How to cite:
Indriati, Rr Sri Endang Puji Astuti, Tuti Anggarawati, Yuni Astuti. (2022).
The Effectiveness of the Papaya Mengkal and Green Grass Jelly Against
the Decrease in the Blood Pressure of the Client's Mild Hypertension.
Journal Eduvest. Vol 2(7): 1.350-1.356
E-ISSN:
2775-3727
Published by:
https://greenpublisher.id/
Eduvest – Journal of Universal Studies
Volume 2 Number 7, July, 2022
p- ISSN 2775-3735- e-ISSN 2775-3727
THE EFFECTIVENESS OF THE
PAPAYA MENGKAL
AND GREEN
GRASS JELLY AGAINST THE DECREASE IN THE BLOOD PRESSURE
OF THE CLIENT'S MILD HYPERTENSION
Indriati
1
, Rr Sri Endang Puji Astuti
2
, Tuti Anggarawati
3
, Yuni Astuti
4
1,2
Nursing Department of Health Polytechnic Semarang, Indonesia,
3,4
Nursing
Academy of Kesdam, Indonesia
Email: iinbimi1234@gmail.com, rarastuti@yahoo.com tutianggarawati@gmail.com,
yunie45tuti@gmail.com
ABSTRACT
Hypertension is condition medical moment pressure blood in
arteries increase exceed normal limit. Various study has
conducted for see effectiveness plant in lower pressure blood
high, such as papaya mengkal and green grass jelly. In one
study said that there was a decrease in blood pressure in
hypertensive clients after giving papaya juice. While green
grass jelly is rich in flavonoid and alkaloid active substances.
The content of flavonoid active substances can act as anti-
hepatotoxic, anti-HIV1, anti-tumor, anti-inflammatory and
can provide a vasodilating effect on blood vessels that helps
protect heart function. Flavonoids can reduce arterial
stiffness and can be an alternative treatment to reduce the
risk of heart disease.
KEYWORDS
Grass Jelly, Papaya Curd, Systolic, Diastolic
This work is licensed under a Creative Commons
Attribution-ShareAlike 4.0 International
INTRODUCTION
Hypertension is a medical condition when the blood pressure in the arteries
increases beyond normal limits (Guyton et al., 1972). Hypertension is one of the most
influential risk factors for the incidence of heart and blood vessel disease. The results of
the 2007 Basic Health Research (Riskesdas) show that most cases of hypertension in the
community have not been diagnosed. This can be seen from the results of measuring
blood pressure at the age of 18 years and over, it was found that the prevalence of
Indriati, Rr Sri Endang Puji Astuti, Tuti Anggarawati, Yuni Astuti
The Effectiveness of the Papaya Mengkal and Green Grass Jelly Against the Decrease in
the Blood Pressure of the Client's Mild Hypertension 1.351
hypertension in Indonesia was 31.7%, where only 7.2% of the population already knew
they had hypertension and only 0.4% of cases took hypertension medication.
The results of Riskesdas 2013 showed that the national prevalence of hypertension
reached 25.8% in the population in Indonesia over the age of 18. The prevalence of
primary/essential hypertension in Central Java in 2012 was 1.67%. In the target area of
the Srondol Health Center, Banyumanik, Semarang city, more than 400 clients suffer
from hypertension. From the prevalence of hypertension above, as many as 7% of people
with hypertension eventually suffer a stroke, the rest develop heart disease (1.5%), heart
failure (0.13%), and kidney failure (0.2%). Hypertension is also the third leading cause of
death after stroke and tuberculosis, reaching 6.7% of the death population at all ages in
Indonesia.
A person diagnosed with hypertension must take medication every day. This often
causes clients to become bored taking medication. Therefore, there needs to be food
based therapy which can be an alternative to relieve symptoms, even cure diseases.
Various studies have been conducted to see the effectiveness of plants in lowering blood
pressure. Elsa's research, et al (2014) said that there was a significant difference between
the mean blood pressure before and after administration of papaya juice to decrease blood
pressure. In this study, Elsa did not mention how many doses of papaya mengkal and how
to make it.
RESEARCH METHOD
The research method used was the Randomized Controlled Trial (RCT), which is a
controlled experimental comparative research method, where the researcher provides two
interventions by determining the sample group randomly.
