Effectiveness of Lemon juice on reduction of blood pressure among hypertensive clients in selected rural community, Mangaluru

 

Mrs. Shilpa T M¹., Dr (Mrs.) Jenifer D’ Souza²

¹Final Year M. Sc (N) Student, Department of Community Health Nursing, Laxmi Memorial College of Nursing, Mangaluru, Karnataka. India.

²Professor and HOD, Department of Community Health Nursing, Laxmi Memorial College of Nursing, Mangaluru, Karnataka. India.

 

ABSTRACT:

 

 

INTRODUCTION:

The world statistics of hypertension in 2018 shows that the prevalence of hypertension is highest in Africa (46% of adult) while lowest in America (35% of adult). Age specific prevalence of hypertension is 3.3% (18-28yrs), 13.2% (30-39yrs), 22% (40-49yrs), 37.5% (50-59yrs), 51% (60-74yrs)¹. In 2019 prevalence of hypertension in India is 24-30% of prevalence of hypertension in urban areas and 12-14% in rural areas². State wise statistics of hypertension shows that in Karnataka 21% of people suffer from hypertension. The statistics of 2015 shows that in Dakshina Kannada 43.6% of adult suffer from hypertension Global Burden of Disease (GBD). Study has estimated that hypertension led to 1.6 million deaths and 33.9 million disability-adjusted life years in 2015 and is most important cause of disease burden in India³.

 

Due to aging process, elderly have the highest prevalence of hypertension. Therefore there is a need to control hypertension, among the elderly, one of the fastest-growing segments of the world population. It is a major risk factor for CVD, which remains one of the leading causes of death among older adults aged 65 years or older. The use of complementary medicine is increasing rapidly, exceeding prevalence of 53% among those aged 50 years and above⁴.

 

Among the various complementary and alternative therapies for management of hypertension, lemon juice is gaining more popularity. Consumption of warm lemon water in the morning in empty stomach, as it is rich in potassium, magnesium, and water help to lower the blood pressure, it helps to kick-start the digestion process for the day. After a night’s sleep the body is dehydrated and ready to flush out toxins. If the body is dehydrated, blood becomes thicker and body has to work too hard to circulate. Lemon which is rich in vitamin c is the perfect tool to hydrate and cleanse the body by expelling toxins from the body⁵.

 

Lemon contains vitamin c, which helps in making the blood vessels soft and pliable and removes their rigidity which in turn lowers the high blood pressure. In fact, when lemon is consumed regularly, there is less chance of heart failure due to its invaluable Vitamin B. It also contains the mineral potassium, which works with sodium to keep blood pressure regulated, and studies have also proved that people who consume more potassium have a lower blood pressure than those who consume less of the mineral. The Review of literature shows that benefits of drinking warm lemon water in the morning in empty stomach are that it decreases blood pressure, cholesterol, stress, arteriosclerosis, heart failure, helps in digestion, liver detoxification, iron absorption, weight loss (if it is combined with a reduced-calorie diet and exercise program),act as diuretic, natural laxative, boost immune system, balance PH, clears skin, enhances mood, hydrates body, promotes wound healing, freshens breath, reduces joint and muscle pain, beneficial during pregnancy, prevents respiratory diseases and lowers blood sugar⁶.

 

A quasi experimental study was done in Dommasandra PHC, Bangalore. The aim of the study was to determine the effect of lemon juice on selected physiological parameters among PIH mothers in experimental group, to compare the physiological parameters of PIH mothers in both experimental and control group and to determine the association between physiological parameters and selected demographic variables among PIH mothers. A sample of 30 PIH mother between the age group of 20-25 were selected by using purposive sampling technique and 15 mothers each were assigned randomly to the experimental and control group. Base line data, mercury sphygmomanometer, stethoscope were used to obtain the data. Result of study revealed that there was significant difference between mean pre test and post test score of systolic blood pressure at 1st day (Mean=138.66) and 5th day (Mean=126), diastolic blood pressure at 1st day (Mean=90) and 5th day (Mean=80) among experimental group. The obtained ‟t” value of systolic and diastolic mean for pre test and post test (5.025 and 5.076) was greater than the table value that inferred that lemon juice is effective in reducing Pregnancy Induced Hypertension. The finding of the study concluded that Lime juice intake is effective during Pregnancy Induced Hypertension in reducing Blood Pressure⁷.

