THE EFFECT OF TWICE-A-DAY INTAKE OF

LEMON GRASS DECOCTION AMONG

HYPERTENSIVE INDIVIDUALS OF BARANGAY
SITUBO, TAMPILISAN, ZAMBOANGA DEL NORTE

A RESEARCH PAPER PRESENTED TO THE FACULTY OF

ATENEO DE ZAMBOANGA UNIVERSITY
SCHOOL OF MEDICINE

IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF MEDICINE

BY
Ian Ray C. Caluscusin
April 2010
i

APPROVAL SHEET
This research entitled THE EFFECT OF TWICE-A-DAY INTAKE OF LEMON
GRASS DECOCTION AMONG HYPERTENSIVE INDIVIDUALS IN
BARANGAY SITUBO, MUNICIPALITY OF TAMPILISAN, PROVINCE OF
ZAMBOANGA DEL NORTE prepared and submitted by Ian Ray C. Caluscusin, in
partial fulfilment of the requirements for the degree of Doctor of Medicine, is hereby
accepted.
_________________________
Dr. Mario R. Arciaga
Adviser

Approved by the Oral Examination Committee with a grade of PASSED.

_________________________
Dr. Pascualito I. Concepcion
Member

_________________________
Dr. Dulce Amor A. Dagalea
Member

_________________________
Dr. Ernesto G. Florendo
Member

_________________________
Dr. Kelly S. Geronimo
Member

_________________________
Dr. Muktader A. Kalbi
Member

_________________________
Dr. Afdal B. Kunting
Member

_________________________
Dr. Rex V. Samson
Member

_________________________
Dr. Analisa A. Santamaria
Member

Accepted in partial fulfilment of the requirements for the degree of Doctor of

Medicine.

________________________
Dr. Mario R. Arciaga
Associate Dean for Research
Ateneo de Zamboanga University
School of Medicine

ACKNOWLEDGEMENT
First and foremost this research acknowledges God and our Savior Jesus
Christ, as the supreme author, without whose blessings guidance, and inspiration this
paper could not have been completed. To Him the glory and honor belongs.
Secondly, I would like to thank the following for their essential contributions:
1. To the Ateneo de Zamboanga University School of Medicine, for making my
dream of becoming a doctor come into reality.
2. To Dr. Mario Arciaga, for his endearing advises, direction, and for challenging
me to write this paper well.
3. To the Research committee of ADZU SOM, for your valuable commentaries
and for bringing up issues that have improved this paper.
4. To Dr. Carmel Mathilda Ladeza, for the support that you have given us for the
entire 4 years our group has been in the community.
5. To the Rangers, my groupmates, for the struggles and triumphs we've shared
during our 4 years together.
6. To Manong Nonoy amd Ma'am Cres Montallana, for allowing us to stay in
your home and taking good care of us during our tour of duty in Situbo. A
heartfelt thanks.
7. To Mrs. Alma Cruz, Mrs. Gemma Larato, Mrs. Nicolasa Martinet, my research
assistants, for the cooperation and commitment you've rendered for this study.
You are the major reason for the success of this paper.
8. To the Residents of Barangay Situbo, my respondents, for believing and
trusting me. You have made me feel like I am a real doctor.
9. To my Parents, Papa and Mama, your generosity overwhelms me and it is
difficult to express my gratitude. It has meant so much to me that you have
been there for me, both in times of financial need and continual support even
during our darkest times. It has always been my dream to make you proud.
10. To my Siblings, Lanie, Ivan, Igan, and Lou, thank you for the laughters we've
had during those days when I was so stressed out. Looking forward for more
laughs.
11. To Ngangi, thank you for lifting my spirits up in times where I felt so down.
You are appreciated.

ii

LIST OF FIGURES

Figure 1.

Conceptual Framework

Page
11

Figure 2.

Flow of Activities

21

Figure 3.

Comparison of the Mean Arterial Pressure

in the 16 weeks Period of Study

23

Figure 4.

Comparison of the Mean Arterial Pressure

between the Baseline Phase and the Bamboo,
Washout, and Placebo Phases of the Study

25

Figure 5.

Comparison of the Mean Heart Rate

between the Baseline Phase and the Bamboo,
Washout, and Placebo Phases of the Study

27

LIST OF TABLES
Table 1.

Profile of Respondents

22

Table 2.

Comparison of the Mean Arterial Pressure

between the Baseline Phase and the 4 weeks of the
Bamboo, Washout, and Placebo Phases of the Study

26

Table 3.

Comparison of the Mean Heart Rate

between the Baseline Phase and the 4 weeks of the
Bamboo, Washout, and Placebo Phases of the Study

29

Table 4.

Comparison of the Clinical Symptoms

in the 16 weeks Period of Study

29

iii

TABLE OF CONTENTS
APPROVAL SHEET
ACKNOWLEDGEMENT
LIST OF FIGURES AND TABLES
TABLE OF CONTENTS
ABSTRACT

Page
i
ii
iii
iv
v

CHAPTER I INTRODUCTION
Background
Statement of the Problem
Objectives
Hypotheses
Significance
Scope and Delimitation
Definition of Terms
Conceptual Framework

1
7
7
8
8
8
9
11

CHAPTER II REVIEW OF RELATED LITERATURE

CHAPTER III METHODOLOGY

Research Design
Respondents
Sampling Design
Research Setting
Research Instrument
Research Assistants
Interventions
Data Gathering Procedures
Statistical Analysis
Flow of Activities

12
12
13
13
14
14
15
18
20
21

CHAPTER IV RESULTS

22

CHAPTER V DISCUSSION
31
CHAPTER VI CONCLUSION AND RECOMMENDATIONS

36

BIBLIOGRAPHY
APPENDIX A WRITTEN INFORMED CONSENT
APPENDIX B RESEARCH INSTRUMENT
APPENDIX C CYMBOPOGON CITRIATUS
APPENDIX D LEMON GRASS DECOCTION AND PLACEBO
42
CURRICULUM VITAE

37
39
40
41

43

iv

ABSTRACT
The study aimed to evaluate the effect of twice-a-day intake of lemon grass
decoction among hypertensive individuals in Barangay Situbo, Municipality of
Tampilisan, Province of Zamboanga Del Norte. The mean arterial pressure, the mean
heart rate, and the clinical symptoms were the outcome parameters measured. The study
utilized a Placebo-Controlled Cross-Over Experimental Design and a Convenience
Sampling Design. The respondents were hypertensive individuals under Stage I
Hypertension JNC 7, not on antihypertensive drug therapy, and with no associated
comorbidities. The study was conducted in 4 phases as follows: Baseline, Lemon Grass,
Washout, and Placebo. Each phase was conducted daily for 4 weeks with a total of 16
weeks period of study. The Baseline Phase consists of twice-a-day monitoring of blood
pressure, heart rate, and clinical symptoms. The Lemon Grass Phase consists of twice-aday intake of 250 ml of Lemon Grass decoction with monitoring of blood pressure, heart
rate, and clinical symptoms. The Washout Phase consists of twice-a-day monitoring of
blood pressure, heart rate, and clinical symptoms. And lastly, the Placebo Phase which
consists of twice-a-day intake of 250 ml of placebo with monitoring of blood pressure,
heart rate, and clinical symptoms. The preparation and dosage of the lemon grass
decoction was based on the folkloric practice of the respondents with some modification
based on the book by Jocano (1985) while the preparation and dosage of the placebo was
based on the color, consistency, and amount of the lemon grass decoction. RepeatedMeasure ANOVA was utilized to determine the level of significance of the outcome
parameteres measured. The results of the 16 weeks period of study showed that the twicea-day intake of lemon grass decoction had a significant effect on the mean arterial
pressure by acting as a diuretic which was evidenced by frequent urination wherein
majority of the respondents manifested this. On the contrary, there was no significant
effect on the mean heart rate and on the clinical symptoms in relation to hypertension

when the twice-a-day intake of lemon grass decoction was instituted. Therefore, the twicea-day intake of lemon grass decoction can serve as an alternative maintenance
medication for hypertensive individuals under Stage I Hypertension JNC 7.