Research design pre and post test control group design. Research respondents were
randomly divided into three groups, namely the papaya skin group, the green grass jelly
treatment group, and the control group. Before treatment, all groups were measured (pre
test). Furthermore, the treatment group was given papaya or green grass jelly every day in
a row for 14 days. When:
a. Systolic blood pressure 110 mm Hg and/or diastolic 70 mm Hg for 3 (three)
consecutive days
b. or the patient complains: dizzy eyes, especially when changing positions,
dizziness, weakness, feels like fainting and turns out after measurement of blood
pressure results in systolic blood pressure 110 mm Hg and/or diastolic 70 mm Hg
then the treatment is stopped.
During 14 days of treatment, researchers monitored the respondent's blood pressure
every day (Ritonga, Setiani, Umaroh, & Amri, 2017). Blood pressure measurements on
the second day onwards were carried out before giving green grass jelly or green grass
jelly, with the reason for this measurement to see the results of giving green grass jelly or
green grass jelly the previous day. In the control group, no treatment was given, but
monitoring was still carried out every day. After treatment, blood pressure measurements
( post test ) were performed in each group. The target population in this study are clients
with mild hypertension who live in Indonesia. Affordable population of mild
hypertension clients who live in Jabungan Village, Banyumanik District, Semarang.
Sample inclusion criteria:
a. Systolic blood pressure of 130-150 mm Hg and/or diastolic blood pressure of 90-100
mm Hg when two consecutive blood pressure measurements are taken with an
interval of 5 minutes in a fairly calm/resting state.
Eduvest – Journal of Universal Studies
Volume 2 Number 7, July 2022
1.352 http://eduvest.greenvest.co.id
b. Age 40-65 years and no plans to become pregnant. This is because the continuous
administration of papaya will cause infertility
c. No heart, kidney, lung disease, DM, stroke
d. Not taking antihypertensive drugs
e. Not obese II or BMI < 30
RESULT AND DISCUSSION
The results of the study provide an overview that the median or mean value of the
pre-test systolic blood pressure measurement in the control group was 140 mm Hg, a
minimum of 130 mm Hg, and a maximum of 150 mm Hg. In the control group, the
median systolic blood pressure on days 3, 7, 11, and 14 was the same, namely 130 mm
Hg.
The median diastolic blood pressure on the 3rd, 7th, 11th, and 14th day was 80
mm Hg. While in the papaya group, the median pre-test systolic blood pressure was 150
mm Hg, on days 3, 7, 11, and 14 were 135 mm Hg, 130 mm Hg, 130 mm Hg, and 120
mm Hg. The median pre-test diastolic blood pressure was 90 mm Hg, days 3, 7, 11, and
14 were the same, namely 80 mm Hg. For the green grass jelly group, the median pre-test
systolic blood pressure was 140 mm Hg, days 3, 7, 11, and 14 were 135 mm Hg, 130 mm
Hg, 130 mm Hg, and 130 mm Hg. The median pre-test diastolic blood pressure was 90
mm Hg, 3,7,11, and 14 days, namely 85 mm Hg, 80 mm Hg, 80 mm Hg, and 85 mm Hg.
All respondents fall into the category of mild hypertension.
Among the three groups above, it can be seen that the systolic blood pressure in the
papaya group had the largest median difference among the other groups (Kana-Sop et al.,
2015). This difference was seen in the pre-test median of 150 mm Hg and the median of
day 14 = 120 mm Hg, meaning the difference was 30 mm Hg. Thus, the papaya group
experienced a definite decrease in systolic pressure from the pre-test until the 14th day of
the study, while the control group and grass jelly respondents did not experience a
significant decrease in systolic pressure. The results of the diastolic pressure
measurement of the three groups from the pre test to day 14 tend to be stable.
The above conditions are in line with the theoretical basis that in normal
conditions the heart is still adapting, the diastolic pressure will not increase because this
pressure is a resting ventricular phase. The absence of a decrease in diastolic blood
pressure is possible because several things are caused by several confounding variables
that are not controlled, including the respondent's genetic factors where the researcher
does not know the respondent's family health history.
According to Junaidi (2010) genetic factors have a close relationship with the
occurrence of hypertension in people who have a family history of hypertension sufferers.
