressure and Anxiety Levels in Pregnant Women
with Hypertension 1.400
psychological changes between the mother and the fetus. The results of the study of
Rubertsson et al stated that depression and anxiety in early pregnancy are associated with
the risk of preeclampsia (Samadi et al., 2018). Based on this, it is necessary to manage
anxiety in pregnant women, including acupressure healing.
RESEARCH METHOD
This research is a type of research including experiments, using the randomized pre-
test post-test control group design. This experimental activity or experiment aims to find
out a symptom or change that arises from the LR-3 acupressure healing intervention and
the control group given the intervention according to standards, by seeing a decrease in
anxiety and blood pressure in pregnant women with hypertension. The reason for choosing
this research design is to address the threat of internal and external validity.
The population in this study was all pregnant women ≥ 20 weeks of pregnancy with
hypertension at the Banyumas Regency Health Center. The calculation of the study sample
uses the calculation formula to compare the mean of two independent groups (Ismael, 2014)
then the required number of samples is 30 responses.
RESULT AND DISCUSSION
A. Result
This research was carried out in the Purwokerto and Semarang areas. Data collection
was carried out from August to September 2018. The total number of respondents in this
study was 30 respondents consisting of 15 respondents grouped in the control group and
the other 15 respondents grouped in the intervention group. this explains the results of the
study according to the research objectives and discussion on " Healing acupressure LR-3
(Babhealing-pressure) affects blood pressure and anxiety levels in pregnant women with
hypertension".
1. Characteristics of Respondents
The characteristics of respondents in this study include age, education, and
occupation
Table 1 Distribution of characteristics of pregnant women
N
o
Intervention
Control
F
%
F
%
1
2
13.3
1
6.7
4
26.7
3
2.0
9
60.0
11
73.3
2
5
10
33.3
66.7
6
9
40
60
3
1
2
9
3
6.7
13.3
60
20
0
7
4
4
0
46.7
26.7
26.7
4
2
4
9
13.3
26.7
1
3
6.7
20
Eduvest – Journal of Universal Studies
Volume 2 Number 7, July 2022
1.401 http://eduvest.greenvest.co.id
60
11
73.3
5
2
13
13.3
86.79
1
14
6.7
93.3
'Table 1 above shows the interpretation of respondents' characteristics by age. The
results of the analysis found that the average age of respondents was 32.69 years. Then the
age of most respondents was more than 30 years old, which was 73.3% in the control group
while 60% in the intervention group.
Table 1 above shows the distribution of respondents' characteristics by occupation,
and antenatal class participation. The results of the analysis showed that 66.7% of pregnant
women did not work in the intervention group while those who did not work in the control
group were 60%. In the antenatal class, it shows that pregnant women have never
participated.
1. Average Blood Pressure and Anxiety Levels Of Pregnant Women Before and After The
Intervention Period In The Intervention Group And Control Group.
The following will be explained the differences in the average blood pressure and
anxiety levels of pregnant women in the intervention group and the control group before
and after the intervention.
Table 2 Distribution of average blood pressure and anxiety levels of pregnant women
before and after intervention in the intervention and control groups.
Table 2 Distribution of average blood pressure and anxiety levels of pregnant women
before and after intervention in the intervention and control groups.
From table 2 above, it can be seen that the average blood pressure of systole pre
averaged 139.13 mmHg and diastole 98.40 mmHg while post systole was 138.60 mmHg
and diastole was 97.20 mmHg pada control group. Meanwhile, the standard deviation of
systole 1,642 SD diastole was 3,509 in the control group. In the SD intervention group of
systole 6,278 SD diastole 3,958.
From table 5.2 above it can be seen that the average level of anxiety there was a
control group was pre-5.93 and post 8.93 with a standard deviation of 0.926 for the
intervention group. In the control group, the average level of anxiety was pre 6.93 and post
7.20 with a standard deviation of 0. 334. The results of the analysis found that there was a
significant difference in the average level of anxiety in the control and intervention groups
(p<0,000).
Group
Control
P
Intervention
p
n
Mean
SD
N
Mean
SD
pre
post
pre
post
Blood
pressure
- Systole
- Diastole
15
139.1
3
98.40
138.60
97.20
1.642
3.509
0.229
0.207
15
137.60
98.07
128.73
89.40
6.278
3.958
0.000
0.000
Anxiety
15
6.93
7.20
1.033
0.334
15
5.93
8.93
0.926
0.000
cortisol
15
429.12
760.19
1.259
0.988
15
546.12
371.20
0.898
0.007
Dina Indrati Dyah Sulistyowati
Healing Acupressure Lr-3 on Blood Pressure and Anxiety Levels in Pregnant Women
with Hypertension 1.402
B. Discussion
The discussion of research results includes the interpretation of research results and
research limitations. The interpretation of the results of the study includes: differences in
the average level of knowledge and attitudes due to the influence of the application of
"Healing acupressure LR-3 (healing-pressure) affects blood pressure and anxiety levels in
pregnant women with hypertension. The general purpose of this study was to determine the
effect of the application of Healing Acupressure LR-3 (healing-pressure) on blood pressure
and anxiety levels in pregnant women with hypertension
The results of this study found that the level of basic education was as much as
(6.7%), while universities were as much as (46.7%). These results show that the education
of pregnant women in Mersi in August – September 2018 is of various levels. A study
conducted by Hastomo (2009) stated that the education of parents, especially women, is
one of the keys to socio-cultural change. Women who are relatively highly educated will
have better health care measures. Women with higher levels of education will have greater
knowledge than lower levels of education.