 

MATERIAL AND METHOD:

STATEMENT OF THE PROBLEM:

Effectiveness of lemon juice on reduction of blood pressure among hypertensive clients in selected rural community, Mangaluru.

 

OBJECTIVES OF THE STUDY:

1    To assess the existing level of blood pressure among clients in both the experimental and the control group.

2    To find the effectiveness of lemon juice in reduction of blood pressure among hypertensive clients in the experimental group.

3    To compare the blood pressure reading between experimental and control group.

4    To find the association of pre-test blood pressure reading with selected demographic variable of hypertensive client.

 

HYPOTHESES:

H₁:   The mean post-test blood pressure reading will be significantly lower than the mean pre-test blood pressure reading in experimental group.

H₂:   There will be a significant difference in the post test blood pressure reading in the experimental and control group.

H₃:   There will be a significant association of pre-test blood pressure reading with the selected demographic variable.

 

Research approach:

A quasi experimental research approach was adopted.

 

Research design:

Interrupted time series design was used.

 

Research setting:

Kalai rural community area, under Benjanapadav PHC, Mangaluru.

 

Sample:

50 hypertensive clients (25 in the experimental and 25 in the control group)

 

Sampling technique:

Non-probability purposive sampling technique adopted.

 

Description of tools:

·       Demographic proforma: It consists of 9 items, which includes age, gender, religion, educational status, occupation, diet, duration of diseases, treatment followed and any associated illness.

·       Diary for recording daily lemon juice intake in hypertensive clients.

·       Record of blood pressure of hypertensive clients in experimental group and control group.

 

Plan of data analysis:

The obtained data was analyzed using descriptive and inferential statistics on the basis of objectives and hypothesis of the study.

·         Computation of frequency and percentage distribution of demographic variables of the hypertensive clients.

·         Range, Mean, Median and Standard Deviation to find blood pressure readings of hypertensive clients in experimental and control group.

·         ANOVA to find the significant difference of mean pre-test and post- test blood pressure reading in the experimental group.

·         Bonferroni ‘t’ test to find multiple comparisons of pre-test and post-test systolic and diastolic blood pressure reading in the experimental group.

·         Mann-Whitney ‘U’ Test to find the significant difference in the mean systolic blood pressure reading and diastolic blood pressure reading in the experimental and control group.

·         Chi square test to find the association of blood pressure reading of experimental and control group with selected demographic variables of hypertensive clients.

 

 

RESULTS:

Section I: Description of the demographic variables of hypertensive clients

 

Table 1: Frequency and percentage distribution of demographic variables of the hypertensive clients n₁=25, n₂=25

Demographic variables	Experimental group (n1=25)		Control group (n2 =25)
	F	%	F	%
1.    Age (years) a.     40-45 b.    45-50 c.     40-55 d.    55-60	- 3 6 16	- 12 24 64	7 14 1 3	28  56 4  12
2.    Gender a.     Male b.    Female	12 13	48 52	10 15	40 60
3.    Religion a.     Hindu b.    Muslim c.     christen d.    Others	1 24 - -	4 96 - -	5 20 - -	20 80 - -
4.    Education Status a.     Non formal b.    Primary c.     Secondary d.    PU and above	12 12 1 -	48 48 4 -	13 10 2 -	52 40 8 -
5.    Occupation a.     Unemployed b.    Skilled c.     Unskilled d.    Professional	6 17 2 -	24 68 8 -	1 18 6 -	4 72 24 -
6.    Diet a.     Vegetarian b.    Non vegetarian c.     Mixed	- 10 15	- 40 60	1 9 15	4  36 60
7.    Duration of diseases a.     <3yrs b.    4-6yrs c.     7-9yrs d.    >9yrs	7 9 8 1	28 36 42 4	6 13 4 2	24 52 16 8
8.    Associated illness if any a.     Nil b.    Gastritis c.     Gastro oesophageal reflex disorder d.    Renal diseases e.     Tooth erosion f.     Any other specify	20 - - - - - 5	80 - - - - - 20	13 5 - - - - 7	52 20 - -     28
9.    Treatment followed a.     Diet modification b.    Any hypertensive drugs c.     Both d.    Any other specify	1 9 15 -	4 36 60 -	6 11 8 -	24 44 32 -

