Comparison Efficiency of Consuming Sweet Star Fruit Juice, Carrot

Juice and Cucumber Juice against Patients with Hypertension

Analyzed with Kruskal Wallis

Novrika Silalahi, Siti Marlina, Septa Dwi Insani, Hengki Frengki

Deli Husada Delitua Health Institute

Faculty of Public Health, Nursing Faculty

Jalan Besar No. 77 Deli Ttua, Deli Serdang 20355

Keywords: hypertension, sweet star fruit, carrots, cucumbers, kruskal wallis

Abstract: Hypertension is still a degenerative disease which remains a major problem in society and even in the world.

Hypertension is one of the main causes of mortality and morbidity in Indonesia, so the management of this

disease is a very common intervention at various levels of health facilities. Intake with modified food

ingredients containing potassium and magnesium into one of the complementary therapies to lower blood

pressure This study examined the effectiveness of sweet star fruit juice, carrot juice, cucumber juice in patients

with hypertension. The sample uses non-probability techniques namely purposive sampling of 54 samples.

This research is a quasi experiment or quasi experiment. Wilcoxon test results of 200 ml sweet starfruit juice

for 7 days can reduce systole 23.89 (p-value = 0,000) and diastole 12.78 (p-value = 0,000), for systolic carrot

juice 9.44 (p-value) = 0.00) and diastole 4.44 (p-value = 0.000), and for cucumber juice cyste 15 (p-value =

0,000) and diastole 7.78 (p-value = 0.001). The results of the kruskal wallis show p-value cystole = 0,000 and

p-value diastole = 0.001 with mean rank cystole and sweet starfruit juice diastole namely 37.5 and 35.03,

mean rank cystole and diastole carrot juice are 18.58 and 16.19 , the mean rank of cucumber and diastole of

cucumber juice is 26.42 and 31.28.

1 INTRODUCTION

Hypertension is a major problem for us all, because it

does not only occur in Indonesia, it remains in the

world. This is because hypertension is an entry point

or risk factor for diseases such as heart disease,

kidney failure, diabetes and stroke. Hypertension is

often found in adults and many adults suffer from the

disease, but are not aware of it. Hypertension is

referred to as the silent killer because it is often

without complaints, so the patient does not know he

has hypertension and only becomes known after

complications occur. Other complications of

hypertension that are not treated can also be

myocardial infarction, kidney failure,

encephalopathy, and seizures. Data shows that around

1.13 billion people in the world have hypertension,

meaning that 1 in 3 people in the world is diagnosed

with hypertension. The number of people with

hypertension continues to increase every year, it is

estimated that in 2025 there will be 1.5 billion people

affected by hypertension, and it is estimated that

every year 9.4 million people die from hypertension

and its complications (Ministry of Health, 2019).

According to Indonesia's 2014 Sample

Registration System (SRS) data, hypertension with

complications (5.3%) is the number 5 cause of death

at all ages. Whereas based on 2017 International

Health Metrics Monitoring and Evaluation (IHME)

data in Indonesia, the first-ranked cause of death is

caused by stroke, followed by ischemic heart disease,

diabetes, tuberculosis, cirrhosis, diarrhea, COPD,

Alzheimer's, lower respiratory tract infections and

disorders neonatal and traffic accidents.

Based on the Basic Health Research

(RISKESDAS) 2018 the prevalence of hypertension

based on measurement results in the 18-year-old

population of 34.1%, From the prevalence of

hypertension of 34.1% it is known that of 8.8%

diagnosed with hypertension and 13.3% of people

diagnosed with hypertension did not take medication

and 32.3% did not take medication regularly. This

shows that most hypertension sufferers do not know

436

Silalahi, N., Marlina, S., Insani, S. and Frengki, H.

Comparison Efﬁciency of Consuming Sweet Star Fruit Juice, Carrot Juice and Cucumber Juice against Patients with Hypertension Analyzed with Kruskal Wallis.

DOI: 10.5220/0009837604360443

In Proceedings of the International Conference on Health Informatics and Medical Application Technology (ICHIMAT 2019), pages 436-443

ISBN: 978-989-758-460-2

that they are hypertensive so they do not get

treatment.