Education is obtained from the learning process through formal and informal
education. The process is expected to gain better knowledge. Higher education will make
it easier for a person to receive information and knowledge to lead a healthy life and
overcome health problems (Ali, 2003 quoted by Estutiningsih, 2009). Another study was
conducted by Fatmawati (2007) with the results on elementary education (42.5%).
The results of the study obtained the results that the application of Healing
Acupressure LR-3 (healing-pressure) affects blood pressure and anxiety levels in pregnant
women with hypertension. This can be seen in the results of the bivariate analysis, it is
known that there is a significant difference between the average blood pressure level and
the anxiety level of pregnant women, in the intervention group before and after the
intervention period. Then there was no meaningful difference between the average blood
pressure level and anxiety levels in the control group before and after the intervention
period. These results show that Healing acupressure LR-3 (healing-pressure) affects blood
pressure and anxiety levels in pregnant women.
Based on WHO, the management of pregnant women with hypertension or arising
after 20 weeks ≥ of gestational age with routine antenatal examinations without
antihypertensive therapy is given, unless the blood pressure shows an increase, then the
patient is referred and given blood pressure-lowering drugs (Bello et al., 2021; Brown et
al., n.d.). The administration of antihypertensive therapy should be taken because of the
negative impact on the baby (Gilbert et al., 2008; Gillon et al., 2014a). Administration of
antihypertensive drugs risks reducing the perfusion of uteroplacental, resulting in low birth
weight (Vickers, 2017).
Treatment of hypertension can be carried out pharmacologically and non-
pharmacologically. Pharmacological treatment is the treatment using drugs that can help
lower and stabilize blood pressure. Meanwhile, nonpharmacological treatment is a form of
treatment service that uses methods, tools, or materials used as an alternative or
complement to certain medical treatments (Mukkamala et al., 2021). The number of
pregnant women in Banyumas Regency reaches 30,095 people, more than 6,000 of whom
have a high risk. The results of preliminary studies show that the treatment of pregnant
women with hypertension has not been combined with nonpharmacological therapy. The
nonpharmacological approach is a new trend that can be developed and is an alternative
Eduvest – Journal of Universal Studies
Volume 2 Number 7, July 2022
1.403 http://eduvest.greenvest.co.id
method that can be offered to the mother because of its not too great effect on both the
mother and the fetus. One of the nonpharmacological therapies that can be used to reduce
hypertension is an acupressure healing therapy (Ghule & Sureshkumar, 2020).
Indonesian people have long applied nonpharmacological and herbal therapies in
overcoming their health. Several nonpharmacological methods have been applied in clinics
or hospitals to help solve problems in pregnant women. Nonpharmacological therapy has
become part of the practice of nursing, in the form of modality therapy that can be used by
nurses as part of a comprehensive nursing plan, in providing support to women during the
pregnancy process.
Human beings can heal themselves. This belief is applied in the self-healing
technique so that harmony and balance are achieved between the body, mind, and mind. In
self-healing exercises, there are several aspects involved, namely breath, motion, silence,
and touch/massage. The touch or massage given is in the form of acupressure (Bastani,
2016).
Acupressure is to provide massage and stimulation at certain points of the body that
are useful for improving health and overcoming pain as well as reducing tension, fatigue,
and various diseases to reactivate the circulation of vital energy and chi.31benefits of
acupressure include helping in stress management, calming nerve tension, and increasing
body relaxation. This therapeutic technique uses fingers that are carried out at points
associated with hypertensive disease. Massages at certain points in acupressure therapy can
stimulate nerve waves so that they can launch blood flow, relax spasms, and lower blood
pressure (Akbarzadeh et al., 2015). As the results of the Randomized Clinical Trial study,
Acupressure on Taichong Acupoint with general hypertension subjects has been shown to
lower blood pressure (p < 0.05) (Lin et al., 2016), while studies with hypertension subjects
in pregnant women have never been studied.
Healing acupressure is a combination of self-healing and acupressure, where the
massage process has 2 reactions, namely the strengthening reaction (yang) and the lowering
reaction (yin). The massage is performed for 30 pressures or turns clockwise. Yin massage
is performed for 40 pressures or turns and counterclockwise. Massage can be started after
finding the right massage point, that is, the onset of a reaction at the massage point in the
form of pain or soreness. Point LR- 3 Taichong is a point of the heart, used to reduce
headaches, vertigo, emotional stress, and blurred vision (Cho & Tsay, 2004). As the results
of a descriptive qualitative study, the research group Nursing Care conducted on pregnant
women in the first trimester, with inclusion criteria, especially in pregnant women at risk,
showed that acupressure points Yongquan (R1), Taichong (F3), Chengshan (B57) can
provide a sense of comfort during pregnancy and reduce anxiety, fatigue, dizziness during
pregnancy (Lan et al., 2015).
During pregnancy, the woman experiences both physical as well as emotional
changes. The anxiety and depression that appear during pregnancy affect negative
psychological changes between the mother and the fetus (Akbarzadeh et al., 2014).The
results of the study of Rubertsson et al stated that depression and anxiety in early pregnancy
are associated with the risk of preeclampsia (Silva et al., 2016). Based on this, it is
necessary to manage anxiety in pregnant women, including acupressure healing.
CONCLUSION
Dina Indrati Dyah Sulistyowati
Healing Acupressure Lr-3 on Blood Pressure and Anxiety Levels in Pregnant Women
with Hypertension 1.404
There were significant differences in blood pressure and anxiety levels of pregnant
women after the intervention in the control and intervention groups. This shows that
Healing acupressure LR-3 (healing-pressure) can reduce blood pressure and anxiety levels
in pregnant women with hypertension. LR-3 Acupressure Healing Program (healing-
pressure) in pregnant women with hypertension can be applied to pregnant women to help
government programs improve the health of women and babies.
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