EFFECT OF BLOOD PRESSURE TREATMENT OF

HYPERTENSION ELDERY LAUGH AT PUSKESMAS WORK

IN AREA DISTRICT JEMBER SUMBERSARI
(NUNING DWI MERINA, 2011)

PAPER

by
Kartika Nurif Adeline Putri
NIM 112310101018

NURSING SCIENCE COURSES

JEMBER UNIVERSITY
2011

EFFECT OF BLOOD PRESSURE TREATMENT OF

HYPERTENSION ELDERY LAUGH AT PUSKESMAS WORK
IN AREA DISTRICT JEMBER SUMBERSARI
(NUNING DWI MERINA, 2011)

PAPER

asked to fill out structure tasks and fulfill one of the requirements to follow
Semester Central Examination in Nursing Science Courses

oleh
Kartika Nurif Adeline Putri
NIM 112310101018

NURSING SCIENCE COURSES

JEMBER UNIVERSITY
2011

CHAPTER 5. RESULT AND RESEARCH

5.1 General description

5.1.1 Overview Karang Jaya Semeru Institution
Karang Jaya Semeru Institution located in reefs in the area of Health
Center Sumbersari work. Institution reefs are formed from the year 2007. Supardi,
A. Manan, Hamdani, and Imam Subagio is the founder of Karang Jaya Semeru
Institution.
Karang Jaya institution Member Semeru is the elderly living in the area of
Mount Semeru, Sumbersari district. The number of members is 54 people in
December 2010 and they are divided into 32 women and 22 men. Choral routine
institution Jaya Semeru is a sport once a week, the collection of the elderly that
conducted twice in a month, and spiritual activities are carried out cecal weeks.

5.1.2 Social Characteristics Table

5.1 Demographic Characteristics of Social Demography by Sex, Age,
Education, and Religion Karang Jaya Semeru Institution
No
.
1.

Total (%)

the treatment
Total (%)

8 (25)

7 (21,9)

8 (25)

9 (28,1)

9 (28,1)

9 (28,1)

3 (9,4)

4 (12,5)

4 (12,5)

3 (9,4)

Gender

Age
1. 60-65 year
2. 66-70 year
3. 71-75 year

3.

Group not given

Characteristics of respondents

1. Male
2. Female
2.

Treatment group

Last educational

1.
2.
3.
4.
5.
4.

Elementary School
Junior High School
Senior High School
Scholar
Master's Degree

1 (3,1)

1 (3,1)

7 (21,9)

11 (21,9)

6 (18,8)

4 (12,5)

2 (6,2)

0 (0)

16 (50)

16 (50)

Religion

Islam
Source: primary data, January 2011

Data 5.1 describes the social demographic data is a characteristic inherent

to the respondent. The number of respondents used in this study a total of 32
respondents with 16 respondents pembagin for a given treatment group and the
remaining 16 respondents for the group given no treatment. The number of
respondents who have recorded as many as 47% were male, and 53% were
female.
Targets in this study were parents who go to class eldery (WHO), aged 6074 years with the division of a division into 3 age groups ie, 56% 60-65 years, 6670 years 22%, and age 71-75 years The remaining 22%.

5.1.3 Picture of Blood Pressure before Treatment Laughter

Table 5.2 Distribution of Blood Pressure Treatment Groups Before the Laughter
Medicine Elderly with Hypertension in Karang Jaya Semeru Institution
Variable
systolic blood pressure

Average

Std Deviation

Min-Max

95% Cl

before treatment is given

145,06

5.790

140-158

141,98-148,15

92,06

2.886

90-98

90,52-93,60

of laughter
diastolic blood pressure
before treatment is given

of laughter
Source: primary data, January 2011
Table 5.2 describes the systolic blood pressure group had been given
treatment before treatment begins to laugh. The respondents on average systolic

blood pressure before treatment is administered 145,06 mmHg and diastolic blood
pressure average was 92,06 mmHg.

5.1.4 Picture of Blood Pressure after Treatment Laughter

Table 5.3 Distribution of Blood Pressure Treatment Group Care Elderly After
Laughter with Hypertension in Karang Jaya Semeru Institution
Variable
systolic blood pressure

Average

Std Deviation

Min-Max

95% Cl

after treatment is given

127,06

8.528

110-140

122,52-131,61

86,25

4.712

80-92

83,74-88,76

of laughter
diastolic blood pressure
after treatment is given

of laughter
Source: primary data, January 2011
Table 5.2 describes the systolic pressure treatment groups were carried out
after the treatment. The average systolic blood pressure after the respondents were
given the treatment is 127,06 mmHg. While the average diastolic blood pressure
after the respondents were given the treatment is 86,25 mmHg.