vi

CHAPTER I
INTRODUCTION
Background of the Study
The early 90s seemed hopeful for the merging of western and alternative
medicine in the Philippines. There was a burgeoning global movement towards
alternative therapies, a new age allure for natural remedies, and in the Philippines,
the beginning of herbal medicinal research and development. In 1992, during the term
of Juan Flavier as Secretary of Health, a brochure of 10 medicinal plants (akapulko,
ampalaya, bawang, bayabas, lagundi, niyog-niyogan, pansit-pansitan, sambong,
tsaang gubat, yerba buena) for common health problems was published and
commercial production was pursued. In 1997, the TAMA (Traditional and Alternative
Medicine Act) was passed, providing a legitimizing boost to the alternative medicine
movement in the Philippines (Stuart, 2004). However, considerations must be taken as
to the availability of these herbs in a certain community as well as the acceptance of
the individuals residing in this community.
In Barangay Situbo, Municipality of Tampilisan, Province of Zamboanga Del
Norte, lemon grass (locally known as tanglad) is used as an agent to decrease blood
pressure. The residents have claimed this therapeutic effect of the said herb and this
has been a folkloric practice for quite some time. It is said that lemon grass decoction
could provide relief from mild headache, nape pain, and dizziness which they know as
symptoms indicating high blood pressure. A majority of these hypertensive
individuals takes the decoction as needed when the symptoms mentioned above are
experienced. The decoction process begins by washing and soaking a bundle of lemon
grass leaves, including its roots, for 10 to 15 minutes, and then having it immersed in
boiling water until the water turns yellow-green.
1

Lemon grass or the local tanglad (scientific name: Cymbopogon ciatrus) is

one those wondrous herbs that one can always associate with Asian cooking.
Vietnamese home-grown meal enthusiasts always have this tropical grass at hand for
its aromatic flavour with a trace of ginger. Few people know that its other popular
name is citronella the common scent you usually find in candles, perfumes, and
soaps. In our country, the herb is added as a stuffing for spit-roasted pig locally known
as lechon.
Lemon grass leaves are employed by the Cuban population as an
antihypertensive and anti-inflammatory folk medicine. In 1989, Carbajal et. al.
conducted a study on this and results showed that lemon grass has a diuretic and
antiinflammatory effect when taken orally.
Lemon grass is generally safe. Leite. et. al. in 1986 conducted a study on the
effect of lemon grass as eventual, toxic, hypnotic, and anxiolytic effects on humans.
The results of the study showed that lemon grass has no potential toxic properties.
Lemon Grass has been known to promote blood circulation. People who suffer
from high blood pressure may find that drinking lemon grass tea can reduce blood
pressure (Montala 2006). The roots of lemon grass yield a decoction used as a diuretic
(Quisumbing 1978). The efficacy of this diuretic action of the herb is their ability to
reduce blood volume by increasing urine output thereby a resultant decrease in blood
pressure (Cecil. et. al., 2004) This is supported by the Joint National Committee on
prevention, detection, evaluation, and treatment of high blood pressure, 7th report in
2003 wherein it recommended the use of diuretics as a first-line antihypertensive
therapy particularly in individuals under Hypertension Stage 1.
Other studies on lemon grass conducted by Department of Science and
Technology (DOST) showed that lemon grass can be an antioxidant. It can also be

used in anti-fungal eye medication. Ohno, Tomoyuki, et. al. in 2003, found that it has
antibacterial properties that prevents the growth of bacterias such as Helicobacter
pylori, Staphylococcus aureus, and Eschericia coli.
This study aims to evaluate the claimed therapeutic effects of twice-a-day
intake of lemon grass decoction in lowering the blood pressure. When it is proven to
be effective, lemon grass decoction could be used as an alternative maintenance
medication among hypertensive individuals which is easy to prepare, affordable, and
readily available. The preparation and dosage of the decoction was based on the local
practice on the use of lemon grass. The outcome parameters to be measured include
the mean blood pressure, mean arterial pressure, mean heart rate, and the clinical
symptoms manifested by the respondents. This study was patterned on the placebocontrolled crossover-experimental study done by Obaidy in 2007 on the effect of
twice-a-day intake of chayote extract among hypertensive individuals in Barangay
Sto. Nio, Liloy, Zamboange Del Norte and by Cuevas in 2009 on the effect of twice-aday intake of bamboo root decoction among hypertensive individuals in Barangay
Veterans Village, Municipality of Ipil , Zamboanga Sibugay.

CHAPTER III
REVIEW OF RELATED LITERATURE
Lemon grass is a perennial plant that grows in warm and tropical
climates like Southeast Asia and the Carribean. It has long, thin, fibrous gray-green
leaves that can grow up to 3 feet tall. Lemon grass looks like any ordinary grass, but
when crushed, its long leaves gives off a lemony aroma and flavor, with a slight hint
of ginger. Outside the kitchen, lemon grass has many other uses, ranging from
aromatherapy to medicinal (Montala 2006).
In the book entitled Medicinal Plants of the Philippines by Quisumbing in
1978, states that the roots yield a decoction used as a diuretic. This is supported by the
study made by Carbajal et. al. in 1989 where a pharmacological screening for
cardiotonic, hypotensive, or bronchodilator activities was performed on their
traditional medical use by the Cuban population. One of which is lemon grass
(Cymbopogon citriatus) leaves employed by the Cuban population as antihypertensive
and antiinflammatory. But the diuretic property of the lemon grass is yet to be
determined. The decoction showed diuretic and anti-inflammatory effect when given
orally. This diuretic effect of lemon grass was also claimed by Montala in 2006.
Cecil et. al. in 2004 stated that diuretics are the oldest, least expensive, and
still among the best antihypertensive medications. Initiation of diuretic therapy,
contraction of blood volume explains the initial fall in blood. With continued diuretic
therapy, blood volume is restored, and vasodilator mechanisms sustain the
antihypertensive action (Cecil. et. al. (2004).
Another study by Runnie et. al. in 2004 stated that lemon grass showed
comparable vasorelaxation on isolated perfused mesenteric artery preparation. The
vascular effect on the aortic ring preparations were mainly endothelium-dependent,
4

and mediated by nitric oxide (NO) as supported by the inhibition of action in the
presence of N(omega)-nitro-L-arginine (NOLA), an nitric oxide synthase (NOS)
inhibitor, or by the removal of endothelium. In contrast, vasodilatory actions in
resistance vessels (perfused mesenteric vascular beds) appear to involve several
biochemical mediators, including NO, prostanoids, and endothelium-dependent
hyperpolarizing factors (EDHFs). Total phenolic contents and antioxidant capacities
varied among different extracts and found to be independent of vascular relaxation
effects.
A research study was done by Elson et. al. in 1989 on the
antihypercholesterolemic and antihypertensive action of geraniol and citral which are
both major properties of lemon grass oil. Twenty-two hypercholesterolemic subjects
(3159 mg cholesterol/dl) were asked to take a daily capsule containing 140 mg of
lemongrass oil. The paired difference in serum cholesterol levels of subjects
completing the 90-day study approached significance (p <0.06, 2-tailed t-test).
Harrison et. al. in 2008 stated that LDL levels promote atherogenesis developmental
process of atheromatous plaques characterized by remodelling or arteries involving
the concomitant accumulation of fatty substances. A wealth of epidemiologic data
support a relationship between hypertension and atherosclerotic risk, clinical trial
evidence has established that pharmacologic treatment of hypertension, can reduce the
risk of stroke, heart failure and CHD events. This is also supported by Durante et. al.
in 1991 conducted a large clinical research trial entitled A Parallel Group DoubleBlind Study of Once Daily Quinapril Versus Enalapril in the Treatment of Mild-ToModerate Hypertension showed that the further risk reduction in cardiovascular
endpoints were achieved by lowering low density lipoprotein.
The Philippine Society of Hypertension in 2010 stated that majority of people