 

Section II: Description of blood pressure readings of hypertensive clients in experimental and control group

 

Table 2: Range, Mean, Median and Standard Deviation of Pre-test and Post-tests of systolic blood pressure of hypertensive clients in experimental and control group n₁=25, n₂=25

Group		Range	Mean	Median	Standard deviation
Experimental group	Pre-test	142-172	156.40	156	8.7
(n1=25)	Post-test I	138-172	153.44	152	9.7
	Post-test II	120-160	143.04	142	11.0
Control group	Pre-test	140-170	153.28	150	9.7
(n2=25)	Post-test I	120-172	149.60	150	12.0
	Post-test II	122-162	148.80	150	11.2

 

The data depicted in Table 2 shows that the mean pre-test systolic blood pressure reading (156.40±8.7) is more than the post-test I (153.44±9.7) and post-test II(143.04±11.0) systolic blood pressure in the experimental group. The mean pre-test systolic blood pressure reading (153.28±9.7) is more the than post-test I (149.60±12.0) and post-test II (148.80±11.2) systolic blood pressure reading in control group.

 

Table 3: Range, Mean, Median and Standard Deviation of Pre-test and Post-tests of diastolic blood pressure of hypertensive clients in experimental and control group n₁=25, n₂=25

Group		Range	Mean	Median	Standard deviation
Experimental group	Pre-test	90-104	98.08	98.00	3.5
(n1=25)	Post-test I	80-100	93.84	94.00	5.3
	Post-test II	80-96	88.72	90.00	5.0
Control group	Pre-test	90-104	96.80	98.00	4.2
(n2=25 )	Post-test I	80-104	94.72	96.00	5.4
	Post-test II	88-100	94.48	96.00	4.0

 

The data depicted in Table 3 shows that the mean pre test diastolic blood pressure reading (98.08±3.5) is more than the post-test I (93.84±5.3) and post-test II (88.72±5.0) diastolic blood pressure reading in the experimental group. The mean pre test diastolic blood pressure reading (96.80±4.2) is more the than post-test I (94.72±5.4) and post-test II (94.48±4.0) diastolic blood pressure reading in the control group.

 

Section III: Effectiveness of lemon juice on reduction of blood pressure among hypertensive clients in the Experimental Group:

To find the significant difference between the pre-test and post-test blood pressure in the experimental group, one way ANOVA was computed.

H0₁: There will be no significant difference in the blood pressure reading before and after lemon juice intake in the experimental group.

 

Table 4: One Way ANOVA results showing the significant difference between pre test and post test blood pressure of the clients in the Experimental Group n₁=25

	Experimental group	Sum of squares	Df	F value	P value
SBP	Between clients	149.60	2
	Within clients	153.44	48	61.915	0.000
	Total	303.04	50
DBP	Between clients	94.72	2
	Within clients	93.84	48	37.857	0.001
	Total	188.56	50

t_(2,48)=3.19, p<0.05, df= degree of freedom

The data depicted in Table 4 shows that the calculated F value (61.91) for the systolic blood pressure was greater than the tabled value t_(2,48) =3.19 at 0.05 level of significance. The calculated F value (37.85) for the diastolic blood pressure was also greater than the tabled value t_(2,48)=3.19 at 0.05 level of significance. Thus the null hypothesis H₀₁ was rejected.