5.1.5 Distribution Changes in Blood Pressure after Treatment Laughter

Respondents
Table 5.4 Distribution of Changes in Systolic Blood Pressure in Older Adults with
Laughter Hipertensi Karang Jaya Institution Semeru after Treatment
Treated Group

Systolic blood

Systolic blood

Systolic blood

Total

pressure rises
Total (%)
-(0)
Source: primary data, January 2011

pressure

pressure

remained
Total (%)
2(12,5)

dropped
Total (%)
14(87,5)

Total (%)
16(100%)

Table 5.5 Dstribusi Changes in Diastolic Blood Pressure in Older Adults with
Hypertension Laughter Karang Jaya Institution Semeru after Treatment
Diastolic

Diastolic

Diasstolic

blood pressure blood pressure blood pressure

Treated Group

rises
remained
Total (%)
Total (%)
1(6,25)
3(18,75)
Source: primary data, January 2011

dropped
Total (%)
12(75)

Total
Total (%)
16(100%)

Based on table 5.4 of respondents who experienced a decrease in systolic

blood pressure after treatment were 14 respondents while the remaining 2
respondents did not experience changes in systolic blood pressure. While Table
5.5 explains that there were 12 respondents who experienced a decrease diastolic
blood pressure after treatment, while 3 respondents did not experience changes in
diastolic blood pressure and a respondent has raised diastolic blood pressure.

5.1.6 Analysis of Statistical Significance Test of the Influence of Laughter

Table 5.6 Distribution of Older Adults with Systolic Blood Pressure before and
after Treatment Hypertesi Karang Jaya Laughter Semeru Institution
Variable
Systolic blood pressure before

Average

Std Deviation

Std Error

treatment is given of laughter

145,06

5.790

1.448

Systolic blood pressure after a

127,06

8.528

2.132

P-value
0,001

given treatment laughter

Source: primary data, January 2011
Table 5.7 Distribution of Older Adults with Diastolic Blood Pressure before and
after Treatment Hypertesi Karang Jaya Laughter Semeru Institution
Variable
Diastolic blood pressure before

Average

Std Deviation

Std Error

92,06

2.886

722

treatment is given of laughter

Diastolic blood pressure after a

P-value
0,001

given treatment laughter

Source: primary data, January 2011

86,25

4.712

1.178

Statistical analysis was used to distinguish the value before and after the
test results paried t-test, where there are differences in systolic blood pressure and
average diastolic blood pressure before and after treatment of laughter in the
elderly with hypertension in Karang Jaya Institution Semeru.
Systolic blood pressure 145,06 mmHg before treatment, while systolic
blood pressure after treatment was 127,06 mmHg. Diastolic blood pressure before
treatment was 92,06 mmHg, while diastolic blood pressure after treatment was
86,25 mmHg.
P-value obtained from this calculation is 0,001 with 95% confidence level
where p <0,05. Based on the value of p, we can conclude that there are significant
differences in blood pressure before and after being given an aging treatment
laughter. This shows the effect of laughter on blood pressure medication elderly
with hypertension.

5.1.7 Differences in Blood Pressure and the Group Given No Treatment Given
Table 5.8 Distribution of the Average Difference in Systolic Blood Pressure of
Elderly People Treated and Untreated Karang Jaya Laughter Semeru Institution
Systolic

Variable
blood

pressure

treatment groups
Systolic blood pressure of the

Average

Std Deviation

Std Error

127,06

8.528

2.132

151,13

13.190

3.298

P-value
0,001

untreated group
Source: primary data, January 2011
Table 5.9 Distribution of the Average Difference in Diastolic Blood Pressure of
Elderly People Treated and Untreated Karang Jaya Laughter Semeru Institution

Diastolic

Variable
blood

Average

Std Deviation

Std Error

86,25

4.712

1.178

pressure

treatment groups
Diastolic blood pressure of the
untreated group
Source: primary data, January 2011

P-value
0,001

93,13

7.719

1.930

Other statistical analysis used to distinguish between groups of

measurements ahir value given and did not laugh the treatment given is tindependent test. Based on Table 5.6, obtained group differences in systolic blood
pressure treated and given treatment group who did not laugh. Treatment group
had systolic blood pressure an average of 127,06 mmHg. While the group is not
given treatment have systolic blood pressure an average of 151,13 mmHg.
Diastolic blood pressure an average of 86,25 mm Hg treated group and week for
the groups who were denied treatment had diastolic blood pressure an average of
93,13 mmHg.
P-value obtained from this calculation is 0,001 with 95% confidence level.
Based on the value of p, we can conclude that there are significant differences in
blood pressure between groups of parents who were and were not given treatment
laughter. This shows the effect of laughter on blood pressure medication elderly
with hypertension.