The second factor (OHTSUKA, KOMIYA, AIZAWA, & YAMADA, 1995), the
respondent's stress level also cannot be controlled. Stress can affect blood pressure
because the hypothalamus stimulates the release of the hormone epinephrine or
adrenaline. Adrenaline hormone will increase blood pressure periodically. Prolonged
stress will cause a permanent increase in blood pressure. The third factor, the respondent's
diet and the type of food consumed contains high salt which is water-retaining so that
blood pressure increases (Lategan, 2011).
Under physiological conditions, blood pressure is always under the Renin
Angiotensin Aldosterone / RAA system (Ames, Atkins, & Pitt, 2019). Renin is an
enzyme
Indriati, Rr Sri Endang Puji Astuti, Tuti Anggarawati, Yuni Astuti
The Effectiveness of the Papaya Mengkal and Green Grass Jelly Against the Decrease in
the Blood Pressure of the Client's Mild Hypertension 1.353
with a small protein released by the kidneys that is stored in the juxtaglomerular
cells when arterial pressure drops very low. This causes the activation of angiotensinogen
to become angiotensin I which has weak vasoconstrictive properties to blood vessels
(MacKenzie, 2011). For 30 minutes - 1 hour, renin will work for the formation of
angiotensin I. When blood passes through the pulmonary veins, angiotensin I meets with
ACE (angiotensin Converting Enzyme) released by the endothelium cells of the
pulmonary blood vessels, converting angiotensin I into angiotensin II.
Angiotensin II has very strong vasoconstrictor properties so that it affects arteries
and is slightly weak in veins, causing an increase in arterial pressure due to increased
peripheral resistance, on the other hand angiotensin II affects the renal cortex to secrete
the hormone aldosterone thereby increasing sodium and water reabsorption in order to
increase plasma volume. thereby increasing blood pressure. Angiotensin II itself within 2
minutes will be inactivated by blood and tissue enzymes, namely angiotensinase (Guyton
& Hall, 2000).
The results of the analysis in the same group showed significant differences in
both the papaya group and the green grass jelly group (Nissa et al., 2020). In the control
group, both systolic and diastolic blood pressure tended to persist from the pre-test to day
14. In line with the results of the analysis between groups, there were significant
differences between the control group, papaya and grass jelly on the 7th, 11th and 14th
days of measurement. Supported by multivariate analysis, it showed that the papaya
group had the most significant difference compared to the control group and the grass
jelly group starting on days 7, 11 and 14 of measuring respondents' systolic and diastolic
pressure with p value: 0.000 (< 0.05).
The results of this study are in line with the results of Elsa's research, et al (2014) which
states that there is a significant difference between the mean blood pressure before and
after administration of papaya juice to decrease blood pressure. In this study, Elsa did not
mention how many doses of papaya mengkal and how to make it.
Various studies have stated that papaya mengkal contains a diuretic, which is high in
potassium of 354 mg/100 grams which has an antihypertensive effect by increasing the
release of water and sodium salts. Potassium will also maintain the stability of the body's
electrolytes through the potassium sodium pump which reduces the amount of water and
salt in the body (Nriagu, Darroudi, & Shomar, 2016). Young papaya besides containing
high calcium, potassium also contains flavonoids. Flavonoids can reduce arterial stiffness
so that they can lower blood pressure. Flavonoids are useful for inhibiting ACE (Kwon et
al, 2010), so that from angiotensin I cannot be converted into angiotensin II which
functions to increase the activity of the sympathetic nervous system, vasoconstriction of
vascular smooth muscle and increase water and sodium retention (Sylvia, 2005).
With the presence of potassium and flavonoids, blood pressure will decrease
Potassium, calcium and magnesium have been known to lower blood pressure (Gilani,
Jabeen, Khan, & Shah, 2008). These minerals inhibit the occurrence of constriction of
blood vessels which causes a decrease in peripheral resistance resulting in a decrease in
blood pressure. Potassium acts as a diuretic so that fluid sodium expenditure increases, it
can help lower blood pressure. Potassium is also useful for inhibiting renin (Emma et al,
1982), so that in the renin-angiotensin system, angiotensinogen cannot be converted into
angiotensin I.