 

Significance of paired difference between the pre-test and post-test mean blood pressure reading among hypertensive clients:

To test the significance difference between the pair of various blood pressure reading, Bonferroni ‘t’ test was computed.

 

Table 5: Bonferroni ‘t’ test showing multiple comparisons of pre-test and post-test systolic and diastolic blood pressure reading in the experimental group. n₁=25

Group	Time	Mean change (%)	Mean difference	P value
Experimental group SBP	Pre-test	15th day 156.40 1.89	02.96	0.00
		30th day 153.44 8.54	13.36	0.00
	15th day	30th day 143.04 6.78	10.40	0.00
Experimental group DBP	Pre-test	15th day 98.08 4.3	4.24	0.00
		30th day 93.84 9.54	9.36	0.00
	15th day	30th day 88.72 5.46	5.12	0.00

t₍₂₄₎= 3.09 , p < 0.005

 

The data depicted in Table 5 shows that the mean difference of pre test to 15^th day of systolic blood pressure (02.96) is less than 15^th day to 30^th day (10.40) and less than pre test to 30^th day (13.36) at 0.005 level of significance. The mean difference of pre test to 15^th day of diastolic blood pressure (4.24) is less than 15^th day to 30^th day (5.46) and less than pre test to 30^th day (9.36) at 0.005 level of significance. This shows that there is significant difference between the pre-test and post-test blood pressure reading (post I and post II) in the experimental group.

 

Section IV: Comparison of blood pressure reading of experimental and control groups:

To find the significant difference between post-test blood pressure reading in the experimental group and control group Mann-Whitney ‘U’ test was computed.

H₀₂: There is no significant difference between post test blood pressure reading in experimental group and control group

 

Table 6: Mann-Whitney ‘U’ Test showing the significant difference in the mean systolic blood pressure reading in the experimental and control group.  n₁ =25 n₂=25

Time	Group	Mean	Median	Change (%)	‘Z’ value	p value
Pre -Post-test I	E	2.96	152.0	1.89	0.44	0.660
	C	3.68	150.0	2.40
Pre-Post-test II	E	13.36	142.0	8.54	3.24	0.001
	C	4.48	150.0	2.92

 t₍₄₈₎=1.96, p < 0.05

 

The data depicted in table 6 shows that the Mann-Whitney ‘Z’ value 0.44 of pre test and post-test I in experimental and control group is less than the tabled value 1.96 at 0.05 level of significance and Mann-Whitney ‘Z’ value 3.24 of pre test and post test II in experimental and control group is greater than the tabled value 1.96 at 0.05 level of significance. It shows there is significant difference in the systolic blood pressure in experimental and control group. Thus H₀₂ was rejected.

 

Section V: Association of blood pressure reading of experimental and control group with the selected demographic variables

To determine the association of blood pressure reading with selected demographic variables Chi square test was computed

H₀₃: There is no significant association of blood pressure reading of experimental and control group with selected demographic variables of hypertensive clients.

 

Table 7: Association of systolic blood pressure reading of experimental and control group with the selected demographic variables n=50

Demographic Variables (156) (156)	≤median	>median	c2 Value	df	c2 Table Value	Inference
1. Age ·    <50yrs   ·    >50yrs   ·    Total	14 10 24	10 16 26	1.97	1	3.84	not significant
2. Gender ·    Male   ·    Female   ·    Total	13 11 24	09 17 26	1.94	1	3.84	not significant
3. Religion ·    Hindu   ·    Muslim   ·    Total	04 20 24	02 24 26	0.29	1	3.84	not significant
4. Education status ·    Illiterate   ·    Primary   ·    Total	17 07 24	08 18 26	8.01	1	3.84	Significant
5. Occupation ·    Skilled   ·    Others   ·    Total	16 08 24	19 07 26	0.24	1	3.84	not significant
6. Diet ·    Non veg   ·    Others   ·    Total	04 20 24	15 11 26	7.25	1	3.84	Significant
7. Duration of diseases ·    <6yrs   ·    >6yrs   ·    Total	18 06 24	17 09 26	0.54	1	3.84	not significant
8. Treatment followed ·    Diet    ·    Others ·    Total	15 09 24	18 08 26	0.25	1	3.84	not significant
9.Associated illness if any ·    Gastritis   ·    Others   ·    Total	13 11 24	07 19 26	3.84	1	3.84	not significant