5.2 Discussion
Based on the Joint National Committee on Detection, Evaluation and
Treatment of High Blood Pressure in Black et al, (2008), all the respondents in
this study included in the first stage of hypertension prior to treatment with
laughter respondents systolic blood pressure between 140-159 mmHg and

diastolic blood pressure between 90-99 mmHg. Respondents in this penelian

included in the eldery same age group (60-74 years) (WHO Mubarak et al., 2007).
This study respondents chose at the age of 60 years of age with risk of
hypertension is two times greater than under 60 years. This is consistent with
national data and Nutrition Examination Survey (2004) in Black et al. (2008)
which shows that individuals aged 60 years who suffer from hypertension have a
risk two times greater than individuals ang aged <59 years. Researchers selected
respondents with hypertension stage 1 because the investigators based on
statements Joewono and Prabowo (2003) that at stage 1 hypertension has not been
suggested to be addressed through pharmacological treatment. So that the results
of older studies of blood pressure will really laugh because of the influence given
by the researchers.
Many factors influence high blood pressure in older adults. Factors that
affect, among other genetic, physiological changes that occur with aging,
unhealthy lifestyle, comorbidity, and stress. This study took the respondents who
did not have comorbid disease as the originator of hypertension (secondary
hypertension).
Some parents in this study says that like to consume food that has a salty
taste on the grounds and add to taste better when eaten, for example: fish sauce
and mustard that has been marinated vegetables. This is because the elderly have
decreased taste sensitivity, so that food with a salty taste choice for parents to be
consumed. In accordance with the declaration of Steven (1999) that the elderly
has decreased sensory sensitivity of the sense of taste, so parents also declined.
Excessive salt intake can lead to an increase in extracellular volume in the
body. The presence of excess salt increases the osmolality of body fluids menigkat
that blood volume increases and consequently also increases blood pressure
(Guyton & Hall, 2007). These patterns can be a factor affecting the increase in
blood pressure in older adults. In addition to physical decline, the elderly also
declined with psychological problems (Steven, 1999).
Elderly are also susceptible to mental problems (Steven, 1999). Some
respondents complained or told the story of life is not fun, among others: loss of

strength and power. Abandoned by partners, as well as having a conflict with

biological children who live with parents. Haal stress can cause themselves to
parents. Stress is the main factor that causes high blood pressure and heart disease
(Kataria, 2004).
Parents will experience stress increases cortisol and epinephrine in the
body (Steven, 1999). Both of these substances affect the person's metabolism and
circulation. Cortisol is a hormone produced by the adrenal cortex and increases
with the aging process. (Mubarak et al., 2007). Increased cortisol hormone
stimulates an increase in sympathetic nerve activity contained in blood vessels.
Increased sympathetic nerve activity will increase vasoconstriction of blood
vessels that affect blood pressure (Guyton & Hall, 2007).
The results of the analysis of systolic blood pressure on average before
treatment was 145,06 mmHg old laugh and diastolic blood pressure of 92,06
mmHg. The group that will be used for comparison have systolic blood pressure
by an average of 92,44 mmHg. All respondents either treatment group will be
given or not given treatment, both classified as stage 1 hypertension.
The results of measurements of blood pressure treatment groups showed
that 87,5% of respondents laughter decrease in systolic blood pressure and 12,5%
of respondents had no change in systolic blood pressure. As for diastolic blood
pressure, there is 75% of respondents had decreased diastolic blood pressure,
18,7% of respondents had no change, while 6,3% of respondents experienced an
increase in diastolic blood pressure. The above results illustrate the influence of
blood pressure reduction on the respondents.
Average systolic blood pressure group was given treatment for 1 month
was 127,06 mmHg and 86,25 mmHg diastolic blood pressure. There are
differences in blood pressure either elderly systolic blood pressure and diastolic
blood pressure after treatment given laughter. According to JNC VII category of
hypertension are included in the range of pre-hypertension, which is between 120139 mm Hg for systolic blood pressure and 80-89 mmHg for diastolic blood
pressure (Black et al., 2008). When viewed in outline then the reduction of
hypertension and stage 1 hypertension to pre-hypertension.