who suffer from high blood pressure do not have symptoms. It is usually an incidental
finding when a blood pressure measurement is done on routine physical examination.
Heart diseases kill more people in the world than any other sickness or disease. There
are several causes of heart disease but the foremost cause of heart disease is
hypertension. It is leading cause of heart attacks and strokes in the world. In the
Philippines, 1 out of 5 individuals suffer from hypertension (Philippine Society of
Hypertension 2010). It is the 5th leading cause of morbidity and heart diseases ranked
as the 1st leading cause of mortality (Department of Health, 2004). The cause of
hypertension is unknown in about 90% of patients, and 80% falls under Stage 1
Hypertension.
Lemon grass has no potential toxic properties. Leite et. al. in 1986 conducted a
study on the effect of lemon grass as eventual, toxic, hypnotic, and anxiolytic effects
on humans. A herbal tea (called an abafado in Brazil) prepared from the dried leaves
of lemongrass was administered to healthy volunteers. Following a single dose or 2
weeks of daily oral administration, the abafado produced no changes in serum
glucose, urea, creatinine, cholesterol, triglycerides, lipids, total bilirubin, indirect
bilirubin, GOT, GPT, alkaline phosphatase, total protein, albumin, LDH and CPK.
Urine analysis (proteins, glucose, ketones, bilirubins, occult blood and urobilinogen)
as well as EEG and EKG showed no abnormalities. There were slight elevations of
direct bilirubin and of amylase in some of the volunteers, but without any clinical
manifestation. These results taken together indicate that lemon grass as used in
Brazilian folk medicine is not toxic for humans.

Statement of the Problem

What is the effect of twice-a-day intake of lemon grass decoction among
hypertensive individuals in Barangay Situbo, Tampilisan, Zamboanga Del Norte?

Objective of the Study

The main objective of this study is to evaluate the effect of twice-a-day intake
of lemon grass decoction among hypertensive individuals in Barangay Situbo,
Municipality of Tampilisan, Zamboanga Del Norte.
It specifically aims to:
12. Determine the mean arterial pressure of the respondents before and after the
intake of lemon grass decoction.
13. To compare the mean arterial pressure of the respondents before and after the
intake of lemon grass decoction.
14. To determine the mean heart rate among the respondents before and after the
intake of lemon grass decoction.
15. To compare the mean heart rate of the respondents before and after the intake
of lemon grass decoction.
16. To determine the clinical symptoms of the respondents before and after the
intake of lemon grass decoction.
17. To compare the clinical symptoms of the respondents before and after the
intake of lemon grass decoction.

Hypotheses
Null
Twice-a-day intake of lemon grass decoction will have no effect on mean
arterial pressure, mean heart rate, and clinical symptoms among hypertensive
individuals in Barangay Situbo, Tampilisan, Zamboanga Del Norte.
Alternative
Twice-a-day intake of lemon grass decoction will have an effect on mean
arterial pressure, mean heart rate, and clinical symptoms among hypertensive
individuals in Barangay Situbo, Tampilisan, Zamboanga Del Norte.

Significance of the Study

Herbalism is a traditional medicinal or folk medicine practice based on the use
of plants and plant extracts. It is a common and an established fact that herbal
medicines can serve as a substitute treatment for certain diseases including
hypertension. This study aims to validate the claimed therapeutic effects of twice-aday intake of lemon grass decoction in lowering the blood pressure. When it is proven
to be effective, lemon grass decoction could be used as an alternative maintenance
medication among hypertensive individuals which is easy to prepare, affordable, and
readily available.

Scope and Delimitation

This study was limited to determining the effect of twice-a-day intake of
lemon grass decoction among hypertensive individuals in Barangay Situbo,
Municipality of Tampilisan, Zamboanga Del Norte and was only applicable to

hypertensive individuals who met the criteria of Hypertension Stage 1 JNC VII. The
outcome parameters measured were the mean arterial pressure, the mean heart rate,
and the clinical symptoms manifested. The study was conducted in 4 parts. Each part
lasted for 4 weeks with a total of 16 weeks period of the study. Lifestyle modifications
such as weight reduction, exercise, and dietary changes geared towards the prevention
of hypertension, smoking cessation, and alcohol reduction were not part of the
intervention.

Operational/Definition of Terms
1. Hypertensive Individuals blood pressure classified under Stage 1
Hypertension, not on antihypertensive drug therapy or under maintenance
medication/s, and with no associated comorbidities.
2. Hypertension Stage 1 JNC VII individuals with a resting blood pressure
between 140 159 mmHg systolic blood pressure and 90 99 mmHg
diastolic blood pressure.
3. Comorbidities diseases other than hypertension such as diabetes mellitus,
heart failure, myocardial infarction, stroke, kidney failure, urinary problem,
cancer, and thyroid disorder diagnosed by a licensed physician before the
period of study.
4. Mean Arterial Pressure (MAP) in mmHg computed as 2 times diastolic
pressure, product plus systolic pressure, and sum divided 3.
5. Heart Rate (beats/min) counted as the number of apical heart beats for one
full minute.
6. Clinical symptoms subjective complaint/s or physical disturbance verbalized
by the respondents before and after intake lemon grass decoction.
9

7. Blinded not formally informed or concealed for the purpose of misleading.

8. Hypertension Stage 1 MAP mean arterial pressure between 106.67 mmHg
and 119 mmHg.
9. Prehypertension MAP mean arterial pressure between 93.33 mmHg and
105.67 mmHg.
10. Normal MAP mean arterial pressure less than or equal to 92.33 mmHg.
11. Normal Heart Rate heart rate between 60 apical beats/min and 100 apical
beats/min.

10

CONCEPTUAL FRAMEWORK

Hypertensive Individuals

Twice-a-day intake of 250 ml

of Lemon Grass Decoction

Has
an effect
in increasing or
decreasing the
MAP, Hear rate,
and Clinical
symptoms

Outcome parameters:
Mean Arterial Pressure
Mean Heart Rate
Clinical symptoms

Has no
effect on the
MAP, Heart rate,
and Clinical
symptoms

Figure 1. Conceptual framework

11

CHAPTER III
METHODOLOGY
Research Design
A placebo-controlled crossover-experimental design was utilized in this study.

Respondents
Inclusion Criteria
1. A permanent resident of Barangay Situbo, Municipality of Tampilisan,
Province of Zamboanga Del Norte with no intentions of leaving the
community within the 16 weeks period of the study.
2. Hypertensive individuals meeting the criteria of Stage 1 Hypertension JNC
VII, not on antihypertensive therapy for the past 3 months, and with no
associated comorbidities.
Drop-out Criteria
1. An increase in systolic blood pressure to 200 mmHg and/or diastolic blood
pressure to 120 mmHg within the period of study.
2. A decrease in systolic blood pressure to 100 mmHg and/or diastolic pressure
to 70 mmHg within the period of the study.
3. Those who would develop clinical symptoms of loss of consciousness, severe
headache, persistent dizziness, persistent blurring of vision, chest pain,
difficulty of breathing, weakness, swelling of extremities, pain upon urination,
no urine output, and fever within the period of the study.
4. A miss of at least 3 measurements of blood pressure and heart rate and/or 3
doses of lemon grass decoction and placebo within the 16 weeks period of the

12

study.