Hypertension can be overcome with

pharmacological treatment and non-pharmacological

treatment. Pharmacological treatment is by taking

antihypertensive drugs. Pharmacological treatment is

by taking antihypertensive drugs and non-

pharmacological treatment by implementing a

healthy lifestyle in the form of weight loss, exercise,

smoking cessation, diet modification such as

consuming fruits and vegetables, reducing salt intake,

and reducing alcohol consumption (PERKI, 2016).

One way to make lifestyle modifications in people

with hypertension is by eating settings. The DASH

(Dietary Approaches to Stop Hypertension) diet is a

lifelong approach to healthy eating that is designed to

help treat or prevent high blood pressure. The DASH

diet encourages reducing sodium in the diet and

eating a variety of nutrient-rich foods that help lower

blood pressure, such as potassium, calcium and

magnesium. The DASH diet is also in line with

dietary recommendations to prevent osteoporosis,

cancer, heart disease, stroke and diabetes.

According to Mama Lubna (2016), one of the

carrots that is good for reducing or controlling blood

pressure is potassium. Potassium is a strong diuretic

that helps maintain blood pressure balance. Potassium

also has a function as a vasodilation in blood vessels.

Vasodilation in blood vessels can reduce peripheral

pressure and increase cardiac output so that blood

pressure can be normal. Research conducted by Nurul

Fitriani Haris (2012), shows that carrot juice has an

effect on reducing blood pressure in hypertensive

patients and research conducted by Fitri Parwanti

(2010) also shows that administration of carrot juice

is effective in reducing systolic blood pressure and

diastolic pressure in hypertensive patients. Based on

Zul Fikar Ahmad (2017), lowering blood pressure can

be done by drinking cucumber juice. Cucumber is a

fruit that is found in many communities and has been

widely consumed as a complement to dishes. Based

on the report of the United State Department of

Agriculture (USDA) every 100 grams of cucumber

contains 147 mg of potassium and does not contain

sodium, and many other nutritional content. The high

potassium content, making cucumbers as one of the

choices in efforts to treat nonpharmacological

hypertension. Based on research conducted by

Kusumastuty, et al (2016) about potassium intake on

blood pressure, found that potassium intake is

associated with systolic blood pressure and diastolic

blood pressure with a negative correlation direction,

it shows that the higher the consumption of

potassium, it can reduce blood pressure in patients

hypertension. The absence of sodium content also

makes clear the benefits of cucumbers. Based on

research conducted Riyadi, et al (2016), that

excessive sodium consumption is four times the risk

of suffering from essential hypertension when

compared with those who consume less sodium.

Sweet star fruit can also be sweet star fruit has a

diuretic effect that can facilitate urine so that it can

reduce the workload of the heart. A food is said to be

healthy food for the heart and blood vessels, if it

contains a ratio of potassium to sodium of at least 5:

1. Star fruit contains potassium and sodium with a

ratio of 66: 1, so it is very good for people with

hypertension (Astawan, 2016). Based on the

explanation above, the researchers aimed to

comparison the effectiveness of sweet star fruit juice,

carrot juice, cucumber juice in patients with

hypertension.

The Kruskal-Wallis test was used to compare two

free samples from two different populations. The

Kruskal-Wallis test was chosen if the data were not

normally distributed and the data variance was

different. The Kruskal-Wallis test, also called the H

test, is an alternative procedure to one-way ANOVA.

The Kruskal-Wallis test also assumes that the

variance between the population k (treatment) is the

same, but the population k has a continuous

distribution and has the same shape (while the shape

can be skewed, bimodal, or whatever). And unlike the

ANOVA test, Kruskal-Wallis, which is an alternative

nonparametric method, can be used for ordinal or

ranked data response. The p-value is less than the

critical limit of alpha, generally 0.05, which means

rejecting Ho or accepting H1, meaning that the

treatment has a significant effect. Kruskall Wallis is

an omnibus test that is a test that can only find out if

there are statistically significant differences without

being able to know which treatments differ, so a Post

Hoc test or a further test is needed. As in the previous

discussion that the Post Hoc test after Kruskall Wallis

can use the Mann Whitney U Test, which is to test the

difference in mean between one group or treatment

with other treatments.