After the treatment given the laughter, the elderly will experience
decreased levels of cortisol in the body. Hajime Kimata and Lee Beerk in
Simanungkalit (2007), mentions that the decrease in cortisol would be obtained
after a person laugh. Decrease in cortisol will stimulate the sympathetic nerve
activity decreases and increases parasympathetic nerve stimulation (Guyton &
Hall, 2007). Decrease in sympathetic nerve activity have an impact on the
reduction of vasoconstriction of blood vessels (vasodilation) (Smeltzer & Bare,
2002).
This will result in decreased renal vasoconstrictor effects of angiotensin II
on sympathetic nerves (Guyton & Hall, 2007). The cause of increased blood flow
to the release of renin and lowers gijal resulted in a decrease of sodium and water
retention by the kidney tubules until finally decreased intravascular volume,
which will lower blood pressure (Price & Wilson, 2006).
William Frey in Simanungkalit (2007) says that laughter is synonymous
with aerobic exercise for the diaphragm muscle and increase the supply of oxygen
to the heart during laughter. Laughter is a physiological response to increase
cardiac output so that the distribution of oxygen will increase. Distribution of
oxygen in turn will improve the endothelium (Kimura et al., 2003). Endothelium
is the elastic back that will cause the blood circulation more smoothly, reducing
the emphasis on blood vessels, so blood pressure can decrease (Kaplan, 2002).
Given treatment group reduced systolic blood pressure in 37,5% of
respondents, 56,2% experienced an increase, while 12,5% of respondents had no
change. While for respondents diastolic blood pressure Diastolic blood pressure
decreased by 37.5% of the respondents, 31.2% of respondents have increased, and
31.3% of respondents had no change in diastolic blood pressure.
When compared with the initial measurement before the intervention
provided by the researcher, then this group is not given this treatment will remain
at stage 1 hypertension category. In accordance with the JNC VII to stage 1
hypertension category has a variety of blood pressure between 140-159 mmHg for
systolic blood pressure and 90-99 mmHg for diastolic blood pressure (Black et al.,
2008).

Measurement results obtained blood pressure reduction of blood pressure

differs between the respondents with other respondents. Hours because of the
nature of his own blood pressure is not constant, changes can be caused by
differences in diet, activity patterns, and stress levels are different in each of the
respondents (Karyadi, 2002).
Respondents who did not experience a decrease in blood pressure says that
the respondent has a pattern of increased activity before the final measurement.
Respondents claimed to often sleep late at night but increased activity in the
daytime so that patterns of activity and rest patterns of respondents experiencing
an imbalance.
Other respondents claimed to have experienced family problems are the
problems with biological children who live with the respondent. This makes the
respondent always thinking about the issue at hand so that it can affect blood
pressure responders. This situation is in accordance with that disclosed by
Joewono and Prabowo (2003) that a person's blood pressure can be influenced by
activity patterns, diet, and stress experienced by a person.
In the group given no treatment, treatment group did not get anything so
that the average blood pressure increase. Although there are some respondents
who experienced a decline. All this because there is no control on the lifestyle and
behavior that can cause changes in blood pressure in older adults for 1 month.
The results of independent tests t-test by comparing the systolic blood
pressure after treatment group and the group was not given treatment produces p =
0,001. This means that there are differences in systolic blood pressure averaged
between treatment groups and the groups who were denied treatment for a month
laughter. While the test results independent t-test by comparing the diastolic blood
pressure in the treated group and the group given no treatment, yielding p = 0,005.
This suggests there are also different from the diastolic blood pressure an average
of treatment and the group was not given treatment for 1 month.
The results of the treatment effect of laughter on blood pressure in older
adults show significant differences in systolic blood pressure and diastolic blood

pressure before and after the intervention. The results agree with the statement in
Schor Berk (2009), which states that laughter lowers blood pressure, high bias,
because laughter reduces the release of the hormone cortisol are associated with
stress. Other research supports the results of this study is Michael Miller's
research at the University of Maryland Medical School (2009) at McGhee (2010)
showed that of 150 respondents with hypertension and heart disease, only <40%
who had a history of such humor and laughter while the >60% do not like the
humor and laughter.
All respondents to follow the treatment schedule given by the researchers
on a regular basis. Based on statistical tests depend on t-test performed on each
group, showed that the p <0,05 for a given treatment group and decreased blood
pressure after being given intrvensi. In the treatment group showed reduced blood
pressure while in the group not given the treatment showed an average increase of
blood pressure. This means no treatment effect of laughter on blood pressure in
older adults in health centers working area Sumbersari Jember.

5.3 Limitations of the Study

This study has several limitations that need improvement for future
studies. Restrictions based on the researchers in this study researchers are less able
to control habits that can arise in research and influencing the way research results
including eating habits, activity patterns, because this study used respondents
residing in the community area. Another limitation is acknowledged by the
researchers is the method used is still using a quasi-experimental (quasiexperimental) in which the sample is not homogeneous completely free so can not
be taken for a sample, the researchers hope further research will be conducted
using the method for true experiments in which samples can be taken
independently because it is homogeneous.
The number of samples in this study only 32 people, with 16 respondents
in the treatment group and the remaining 16 respondents in the group given no

treatment. But researchers hope that this research can be used as inputs in the
science of nursing.