Sampling Design
The study utilized a convenience sampling design. A house-to-house survey
was conducted by the researcher for 2 weeks (August 3-14, 2009) to identify
hypertensive individuals. The researcher also used the list that the barangay health
midwife has for the known hypertensive individuals within the area. These individuals
were assessed thoroughly by doing a complete clinical history and physical
examination to determine their qualification in the inclusion criteria.
During the 2 week house-to-house survey, there were a total of 31 potential
respondents. Their blood pressures were taken twice daily at 8 a.m. and 3 p.m. for 2
weeks to determine their qualification under Stage I Hypertension. These respondents
were also asked to stop taking any herbal medications (specifically tanglad) to
minimize potential carry-over effect.
The 31 respondents were divided into 3 subgroups depending on the
geographic location of their homes. The researcher conducted separate meetings
(August 20-21, 2009) with these subgroups to formally present the study using visual
aids. An open forum followed after for better understanding of the said study. An
informed written consent was sought to these 31 respondents (See Appendix A,
Informed Written Consent). All the 31 respondents participated in the study and were
able to complete the 16 week period.

Research Setting
This study was done in Barangay Situbo, Municipality of Tampilisan, Province
of Zamboanga Del Norte. It is situated 9 kilometres away from the national highway
13

going to Dipolog City. It is classified as an agricultural land with a total area of

1,492.72 hectares. It has an estimated 5 hectares of forest area with a topographical
description of slightly hilly and has a clay loam type of soil. Majority of the residents
are purely Bisaya and depend much on their agriculture. There is a total of 7
organized puroks, 1,298 individuals, with 286 households (See Appendix B, Spot
Map).

Research Instrument
The research instrument was patterned by the researcher from the study done
by Cuevas in 2009 on the effect of twice-a-day intake of bamboo root decoction among
hypertensive individuals in Barangay Veterans Village, Municipality of Ipil , Zamboanga
Sibugay. The following were used as outcome parameters: mean arterial pressure,

mean heart rate, and the clinical symptoms felt by the respondents (See Appendix C,
Research Instrument).

Research Assistants
The researcher conducted a meeting with the municipal health officer and the
barangay health midwife as to the purpose and objectives of the study on August 17,
2009. The researcher was granted the permission to select 3 Barangay Health Workers
of Barangay Situbo to work as research assistants.
The researcher selected 3 Barangay Health Workers living geographically near
to each of the 3 subgroups of respondents. The employed strategy was proven
beneficial for the following reasons: (a) the research assistants selected have enough
knowledge on hypertension and skills on blood pressure taking and heart rate
monitoring since they have been in the medical field for an average of 5 years, (b) the
14

respondents were at ease knowing that the research assistants just lives geographically
near and that if ever emergent care is needed, these research assistants are readily
available, and (c) the performances of the research assistants were efficient due to the
decrease in workload since 2 research assistants handled 10 respondents and 1
research assistant handled 11 respondents only. A monetary incentive was given to the
research assistants every month.
The researcher conducted a lecture (August 19, 2009) on hypertension and
demonstration on blood pressure and heart rate monitoring, utilization of the research
instrument, and a training on proper preparation of lemon grass decoction and
placebo.

The

research

assistants

were

provided

with

new

aneroid

sphygmomanometers and stethoscopes, copies of the research instrument to be

utilized with envelopes, pens, and materials for the preparation of lemon grass
decoction and placebo. A demonstration on blood pressure and heart rate monitoring
and utilization of research instrument was conducted during the gathering of the 31
respondents (August 20-21, 2009) with the researcher to evaluate potential interobserver variability and to obtain and attain uniformity and accuracy of results.
The researcher asked some advice with a local resident on the procurement of
lemon grass within the area. He was able to identify some sources of lemon grass. The
research assistants also helped in identifying sources of lemon grass and also planted
on their respective backyards for additional sources.

Interventions
A re-evaluation on blood pressure and heart rate monitoring and utilization of
research instrument was done by the researcher with the research assistants before the
start of each phase. This is to determine the competency level of the research
15

assistants in taking the blood pressure and monitoring the heart rate. A return
demonstration was also done on the preparation of the lemon grass decoction and
placebo before the start of lemon grass and placebo phase respectively. The researcher
also conducted house visits at the end of each phase to ensure the complete well being
of his respondents within the period of the study.

Blood Pressure Monitoring

Blood pressure should be measured no less than 1 hour after exercising,
smoking, or consuming caffeine since a small amount of fluctuation can occur and
could affect the accuracy of the blood pressure reading. The respondents should be
well rested for at least 10 minutes before the blood pressure is being measured. One of
the most important factors that could influence the accuracy of blood pressure
readings is the size of blood pressure cuff that is used. An adult sized cuff bladder
encircling at least 2/3 of the arm was utilized and at least 2 measurements were at
least 3 to 5 minutes apart with the average blood pressure recorded to ensure accuracy
of the results. Blood pressure was measured with while the respondent is seated
comfortably on a chair and feet on the floor. The arm being used should be relaxed,
uncovered, and supported at the level of the heart. Only the part of the arm where the
blood pressure cuff is fastened needs to be at heart level, not the entire arm. The blood
pressure was monitored using a new aneroid sphygmomanometer and a new
stethoscope via the auscultatory method.
An increase in the systolic blood pressure of greater than or equal to 200
mmHg and/or an increase in diastolic blood pressure of greater than or equal to 120
mmHg must be reported to the researcher immediately. Likewise, if there is a
decrease in systolic blood pressure of less than 100 mmHg and/or a decrease in

16

diastolic pressure of less than 70 mmHg should also be reported to the researcher as
soon as possible. The respondents were blinded about their blood pressure.
Heart Rate Monitoring
The heart rate of the respondents was also monitored with diaphragm of the
stethoscope placed over the precordium (5th intercostal space, left midclavicular line)
and the apical heart beats counted for 1 full minute. This was done after the blood
pressure was taken. The respondents were blinded about their heart rate.
Clinical Symptoms Monitoring
The clinical symptoms complaint by the respondents was monitored utilizing
the research instrument. The researcher instructed the research assistants to simply ask
the respondents about what they presently feel or have felt during the course of the 16
week period of the study. The researcher and the research assistants will not ask about
the symptoms but rather it must be reported by the respondents who have participated
in the study.
Clinical symptoms such as loss of consciousness, severe headache, persistent
blurring of vision, chest pain, palpitations, difficulty of breathing, weakness,
numbness, swelling of extremities, tremors, flank pain, painful urination, no urination,
and fever within the 16 week period of the study must be reported immediately to the
researcher to ensure safety of the respondents.
Lemon Grass Decoction
The preparation and dosage of the lemon grass decoction was based on the
practice of the respondents but with some modification based on the book by Jocano
(2003). This was prepared in the respective homes of the research assistants. The
decoction process will begin by washing and soaking the lemon grass leaves in water
overnight. Then the decoction was prepared by boiling 20 leaves about 1 foot in

17

length including its roots in 1 liter for 20 minutes. The decoction was allowed to cool
down by natural process. Straining will be done after and the liquid will be poured
into a 250 ml plastic bottle with cover. The said preparation was good for 4
respondents. The respondents were blinded about the lemon grass decoction.
Placebo
The preparation and dosage of the placebo was based on the color,
consistency, and amount of lemon grass decoction. This was prepared in the
respective homes of the research assistants. The placebo was prepared by mixing 6-8
teaspoons of commercially prepared lemon flavoured food artificial food color in 1
liter of water. This was then poured into a 250 ml plastic bottle with cover. The
preparation was good for 4 respondents. The respondents were not informed that it
was a different decoction that was the taken during the lemon grass phase. Lemon
grass has a pungent odor that could not be replicated by the researcher. This baffled
the respondents but were informed that it was still the same decoction that they took
during the Lemon Grass Phase just to a lesser concentration.