2 METHODS

This research was conducted at the Namorambe

Health Center, Namorambe District, Deli Serdang

Regency. From Table 1 it can be seen that this study

used a sample of 54 adults with a non-probability

sampling technique that is purposive sampling. This

study used 3 groups of juice therapy samples: the first

group 18 samples using star fruit juice, the second

Comparison Efﬁciency of Consuming Sweet Star Fruit Juice, Carrot Juice and Cucumber Juice against Patients with Hypertension Analyzed

with Kruskal Wallis

437

group 18 samples using carrot juice, and 18 samples

using cucumber juice. All samples were hypertension

patients aged 26-70 years, with the classification of

mild hypertension (stage 1) 140-159 mmHg and

moderate hypertension (stage 2) 160-179 mmHg.

Table 1: Pretest and Posttest data for Patient Hypertension

with Sweet Star Fruit Juice

No Age

Gend

Blood pressure

Juice

Ther

apy

Pre-Test

Post-

Test

1 56 P 160/90 140/80

Sweet

Star

fruit

juice

2 50 P 170/100 150/90

3 55 L 160/100 130/80

4 46 P 150/100 120/80

5 57 L 150/90 130/80

6 48 P 140/90 120/80

7 62 L 160/90 150/80

8 44 P 150/90 130/80

9 44 P 140/80 110/70

10 60 P 150/100 120/80

11 55 L 150/90 130/80

12 64 P 170/100 140/90

13 51 P 160/90 130/80

14 50 L 160/100 130/80

15 55 L 170/100 150/80

16 63 L 150/90 130/80

17 50 P 140/90 120/80

18 53 L 150/100 120/90

Table 2 : Pretest and Posttest data for Patient Hypertension

with Sweet Carrot Juice

No Age

Gend

Blood pressure

Juice

Therap

Pre-

Test

Post-

Test

52 L 160/90 150/90

Carrot

juice

2 40 L 150/90 140/90

3 53 P 160/100 150/90

4 55 L 160/90 150/80

5 42 P 160/90 160/100

6 56 P 170/100 160/90

7 43 L 150/90 140/90

8 60 P 150/90 140/90

9 63 L 160/100 150/90

10 52 L 140/90 130/90

11 50 P 150/100 140/90

12 66 P 150/100 140/90

13 59 P 170/100 160/90

14 46 L 150/90 140/90

15 57 P 140/90 130/80

16 64 L 160/90 150/80

17 60 L 160/80 150/90

18 58 P 160/100 150/90

Table 3 : Pretest and Posttest data for Patient Hypertension

with Cucumber Juice

No Age

nde

Blood pressure

Juice

Ther

apy

Pre-Test

Post-

Test

1 50 L 160/100 130/80

Cucu

mber

juice

2 55 L 170/100 150/80

3 63 L 150/90 130/80

4 50 P 140/90 120/80

5 53 L 150/100 120/90

6 63 L 160/100 150/90

7 52 L 140/90 130/90

8 53 L 150/100 120/90

9 52 L 160/90 150/90

10 40 L 150/90 140/90

11 63 L 160/100 150/90

12 52 L 140/90 130/90

13 50 P 150/100 140/90

14 66 P 150/100 140/90

15 59 P 170/100 160/90

16 46 L 150/90 140/90

17 57 P 140/90 130/80

18 40 L 150/90 140/90

This research is a quasi-experimental where the

research is given treatment to the research subjects.

This research was carried out by means of

preliminary data collected including measurement of

hypertension blood pressure with a

sphygmomanometer before being given the treatment

of star fruit juice, carrot juice and cucumber juice.

During treatment, the sample is monitored for the

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

438

portion of juice consumed and all complaints

experienced by the sample are recorded. This

treatment is given for 7 days, each juice group sample

taken by 100 ml. After 7 days, blood pressure

measurements were taken to systole and diastole with

a sphygmomanometer. The ingredients used to make

juice are blenders, knives, filters, measuring cups,

Liostar brand scales with a capacity of 3 kg. The data

obtained were processed using the Wilcoxon Rank

and Kruskal Wallis tests. Prior to the Wilcoxon Rank

and Kruskal Wallis tests, the normality and

homogeneity tests were previously carried out, which

is to find out whether the data is normal or not and

homogeneous or not. Because to use the test data

must not be normally distributed. Normality test

obtained p-value <0.05 and vice versa for data not

normally distributed.