p< 0.05

 

The data depicted in the table 7 shows that there was a significant association of level of systolic blood pressure with educational status (c²=8.013) and diet (c²=7.259) at 0.05 level of significance. Hence a null hypothesis (H₀₃) was rejected for the demographic variables like educational status and diet.

 

Table 8: Association of diastolic blood pressure reading of experimental and control group with the selected demographic variables n=50

Demographic  Variables (10) (10)		≤median	>median	pValue		Table Value	Inference
1.  Age ·   45-50yrs   ·   51- 60yrs   ·   Total		05 06 11	03 09 09	0.46		0.05	not significant
2.Religion ·   Hindu   ·   Muslim   ·   Total		10 01 11	08 01 09	0.71		0.05	not significant
3.Education status ·   Illiterate   ·   Primary   ·   Total		08 03 11	07 02 09	0.60		0.05	not significant
6.Monthly income ·   <2,500   ·   2,501-5,000   ·   Total		09 02 11	09 00 09	0.28		0.05	not significant
7.Type of family ·   Nuclear   ·   joint   ·   Total		02 12 17	14 19 33	0.80	1	3.84	not significant
7.Duration of diseases ·   <yrs   ·   >6yrs   ·   Total		10 07 17	25 08 33	1.53	1	3.84	not significant
8.Treatment followed ·   Diet    ·   Present   ·   Total		11 06 17	22 11 33	0.01	1	3.84	not significant
9.Associated illness if any ·   Gastritis    ·   Others   ·   Total	08 09 17		12 21 33	0.53	1	3.84	not significant

p<0.05

 

The data depicted in the table 8 shows that there is no significance association of levels of diastolic blood pressure with age (c²=2.88), gender (c²=0.83), religion (c²=0.17), education (c²=0.08), occupation (c²=0.00), diet (c²=0.80), duration of diseases (c²=1.53), treatment followed (c²=0.01) and associated illness (c²=0.53) at 0.05 level of significance. Hence null hypothesis (H₀₃) was rejected for these selected demographic variables.

 

DISCUSSION:

The mean post test blood pressure reading in the experimental group was less than the controls group. ANOVA test showed that the calculated F value (61.91) for the systolic blood pressure was greater than the tabled value t_(2,48) =3.19 at 0.05 level of significance. The calculated F value (37.85) for the diastolic blood pressure was also greater than the tabled value t_(2,48)=3.19 at 0.05 level of significance. The finding of the present study is supported by a study done, to assess the effectiveness of lemon juice on blood pressure among pregnancy induced hypertension in antenatal mothers in Bangalore. The study finding shows that there was significant deference between mean pre test and post test score of systolic blood pressure at 1st day (Mean=138.66) and 5th day (Mean=126), diastolic blood pressure at 1st day (Mean=90) and 5th day (Mean=80) among experimental group⁷. The Mann-Whitney ‘Z’ value 0.44 of pre test and post-test I in experimental and control group is less than the tabled value 1.96 at 0.05 level of significance and Mann-Whitney ‘Z’ value 3.24 of pre test and post test II in experimental and control group is greater than the tabled value 1.96 at 0.05 level of significance. The finding of the study is supported by a study conducted in Isfahan Cardiovascular Research Centre. The aim of the study is to find the effects of garlic and lemon juice mixture on cardiovascular risk factors. The study result showed that there was a greater reduction in systolic and diastolic blood pressure observed in Group 1 SBP (134 ± 21 to 97), DBP (86±10 to 62 ) compared with Groups 2 SBP (128 ± 12 to 95), DBP (81 ± 11 to 63) , Group 3 SBP (122± 2 to 121), DBP (68 ± 2 to 69) and 4 SBP(122± 32 to 122), DBP (72 ± 13 to 71), p<0.001 respectively⁸. There was a significant association of level of systolic blood pressure with educational status (c²=8.013) and diet (c²=7.259) at 0.05 level of significance. There is no significance association of levels of diastolic blood pressure with age(c²=2.88), gender (c²=0.83), religion (c²=0.17), education (c²=0.08), occupation (c²=0.00), diet (c²=0.80), duration of diseases (c²=1.53), treatment followed (c²=0.01) and associated illness (c²=0.53) at 0.05 level of significance. Another study supporting the present study is to assess the age, religion, occupation on BP among hypertensive patient. The study showed hypertension found to be significantly associated with age (ᵡ 2 = 43.54, df = 4, p-value < 0.001), religion (ᵡ 2 = 15.17, df = 3 p-value = 0.001), and education (ᵡ 2 = 10.74, df = 1, p-value = 0.005) of the subjects. However, hypertension was not found to be significantly associated with sex (p-value = 0.075) and occupation (ᵡ 2 = 7.18, df = 5, p-value = 0.167) of the study subjects.⁹

 

CONCLUSION:

Hypertension is one of the most important cardiovascular risk factors worldwide. This study has made an effort to introduce lemon juice as a remedial and cost effective way to reduce hypertension.

 

LIMITATION OF THE STUDY:

There was drop out of clients who were selected, due to development of other health problems. The investigator had to look for additional participants.

 

The study was confined to hypertensive clients who were below 60 years.

 

RECOMMENDATIONS:

1.     The study can be replicated on the larger samples for the generalization of finding.

2.     A similar study can be conducted for a longer duration.

3.     A planned teaching program for nurses on alternate therapies for management of hypertension can be organised.

 

REFERENCES:

1.      Belachew A, et al. Prevalence and associated factors of hypertension among adult patients. Biomed Central Research Note. 2018; 87(11): 2-6.

2.      Sawase G, et al. A study of hypertension and socio demographic factors in urban slam, Maharastra. International Journal of Community Medicine and Public Health. Feb 2019; 6(2): 585-589.

3.      Guptha A, et al. Prevalence and correlation of hypertension in the rural community of DK, Karnataka, India. International Journal of Medical Science and Public Health. July 2015; 15:1-8.

4.      Siddiqui et al. Role of complimentary and alternate medicine in geriatric care. Pharmacognosy Review. Dec 2014; 8(16): 81-87.

5.      Salt and blood pressure. Blood pressure UK [Available from: URL: https://www.blood pressureuk.org]

6.      What are the health benefits of lemon? Quora. [Available from: URL: https://www.quora.com/what-are-the-health-benifits-of-lemon]

7.      Pallavi U. An effective study to assess the effectiveness of lemon juice on pregnancy induced hypertension among antenatal mothers in Bommasandra PHC. International Journal of Advanced Research. Jan 2018; 6 (1):1402-1407.

8.      Aslani M, et al. Effect of garlic and lemon juice mixture on lipid profile and some cardiovascular risk factors in people 30-60 years old with moderate hyperlipidemia. International Journal of Preventive Medicine. July 2016; 95(7) 70-95.

9.      Kashyap V, Kumar C, Haider S. Prevalence of hypertension and its association with selected socio demographic factors in rural area of Jharkand. IOSR Journal of Dental and Medical Science. April 2015:01-06.

 

 

 

 

Received on 13.11.2019         Modified on 08.12.2019

Accepted on 31.12.2019      ©A&V Publications All right reserved