Data Gathering Procedure

The study was conducted in 4 phases namely, Baseline, Lemon Grass
Decoction, Washout, and Placebo. Each phase was conducted for 4 weeks with a total
of 16 weeks period of study (August 24 December 7, 2009). The researcher
performed at least twice to thrice a week monitoring of blood pressure, heart rate, and
clinical symptoms. This is to compare the variability, uniformity, and accuracy of the
data being gathered. The researcher also performed a once a week monitoring in the
preparation of the lemon grass decoction and placebo as well. The research
instruments were gathered every Sunday of each week of the study. The daily blood
18

pressure, heart rate, and clinical symptoms were translated into mean arterial pressure,
mean heart rate, and clinical symptoms.
Baseline Phase
The blood pressure, heart rate, and clinical symptoms were monitored by the
research assistants twice daily, at 8 a.m. and 3 p.m. in the afternoon respectively. The
baseline phase was conducted for 4 weeks. It ran from August 24, 2009 to September
20, 2009. The data gathered were recorded by utilizing the research instrument
formulated by the researcher for comparison of the outcome parameters measured in
the study.
Lemon Grass Phase
Treatment with twice-a-day intake of lemon grass decoction was given to the
respondents. Two hundred fifty (250) milliliters of lemon grass decoction was
delivered personally before 8 a.m. and 3 p.m. by the research assistants to the
respective homes of the respondents to facilitate compliance. The decoction was taken
from September 21, 2009 and ended on October 18, 2009. This phase was conducted
for 4 weeks.
Monitoring of blood pressure and heart rate was taken at least 2 hours after
every intake of the decoction. The data gathered were recorded by utilizing the
research instrument guided by the outcome parameters mentioned above. This served
as monitoring of the effect of twice-a-day intake of lemon grass decoction.
Washout phase
The blood pressure, heart rate, and clinical symptoms were monitored by the
research assistants at 8 a.m. and 3 p.m. daily for a total of 4 weeks. This phase started
on October 19, 2009 and ended on November 8, 2009. The data gathered were
recorded by utilizing the research instrument guided by the outcome parameters

19

mentioned above. This served as a monitoring of the potential carry-over effect of the
lemon grass decoction.
Placebo phase
The placebo was placed in a 250 ml plastic bottle for each respondent and was
delivered by the research assistants in the respective homes of the respondents before
8 a.m. and 3 p.m. daily for a total of 4 weeks. This phase started on November 9, 2009
and ended on December 7, 2009. The blood pressure, heart rate, and clinical
symptoms were monitored at least 2 hours after the intake of the placebo. The data
gathered were recorded by utilizing the research instrument guided by the outcome
parameters mentioned above. This served as a monitoring of the effect of the twice-aday intake of placebo.

Statistical Analysis
The study utilized Frequency Distribution, Measures of Central Tendency, and
Repeated-Measure ANOVA for data processing and analysis.

20

FLOW OF ACTIVITIES
Research Protocol

House to House Survey

Selection of Respondents

Formal Presentation of Study

Signing of Informed Written Consent

Recruitment of Research Assistants

Baseline Phase
Monitoring of Outcome Parameters

Lemon Grass Phase

Twice-a-day Intake of Decoction
Monitoring of Outcome Parameters

Washout Phase
Monitoring of Outfome Parameters

Placebo Phase
Twice-a-day Intake of Placebo
Monitoring of Outcome Parameters

Data Processing and Analysis

Research Paper

Figure 2. Flow of Activities

21

CHAPTER IV
RESULTS
There was a total of 31 respondents (100%) who participated in the study.
There was no dropout; hence, all 31 respondents were able to complete a total of 16
weeks of the study.
Table 1. Profile of Respondents (N = 31)
PROFILE

FREQUENCY

PERCENTAGE

3
4
5
4
7
4
2
2

9.68
12.90
16.13
12.90
22.58
12.90
6.45
6.45

2
3
3
1
3
2
0
1
15

6.45
9.68
9.68
3.23
9.68
6.45
0.00
3.23
48.39

1
1
2
3
4
2
2
1
16

3.23
3.23
6.45
9.68
12.90
6.45
6.45
3.23
51.61

5
8
8
4
3
3

16.13
25.81
25.81
12.90
9.68
9.68

Age
35 39
40 44
45 49
50 54
55 59
60 64
65 69
70 74
Sex Distribution by Age
Male
35 39
40 44
45 49
50 54
55 59
60 64
65 69
70 74
Total
Female
35 39
40 44
45 49
50 54
55 59
60 64
65 69
70 74
Total

Years Hypertensive
23
45
67
89
10 11
12 13

22

The table above shows that majority of the respondents belongs to the 55-59
age group (22.58%) followed by the 45- 49 age group (16.13%), and 60-64 age group,
50-54 age group and 40-44 age group (12.90%). This means that the top 3 age groups
are in the older adulthood and middle-aged bracket. The mean age of the respondents
is 54.5 years old with a range of 35-74 years. Majority of the respondents are females
(51.61%) as compared to males (48.39%). The sex ratio is 6-7 males for every 10
females.
Majority of the respondents have been hypertensive for 4-5 years and 6-7
years (25.81%). The mean number of hypertensive years is 7.5 years with a range of
2-13 years.

Figure 3. Comparison of Mean Arterial Pressure (in mmHg) in the 16 weeks period
of Study
The 16 week period of study was divided into 4 phases namely Baseline,
Lemon Grass, Washout, and Placebo with each phase lasting for 4 weeks. The mean
arterial pressure was analyzed using the Repeated-Measure ANOVA to determine the
level of significance.
On the figure indicated above, it showed that the mean arterial pressure during

23

the Baseline Phase falls under Stage 1 Hypertension MAP. This means that the 31
respondents were under Stage I Hypertension on the Baseline Phase.
During the Lemon Grass Phase, there was a progressive decline from the 1st
week of twice-a-day lemon grass intake until the 4th week of the same phase. This
progressive decline of mean arterial pressure falls under the Prehypertension MAP.
The maximum decline of MAP (3.36 mmHg) was noted after the 3rd week of the
lemon grass phase and the minimum decline of MAP (1.02 mmHg) was noted after
the 4th week of twice-a-day lemon grass intake.
The mean arterial pressure progressively increased on the Washout Phase of
the study. After the 1st week of the Washout Phase, the figure indicated above showed
that it still falls under Prehypertension MAP. But from the 2nd week until the 4th week
of the same phase, the mean arterial pressure of the respondents were back to Stage I
Hypertension MAP. This indicates the validity of the washout. The minimum increase
in MAP was noted after the 1st week of the Washout Phase (1.15 mmHg) and the
maximum increase in MAP was noted after the 2nd week of the Washout Phase (3.91
mmHg).
The mean arterial pressure was stable until the end of the Placebo Phase and
falls under Stage 1 Hypertension MAP. This indicates that the respondents were under
Stage I Hypertension on the Placebo Phase.
In summary, the mean arterial pressure in the 16 week period of the study was
stable during the Baseline Phase. Progressive decline of the mean arterial pressure
was noted after the 1st week of the Lemon Grass Phase until the 4th week of the same
phase with a carry-over effect until the 1st week of the Washout Phase. The mean
arterial pressure then progressively increased from the 1st week of the Washout Phase
until the 4th week of the same phase and was stable during the 4 weeks of placebo

24

phase with little fluctuations. The decline in mean arterial pressure, however, never
reached Normal MAP.

Figure 4. Comparison of Mean Arterial Pressure (in mmHg) between the Baseline
Phase and the Lemon Grass, Washout, and Placebo Phases of the Study
Based on the figure shown above, there was a significant difference on the
mean arterial pressure between the Baseline and Lemon Grass Phase of the study.
There was also a significant difference between the mean arterial pressure of the
Baseline phase and Washout Phase as well.