Figure 1: The process of making juice

Comparison Efﬁciency of Consuming Sweet Star Fruit Juice, Carrot Juice and Cucumber Juice against Patients with Hypertension Analyzed

with Kruskal Wallis

439

3 RESULTS AND DISCUSSION

Based on the results of research conducted for 7 days,

obtained samples that suffer from hypertension as

many as 54 people, each grouped 18 people using

sweet starfruit juice, 18 people using carrot juice, and

18 people using cucumber juice, obtained blood

pressure data after drinking juice as follows:

Table 4: Result of Differences in Juice Therapy with Wilcoxon Test in Hypertension

Pressue Results Blood

Mean Median SD p-value

Sweet star

fruit juice

Pretest sistole 18 154,4 150 9,835

0,000

Post test sistole 18 130,5 130 11,617

Pretest diastole 18 93,8 90 6,076

0,000

Post test diastole 18 81,1 80 4,714

Carrot

juice

Pretest sistole 18 155,5 160 8,555

0,000

Post test sistole 18 146,1 150 9,164

Pretest diastole 18 94,4 90 5,113

0,000

Post test diastole 18 88,8 90 4,714

Cucumber

juice

Pretest sistole 18 152,22 150 9,428

0,000

Post test sistole 18 137,22 140 11,785

Pretest diastole 18 95 95 5,145

0,001

Post test diastole 18 87,22 90 4,609

ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology

440

Figure 2: The Graphic Prestest and Posttest Systole-

Diastole

Based on Table 4, the p-value of systole 0.001 and

diastole 0.000 is obtained so that it can be concluded

that Reject H

which means there is a difference in the

effectiveness of giving sweet star fruit juice, carrot

juice and cucumber juice to decrease high blood

pressure in people with hypertension. With the mean

rank of systole sweet starfruit juice group 37.50 and

systole carrot juice group 18.58, and systole

cucumber juice group 26.42. While the results of

diastole in the sweet starfruit juice group 35.03,

diastole in the carrot juice group 16.19, and diastole

in the cucumber juice group 31.28. From the above

results it can be seen that sweet starfruit juice is more

effective in lowering blood pressure in people with

hypertension compared to carrot juice and cucumber

juice.

Table 5: Distribution of Average Diffrences in

Effectiveness of Juice Therapy with the Kruskal Wallis Test

in Hypertension

Blood Pressure Results

Mean

Rank

p-value

Sweet star fruit systole 18 37,50

0,001

Carrot systole 18 18,58

Cucumber systole 18 26,42

Sweet star Fruit Diastole 18 35,03

0,000

Carrot Diastole 18 16,19

Cucumber Diastole 18 31,28

The results of this study are in line with research

based on DASH (Dietary Approaches to Stop

Hypertension) said to reduce blood pressure is highly

recommended to consume foods high in potassium

and fiber (Chaturvedi, 2009). Sweet star fruit has a

diuretic effect that can expedite urine so as to reduce

the workload of the heart. A food is said to be healthy

food for the heart and blood vessels, if it contains a

ratio of potassium to sodium of at least 5: 1. Sweet

star fruit contains potassium and sodium with a ratio

of 66: 1, so it is very good for people with

hypertension (Astawan, 2009). Diuretics have an

antihypertensive effect by increasing the release of

water and sodium salt. Potassium maintains the

stability of the body's electrolytes through potassium

sodium pumps, reducing the amount of water and salt

in the body and loosening blood vessels so that the

amount of salt in blood vessels enlarges, this

condition helps blood pressure to become normal.