Eduvest – Journal of Universal Studies
Volume 2 Number 7, July 2022
1.354 http://eduvest.greenvest.co.id
Likewise with green grass jelly, green grass jelly leaves contain tetradine alkaloids
which have the effect of lowering blood pressure (Shine, Anuja, Suja, Raj, & Latha,
2020). According to Katrin et al. (2012), grass jelly plants are rich in flavonoid and
alkaloid active substances. Research by Lokesh and Amitsankar (2012) states that the
active substance of flavonoids can act as anti-hepatotoxic, anti-HIV 1, anti-tumor, anti-
inflammatory and can provide a vasodilating effect on blood vessels that helps protect
heart function. Research by Curtis et al. (2013) showed that flavonoids can reduce arterial
stiffness and can be an alternative treatment to reduce the risk of heart disease in
postmenopausal diabetes mellitus patients. Green grass jelly contains potassium about
100 mg / 100 grams of leaves.
According to Astawan (2011), grass jelly leaves also contain chlorophyll which can
function as an antioxidant, anti-inflammatory, and anticancer. The alkaloid components
contained in green grass jelly are more than those found in black grass jelly. Green grass
jelly leaves also contain components of polyphenols, saponins, and flavonoids that play a
role in lowering blood pressure (Rockmana, Suwondo, & Sulistiyani, n.d.).
Fitriana Sundari, et al (2015) research said that there was a significant difference
in blood pressure before and after giving green grass jelly, because green grass jelly
contains flavonoids. The content of flavonoid active substances can act as anti-
hepatotoxic, anti-HIV-1, anti-tumor, anti-inflammatory and can provide a vasodilating
effect on blood vessels that helps protect heart function (Zulfa & Fitriyanti, n.d.).
Researchers have not mentioned how many doses of green grass jelly, how to make it,
and how long to give it (Aiyalu, Govindarjan, & Ramasamy, 2016). Research by Curtis et
al. (2013) showed that flavonoids can reduce arterial stiffness and can be an alternative
treatment to reduce the risk of heart disease.
The results of this study showed that the papaya group had the most significant
difference compared to the control group and the grass jelly group starting on days 7, 11
and 14 of measuring respondents' systolic and diastolic pressure with p value: 0.000
(<0.05). In line with the results of Sundari's (2014) study, the decrease in blood pressure
in research respondents who consume grass jelly will decrease starting on the 14th day.
Why the papaya group tends to be more dominant in its impact on lowering blood
pressure, this is possible because the content of potassium and flavonoids in papaya is
higher than in grass jelly. Papaya contains high potassium of 354 mg/100 grams while
green grass jelly contains potassium about 100 mg/100 grams of leaves. Potassium is a
good diuretic so that it will reduce plasma volume gradually thereby lowering the
respondent's blood pressure.
In this study, the respondent's age factor contributed to the measurement results
because after a person is 45 years old and over, the arterial walls will experience
thickening due to the buildup of collagen substances in the muscle layer, so that the blood
vessels will gradually narrow and become stiff. Systolic blood pressure increases due to
decreased flexibility of large blood vessels (Sherwood, 2001).
The results of this study are expected to provide hope that someone diagnosed with
hypertension will not get bored of taking medication because there is a food based
therapy technique that can be an alternative to relieve symptoms, even cure disease.
However, there is one obstacle in the use of natural ingredients that have not been able to
determine how large the dose is consumed (Ojovan, Lee, & Kalmykov, 2019) .
Indriati, Rr Sri Endang Puji Astuti, Tuti Anggarawati, Yuni Astuti
The Effectiveness of the Papaya Mengkal and Green Grass Jelly Against the Decrease in
the Blood Pressure of the Client's Mild Hypertension 1.355
CONCLUSION
The papaya group had the most significant difference compared to the control
group and the grass jelly group starting on days 7, 11 and 14 of the respondents' systolic
and diastolic pressure measurements with p value: 0.000 (<0.05). There needs to be a
breakthrough in the provision of food-based treatment technology (Food Based Therapy)
and it is necessary to consider determining the exact dose in each consumption so that
unexpected negative effects are minimized. New breakthroughs are needed to explore
food-based therapy other than papaya and green grass jelly as consumption plants to
lower blood pressure such as advocate leaves, celery, cucumber, and others. Further
research is needed that provides treatment with graded doses of papaya juice and control
of disturbing factors in this study including economic status, type of work and type of
hypertension of the respondents.
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