25

Table 2. Comparison Mean Arterial Pressure between the Baseline Phase and the 4
weeks of the Lemon Grass, Washout, and Placebo Phases of the Study (p < 0.05*)
Baseline MAP
Mean Arterial Pressure Level of Significance
(108.01 mmHg)
(mmHg)
(p < 0.05*)
Lemon Grass 1*

105.98

0.0000*

Lemon Grass 2*

102.67

0.0000*

Lemon Grass 3*

98.99

0.0000*

Lemon Grass 4*

97.97

0.0000*

Washout 1*

99.12

0.0000*

Washout 2*

103.03

0.0000*

Washout 3*

106.05

0.0000*

Washout 4

108.05

1.0000

Placebo 1

107.89

1.0000

Placebo 2

108.06

1.0000

Placebo 3

107.87

1.0000

Placebo 4

108.01

1.0000

Table 2 shows that there was a significant difference on the mean arterial
pressure between the Baseline Phase and 4 weeks of Lemon Grass Decoction Phase
and the first 3 weeks of the Washout Phase as well. However, there was no significant
difference between the Baseline Phase and 4th week of the Washout Phase and also
between the Baseline Phase and the 4 weeks of Placebo Phase.

26

Figure 5. Comparison of Mean Heart Rate (beats/min) in the 16 Weeks Period of

Study
The 16 week period of study was divided into 4 phases namely Baseline,
Lemon Grass, Washout, and Placebo with each phase lasting for 4 weeks. The mean
heart rate was analyzed using the Repeated-Measure ANOVA to determine the level
of significance.
On the figure indicated above, it showed that the mean heart rate during the
Baseline Phase was within the Normal Heart Rate throughout the 4 weeks with an
average fluctuation of 0.25 beats/min.
During the Lemon Grass Phase, there was an average fluctuation of 0.43
beats/min. After the 1st week of the twice-a-day intake of lemon grass, there was a
decline of 0.57 beats/min which was the maximum decreased noted. The heart rate
then increased to 0.73 beats/min after the 2nd week of twice-a-day lemon grass intake
which was the maximum increased noted. The mean heart rate decreased by 0.33
beats/min on the 3rd week and increased again by 0.10 beats/min on the 4th week.
The mean heart rate of the Lemon Grass Phase was within the Normal Heart Rate
throughout the entire 4 weeks.

27

The mean heart rate progressively increased during the 1st week of the
Washout Phase until the 3rd week with minimal fluctuations. There was an increase of
0.10 beats/min after the 1st week, ,0.09 beats /min after the 2nd week, and 0.16
beats/min after the 3rd week of the study. On the 4th week of the Lemon Grass Phase,
there was a decline of 0.38 beats/min which was the maximum decreased noted in this
phase. The mean heart rate was within the Normal Heart Rate throughout the entire 4
weeks with an average fluctuation of 0.16 beats/min.
The mean heart rate was stable with minimal fluctuations on the Placebo
Phase of the study. The mean heart rate was within the Normal Heart Rate throughout
the entire 4 weeks with an average fluctuation of 0.68 beats/min.
The mean heart rate in the 16 weeks period of the study was within the Normal
Heart Rate with an average fluctuation of 0.38 beats/min during the entire course.
There was a decrease in the mean heart rate after the 1st week of the Lemon Grass
Phase but this decline did not continue on. Then a progressive increase in the mean
heart rate was noted on the 1st, 2nd, and 3rd week of the Washout Phase.

28

Table 3. Comparison Mean Heart Rate Between the Baseline Phase and the 4 weeks
of the Lemon Grass, Washout, and Placebo Phases of the Study (p < 0.05*)
Baseline MAP
Mean Arterial
Level of Significance
(70.18 beats/min)
Pressure
(p < 0.05*)
(beats/min)
Lemon Grass 1

69.97

1.0000

Lemon Grass 2

70.54

1.0000

Lemon Grass 3

69.81

1.0000

Lemon Grass 4

70.14

1.0000

Washout 1

70.24

1.0000

Washout 2

70.33

1.0000

Washout 3

70.49

1.0000

Washout 4

70.11

1.0000

Placebo 1

70.12

1.0000

Placebo 2

70.73

1.0000

Placebo 3

70.14

1.0000

Placebo 4

70.97

1.0000

The table shows that there was no significant difference on the mean heart rate
between the Baseline Phase and the 4 weeks of Lemon Grass, Washout, and Placebo
Phases of the study.
Table 4. Comparison of the Clinical Symptoms in the 16 weeks period of the Study
(N/Symptom/Week = 238)
Clinical
Baseline
Lemon
Washout
Placebo
Symptoms
Grass
Mild Headache

1 --- 3

4 --- 1 --- 2 --- --- ---

---

Dizziness

1 --- ---

---

Nape Pain

1 --- --- --- --- --- ---

---

LBM

--- --- --- --- --- --- --- 3 --- --- --- --- --- --- --- ---

Frequent
Urination

--- --- --- --- 24 25 24 27 9

---

Thirsty

--- --- --- --- 7 12 13 12 ---

--- ---

---

Week

2 --- 1

The 16 week period of study was divided into 4 phases namely Baseline,
Lemon Grass, Washout, and Placebo with each phase lasting for 4 weeks. The clinical
29

symptoms complaint by the respondents were monitored daily.

As shown in the table above, a total of 6 clinical complaints namely, mild
headache, dizziness, nape pain, loose bowel movement, frequent urination, and being
thirsty, were verbalized the by the respondents in the 16 week period of study.
Three symptoms were manifested during the Baseline Phase of the study and
are the following in decreasing frequency; dizziness, mild headache, and nape pain.
Majority of those who experienced dizziness noted this on the 1st, 3rd, and 4th week of
the Baseline Phase.
Five symptoms were manifested during the Lemon Grass Phase and are the
following in decreasing frequency; frequent urination, being thirsty, dizziness, mild
headache and loose bowel movement. Majority of those who experienced frequent
urination noted this on the 4th week of the Lemon Grass Phase.
Five symptoms were manifested during the Washout Phase are the following
in decreasing frequency; frequent urination, dizziness and mild headache, nape pain,
and being thirsty. Majority of those who experienced frequent urination noted this on
the 1st week of the Washout Phase.
Five symptoms were manifested during the Placebo Phase and are the
following in decreasing frequency; dizziness, frequent urination, being thirsty, nape
pain, and mild headache. Majority of those who experienced dizziness noted this on
the 4th week of the Placebo Phase.

30

CHAPTER V
DISCUSSION
The study aimed to validate the effect of twice-a-day intake of lemon grass
decoction among hypertensive individuals in Barangay Situbo, Municipality of
Tampilisan, Province of Zamboanga Del Norte.
The mean arterial pressure significantly declined during the Lemon Grass
Phase as compared to the Baseline Phase (See Results, Figure 4). This decline in the
mean arterial pressure was due to the diuretic effect of the lemon grass decoction that
was taken twice-a-day as evidenced by the frequent urination manifested by majority
of the respondents during the Lemon Grass Phase. This diuretic action of the twice-aday intake of lemon grass decoction is supported by Montala in 2006, Jocano in 2003,
and Quisumbing in 1978. The respondents were blinded about the decoction and its
effectiveness in lowering the blood pressure.
During the Lemon Grass Phase, there was a progressive decline in the mean
arterial pressure from the 1st week of twice-a-day lemon grass intake until the 4th
week of the same phase. This progressive decline of mean arterial pressure falls under
the Prehypertension MAP (See Results, Figure 2). This states that the respondents
were in Prehypertension MAP when the twice-a-day intake of lemon grass decoction
was initiated for 4 weeks as compared to the Hypertension Stage I MAP during the
Baseline Phase. The maximum decline of MAP (3.36 mmHg) was noted after the 3 rd
week of the lemon grass phase and the minimum decline of MAP (1.02 mmHg) was
noted after the 4th week of twice-a-day lemon grass intake (See Results, Figure 3).
Cecil. et. al. (2004) cited that with initiation of diuretic therapy, contraction of blood
volume explains the initial fall in blood pressure. With continued diuretic therapy,
blood volume is restored, and vasodilator mechanisms sustain the antihypertensive
31