Magnesium and potassium affect the smooth muscle

of blood vessels then cause vasodilation and decrease

peripheral resistance and blood pressure. Star fruit is

rich in content of provitamin A, vitamin B1, vitamin

B2, and vitamin C, in addition there are other contents

such as phosphorus, calcium, potassium, iron, pectin,

and fiber that can help nourish blood vessels while

lowering blood pressure. This study is in line with

research conducted by Dwipayanti (2011) entitled

"Effectiveness of Star Fruit on Reducing Blood

Pressure in People with Hypertension", it was found

that starfruit is effective for reducing blood pressure

in patients with hypertension because star fruit has

high potassium (potassium) levels with low sodium

as a proper hypertension drug. Research conducted by

Wanayanti (2015) entitled "Effect of Starfruit Juice

(Avverhoa Carambola Linn) on Reducing Blood

Pressure in Elderly Patients with Hypertension", the

results showed that there was an effect of star fruit

juice on reducing blood pressure in patients with

hypertension in the elderly group. Research

conducted by Ardiyanto (2014) entitled

Comparison Efﬁciency of Consuming Sweet Star Fruit Juice, Carrot Juice and Cucumber Juice against Patients with Hypertension Analyzed

with Kruskal Wallis

441

"Effectiveness of Starfruit Juice on Reducing Blood

Pressure in the Elderly in Tawangmas Baru Sub-

District, West Semarang District", found the effect of

starfruit juice on reducing pressure in the elderly with

hypertension in Tawangmas Barat Sub-District, West

Semarang District .

4 CONCLUSION

Based on the results of the study, it was found that

there were differences in the effectiveness of

administration of sweet starfruit juice, carrot juice

and cucumber juice to decrease high blood pressure

in people with hypertension. With the mean rank of

cystole sweet starfruit juice group 37.50 and systole

carrot juice group 18.58, and cystole cucumber juice

group 26.42. While the results of diastole in the sweet

starfruit juice group 35.03, diastole in the carrot juice

group 16.19, and diastole in the cucumber juice group

31.28. From the above results it can be seen that sweet

starfruit juice is more effective in lowering blood

pressure in people with hypertension compared to

carrot juice and cucumber juice.

Star fruit is rich in content of provitamin A,

vitamin B1, vitamin B2, and vitamin C, in addition

there are other contents such as phosphorus, calcium,

potassium, iron, pectin, and fiber that can help

nourish blood vessels while lowering blood pressure.

For kidney disease sufferers it is not recommended to

consume star fruit, so in this study if hypertensive

sufferers who experience kidney disease are not

advised to drink star fruit juice. Other scientific

research shows, the content of pectin in star fruit has

a role in lowering blood pressure. Pectin in star fruit

works by binding cholesterol, then taking it out with

feces. Therefore, people who consume star fruit to

lower blood pressure also get a bonus to reduce levels

of bad cholesterol. This fruit has vitamin A and C

which is quite high. Especially vitamin C which

reaches 33.00 mg in 100 grams of star fruit. Of

course, high vitamin C content has antioxidant

benefits that can prevent the development of cancer

cells and enhance the body's immune system. Star

fruit has very effective properties to reduce high

blood pressure or hypertension when consumed in

juice. This is because the content of vitamins,

minerals, fiber and various antioxidants in star fruit

that is useful for people with hypertension to lower

blood pressure. Star fruit also contains less than 1

gram of fat, so it is very good for people with

hypertension who have an obsession in losing weight.

The fat contained in star fruit is polyunsaturated fat

that can produce vitamin E and antioxidants. These

compounds can help protect body cells. When weight

has fallen to the ideal range thanks to the consumption

of star fruit, blood pressure will be stable in the

normal range and the occurrence of heart disease and

stroke in the future can be avoided. According to the

National Kidney Foundation, consumption of star

fruit in people suffering from kidney disease will

cause reactions such as hiccups, confusion, and

seizures. That is caused by the inability of the kidneys

to process and get rid of "poisons" from star fruit. As

a result, what happens next is damage to the brain.

Starfruit effective for reducing high blood pressure in

people with hypertension that only applies to people

with hypertension whose disease is still not severe. If

the disease is already severe and causes complications

to the kidneys, starfruit can even bring disaster to

health

ACKNOWLEDGEMENTS

This research was supported by Health Institute of

Deli Husada, Health Institute of Medistra Lubuk

Pakam, Sembiring General Hospital Foundation, and

Medistra Foundation, Indonesia

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Comparison Efﬁciency of Consuming Sweet Star Fruit Juice, Carrot Juice and Cucumber Juice against Patients with Hypertension Analyzed

with Kruskal Wallis

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