action. The results of the study showed that the main clinical symptom experienced by
the respondents during the Lemon Grass Phase was frequent urination (See Results,
Table 4). Despite of the significant decrease in mean arterial pressure during the 4
weeks of the Lemon Grass Phase, Normal MAP was not attained.
Harrison et. al. in 2008 stated that vascular volume is a primary determinant of
arterial pressure over the long term. Although the extracellular fluid space is
composed of vascular and interstitial spaces, in general, alterations in total
extracellular fluid volume are associated with proportional changes of blood volume.
Therefore the assumed diuretic action of the twice-a-day intake of lemon grass
decoction would probably increase the amount of salt and fluid that one would pass
out as urine. The volume of the fluid in circulation is reduced, which in effect, reduces
the blood pressure.
In the U.S., a Joint National Committee (JNC) on the prevention, detection,
and evaluation meets on a regular basis to summarize suggested guidelines for doctors
on treating hypertension based on medical research. The findings of the JNC are
based on the information stemming from a landmark investigation at the UT School
of Public Health, which in 2002 established that diuretics were as good as better
than 3 other classes of antihypertensive medications for high blood pressure. In 2003,
the Seventh Report of the Joint National Committee (JNC) on the Prevention,
Detection, Evaluation, and Treatment of High Blood Pressure recommended the use
of diuretics as first-line antihypertensive therapy particularly for most individuals
under Stage 1 Hypertension Without Compelling Indications. Lilly et. al. in 1997 also
stated that a diuretic is effective in patients with mild to moderate hypertension who
have normal renal function. The mean arterial pressure during the Baseline Phase was
stable and falls under Stage 1 Hypertension MAP which indicates that the respondents

32

were under Hypertension Stage 1 JNC 7 on the Baseline Phase (See Results, Figure
3).
There was a significant decrease in the mean arterial pressure on the first 3
weeks of the Washout Phase, but there was no significant difference between the
Baseline Phase and 4th week of Washout Phase. This is probably due to the extended
diuretic effect of the twice-a-day intake of lemon grass decoction. But there are no
literature evidence to support this. The results of the study showed the main clinical
symptom complaint by the respondents during the Lemon Grass Phase was frequent
urination (See Results, Table 4). The 1st week and 2nd week of the same phase fall
under Prehypertension MAP while the 3rd week and 4th week fall under Stage 1
Hypertension MAP which indicates the respondents were under Hypertension Stage 1
JNC 7 on the 3rd week and 4th week of the Washout Phase. This shows the validity of
the Washout Phase (See Results, Table 2).
There was no significant difference between the Baseline Phase and Placebo
Phase of the study (See Results, Figure 4). This is most probably due to the inertness
of the twice-a-day intake of placebo. The preparation and dosage of the placebo was
based on the color, consistency, and amount of the lemon grass decoction. Lemon
grass has a pungent odor that could not be replicated by the researcher. This baffled
the respondents but were informed that it was still the same decoction that they took
during the Lemon Grass Phase just to a lesser concentration. The results of the study
showed that the mean arterial pressure was stable on the Placebo Phase and falls
under Stage 1 Hypertension MAP (See Results, Figure 3) which indicates that the
respondents were under Hypertension Stage 1 JNC 7.
Although there was no significant decrease in the mean arterial pressure
during the Placebo Phase, the 1st week and 3rd week MAPs of the Placebo Phase were

33

lower with a decrease of 0.12 mmgHg and 0.14mmHg respectively compared to the
Baseline Phase MAP. The 4th week MAP of the Placebo Phase was the same as the
Baseline Phase (See Results, Table 2). Still, frequent urination was still one of the
major complaints of the respondents on the Placebo Phase (See Results, Table 4). The
respondents were blinded on the twice-a-day intake of placebo and the lower mean
arterial pressure may be attributed to the placebo.
For high blood pressure, diuretics, as stated above helps the body get rid of
unneeded water and salt through urine. Getting rid of excess salt and liquid helps
lower blood pressure and can make it easier for the heart to pump because of the
decrease in the degree of tension on the muscle when the heart contracts. This
explains the decrease in mean heart rate during the Lemon Grass Phase in comparison
with the mean heart rate on the Baseline Phase (See Results, Figure 6). Although the
mean heart rate was lower during the Lemon Grass Phase, the mean heart rate did not
significantly decrease on the Lemon Grass, Washout, and Placebo Phases of the study
(See Results, Table 3). The mean heart rate during the 4 phases of the study were
within the Normal Heart Rate (See Results, Figure 6)
The Philippine Society of Hypertension in 2010 stated that majority of people
who suffer from high blood pressure do not have symptoms. It is usually an incidental
finding when a blood pressure measurement is done on routine physical examination.
In some cases though, one may experience these symptoms; extreme headaches
particularly in the nape area, dizziness, racing heartbeat, breathing difficulties,
nosebleeds, and poor vision.
The respondents though have attributed mild headache, dizziness, and nape
pain as symptoms that relate to hypertension. These clinical symptoms were included
as one of the outcome parameters and were evaluated. The results of the study showed

34

that these symptoms perceived by the respondents in relation to hypertension did not
significantly decrease on the Baseline, Lemon Grass, Washout, and Placebo phases of
the study (See Results, Table 5).
The diuretic action of the twice-a-day intake of lemon grass decoction
probably minimized these symptoms (mild headache, dizziness, and nape pain) due to
its assumed diuretic action which yielded a significant decreased in the mean arterial
pressure during the 4 weeks of lemon grass phase (See Results, Table 2).
Being thirsty was the 2nd complaint of the majority of the respondents during
the entire 4 weeks of twice-a-day intake of lemon grass decoction preceding frequent
urination which was the desired effect (See Results, Table 4). This is primarily due to
autoregulatory mechanisms initiated by the body's system. Guyton et. al. in 2006
stated that decreases in extracellular fluid volume and arterial pressure stimulates
thirst by a pathway that is independent of the one stimulated by increase plasma
osmolarity. This probably occurs because of the neural input from cardiopulmonary
and systemic arterial baroreceptors in the circulation.
The oral intake of lemon grass decoction has also been proven safe. There
were no reports of any serious untoward reactions experienced by the respondents
during the 16 weeks period of the study.
In summary, the effectiveness of twice-a-day intake lemon grass decoction in
decreasing the mean arterial pressure is through diuresis. An increase in the frequency
of urination was manifested by the respondents during the time when the lemon grass
decoction was initiated. The decrease in volume decreases workload of the heart,
thereby, decreasing the blood pressure.

35

CHAPTER VI
CONCLUSION AND RECOMMENDATIONS
Conlusion
The study was conducted in 4 phases namely, Baseline, Bamboo, Washout,
and Placebo. Each phase was conducted daily for 4 weeks with a total of 16 weeks
duration of the study. The mean arterial pressure, mean heart rate, and the clinical
symptoms in relation to hypertension were the outcome parameters. RepeatedMeasure ANOVA was utilized to analyze in determining the level of significance. The
results of the 16 weeks duration of the study showed that twice-a-day intake of lemon
grass decoction had a significant effect on the mean arterial pressure. However, the
twice-a-day intake of lemon grass decoction had no significant effect on the mean hert
rate and on the clinical symptoms in relation to hypertension. Therefore, twice-a-day
intake of lemon grass decoction can serve as an alternative maintenance medication
for hypertensive individuals under Hypertension Stage 1 JNC 7.

Recommendations
1. The twice-a-day intake of lemon grass decoction be promoted to the
hypertensive individuals under Hypertension Stage 1 JNC 7 as an alternative
maintenance medication in conjunction with lifestyle modifications.
2. The twice-a-day intake of lemon grass decoction should be compared to the
recommended

antihypertensive

drug

therapy

for

individuals

under

Hypertension Stage 1 JNC 7.

3. Further research on the antihypertensive properties of the lemon grass
particularly the primary active component resulting to the diuretic action.

36

BIBLIOGRAPHY

Asian Hospital and Medical Center Health Digest (2009). Lemon Grass: More
Than A Kitchen Condiment.

2205 Civic Drive, Filinvest Corporate City,

Alabang, Muntinlupa City, 1780 Philippines

Cuevas, C. (2009). The Effect of Twice-a-Day Intake of Bamboo Root

Decoction among Hypertensive Individuals in Barangay Sto. Nio, Liloy,
Zamboanga del Norte. ADZU-SOM.

Department of Health. (2004). Hypertension: Morbidity and Mortality.

National Center for Disease Prevention and Control, Department of Health,
Philippines.

Department of Science and Technology (2003) Lemon Grass As An Antifungal

Eye Medication. Technology Development Institute, Department of Science
and Technology, Philippines.

Elson, C.E (1989). Antihypercholesterolemic and Antihypertensive Action of

Lemon Grass Oil.

Fauci M.D., A. S. et. al. (2008). Hypertensive Vascular Disease. Harrisons

Principles
of Internal Medicine, 17th Edition, Chapter 241, Pages 1549-1562.

Guyton M.D., A. C. et. al. (2006). Kidney Diseases and Diuretics, Nervous
Regulation of
the Circulation and Rapid Control of Arterial Pressure, The Integrated System

for Pressure

Control. Textbook of Medical Physiology, 11th Edition, Chapters 18,

19, 31, Pages 204-215,

216-231, 402-415.

Goldman M.D., L. et. al. (2004) Arterial Hypertension.Cecil Textbook of

Medicine, 22nd Edition, Chapter 63, Pages 346-363
37

Jocano, F. L. (2003). Folk Medicine in a Philippine Municipality. Philippine

Medicinal
Plants, Philippine Alternative Medicine.

Joint National Committee on Prevention, Detection, Evaluation, and

Treatment of High
Blood Pressure, 7th Report. (2003). Hypertension. American Heart

Association
Incorporated, USA.

Leite, J.R. (1986). Pharmacology of Lemon Grass (Cymbopogon Citriatus).

Assessment of Eventual Toxic , Hypnotic, and Anxiolytic Effects On Humans.

Obaidy, S. (2007). The Effect of Twice-a-Day Intake of Chayote Extract among

Hypertensive Individuals in Barangay Sto. Nio, Liloy, Zamboanga del Norte.
ADZU-SOM.

Ohno, Tomoyuki et. al. (2003). Antimicrobial Activity Of Essential Oils

Against Helicobacter Pylori. Third Department of Internal Medicine, Kyoto
Prefectural Medicine, Kyoto, Japan.

Philippines Society of Hypertension. (2005). Understanding Hypertension.

Austria M.D., G. F., Founding President, Philippine Society of Hypertension.

Quisumbing Ph.D., E. (1978). Medicinal Plants of the Philippines. Katha

Publishing
Corporation Incorporated, Quezon City, Philippines, Pages 85-86.

Runnie, M.N., Salleh (2004) Vasorelaxation Induced by Common Edible Plant

Extracts in Isolated Rat Aorta and Mesenteric Vascular Bed. Health Sciences
and Nutrition, Kintore Avenue, Australia.

38

APPENDIX A
INFORMED WRITTEN CONSENT

I, ______________________________, have attended the presentation of the entitled

THE EFFECT OF TWICE-A-DAY INTAKE OF A DECOCTION AMONG
HYPERTENSIVE INDIVIDUALS IN BARANGAY SITUBO, MUNICIPALITY OF
TAMPILISAN, PROVINCE OF ZAMBOANGA DEL NORTE
ON SEPTEMBER _______ 2009.

The study has been fully explained to me by the researcher to my understanding by

the researcher and I am affixing my signature to signify my willingness to include
myself as a respondent.

_____________________________________________________________________
___

_______________________________
Respondent
Signature over printed name

_______________________________
Witness
Signature over printed name

_______________________________
Researcher
Signature over printed name

39

APPENDIX B
RESEARCH INSTRUMENT
Name: ____________________________

Age:

_______________________
Address: __________________________

Sex:

_______________________
Phase: ____________________________

Week:

______________________

BP
A.M.
P.M.

Mon

Tue

Wed

Thur

Fri

Sat

Sun

Avg (MAP)

HR
A.M.
P.M.

Mon

Tue

Wed

Thur

Fri

Sat

Sun

Avg

Wed

Thur

Symptoms
M. Headache
S. Headache
Nape Pain
F. Urination
L. O. C.
Dizziness
B. O. V.
Chest pain
Palpitation
D. O. B.
Weakness
Numbness
Edema
Tremors
Flank Pain
No Urine
Output
Fever
Others

Mon

Tue

Fri

Sat

Sun

Avg

40

APPENDIX C
Cymbopogon citriatus

Lemon grass is an aromatic tropical grass with clumped, bulbous stems that
ultimately become leaf blades. Lemon grass is in the same grass family as
citronella and palmarosa; it has a lemon flavor. It has a branched cluster of
stalked flowers and grows in clumps up to 6' tall; when crushed the fragrance
resembles the scent of lemon.

41

APPENDIX D
LEMON GRASS DECOCTION AND PLACEBO
LEMON GRASS DECOCTION
Materials

20 leaves including its roots of lemon grass about 1 foot long

1 basin
1 liter of water
1 steel pot
1 strainer
1 pitcher
pieces of 250 ml plastic bottles

Procedure

Thoroughly wash the lemon grass with water

Soak the leaves and its roots for about 10 to 15 minutes
Boil 20 leaves of lemon grass and its roots in liter for 20 minutes
Allow the decoction to cool down by natural processing
Strain and pour the decoction into a 250 ml plastic bottle

PLACEBO
Materials

1 bottle of commercially prepared lemon flavoured articial food color

1 liter of water
1 stirring rod
1 pitcher
4 pieces of 250 ml plastic bottles

Procedure

Mix about 6 to 8 teaspoons of commercially prepared lemon flavoured

artificial food color in 1 liter of water
Mix and pour the placebo into a 250 ml plastic bottle

42

CURRICULUM VITAE
PERSONAL INFORMATION
Name:
Age:
Sex:
Civil Status:
Date of Birth:
Address:
Religion:
Father:
Mother:

Ian Ray C. Caluscusin

25 years old
Male
Single
March 18, 1985
60 D Feliciano Drive, MCLL Highway, Tetuan,
Zamboanga City
Roman Catholic
Dr. Baltazar P. Caluscusin
Mrs. Melanie C. Caluscusin

EDUCATIONAL BACKGROUND
GRADUATE
Degree:
School:
Place:
Year of Graduation:

Doctor of Medicine
Ateneo de Zamboanga University School of Medicine
La Purisima St. Zamboanga City
2010

COLLEGE
Degree:
School:
Place:
Year of Graduation:

Bachelor of Science in Nursing

Ateneo de Zamboanga University
La Purisima St., Zamboanga City
2006

HIGH SCHOOL
School:
Arturo Eustaquio Memorial Science High School
Place:
Don Toribio Street, Tetuan, Zamboanga City
Year of Graduation: 2002
ELEMENTARY
School:
Zamboanga Chong Hua High School
Place:
Pilar St. Zamboanga City
Year of Graduation: 1998

43