Effect of Potassium and Fiber Contains in Tomato (Solanum

Lycopercium L) and Cucumber (Cucumis Sativus L) Juice to Lowering

Blood Pressure of Hypertensive Patient at Primary Health Care

Kebayoran Lama

Nursyifa Rahma Maulida, Hafidhah, Gunarti Yahya

and Imas Arumsari

University of Muhammadiyah Prof. Dr. Hamka, Indonesia

Keywords: Blood Pressure, Diet Modification, Hypertension, Tomato-Cucumber Juice.

Abstract: Hypertension is also a cause of death with 23.7% of the total 1.7 million deaths in Indonesia. Modification of

food intake that contains high potassium, magnesium, and fiber, and low sodium is one of the alternative to

reduce blood pressure (BP). The purpose of this study was to describe the effect of combination tomato-

cucumber juice on lowering BP at Primary Health Care Kebayoran Lama in 2020. The quasi pre-experiment

study was used as the study design with 30 patient of hypertension who have BP level >120/80 mmHg. The

subject was divided into two groups consecutively (control and intervention group) to given the treatment.

The intervention group received the juice made from 150g tomatoes and 100 g cucumber/day for 7 days. The

result showed that there was a significant difference of systolic BP in the control (p=0,003) and intervention

(p=0,001) group. The similar result revealed for diastolic BP between those group. Futhermore, the

intervention group experienced higher lowering systolic and diastolic blood pressure compared to the control

group significantly. Diet modification by giving combination juice (tomato and cucumber) as a treatment can

be suggested by health professional for hypertensive patients on preventing complication disease caused high

blood pressure.

1 INTRODUCTION

Hypertension is a condition when blood pressure is

too high occurs chronically. According to the Joint

National Committee 8 (JNC 8), hypertension is

defined as systolic blood pressure (BP) level of ≥ 140

mmHg and/or diastolic BP level ≥ 90 mmHg. Systolic

BP level <120 mmHg and diastolic BP level <80

mmHg is a normal blood pressure. Prehypertension is

defined as the grey area falling between 120-139

mmHg systolic BP and 80-89 mmHg diastolic BP

(James et al., 2014). Hypertension is one of the health

problems worldwide because of its high prevalence.

It continues to increase as a major risk factor for

chronic heart disease, stroke, and chronic kidney

disease (Singh et al., 2017).

An estimated 1.13 billion people worldwide have

hypertension. At the global prevalence, hypertension

prevalence is 22% and in the Southeast Asia is 25%

including Indonesia (WHO, 2020). The number of

people with hypertension is estimated to reach 1.5

billion individuals by 2025, with deaths reaching 9.4

million individuals. Basic Health Research

(Riskesdas) 2013 resulted in prevalence hypertension

at age 18 years in Indonesia reached 25.8%, which

was diagnosed by health workers and/or have a

history of taking medication is only 9.5%, indicating

that most cases of hypertension in the community

undiagnosed and reached by the team health services

(Adrian & Tommy, 2019). DKI Jakarta as the capital

city of Indonesia is ranked 5th as the city with the

highest prevalence of hypertension reaching 10.47%

(Kemenkes RI, 2018).

Hypertension remains one of the most important

preventable contributors to disease and deaths. Many

drugs related to reduce blood pressure are available.

However, alternative and complementary treatment

for blood pressure control is needed to reduce the high

profile of side effects of anti-HT drugs (Wolak et al.,

2019). This includes lifestyle modifications,

especially dietary interventions such as consumption

of more fruits and vegetables. Modification of food

intake that contains high potassium, magnesium, and

fiber, and low sodium is one of the recommendations

118

Maulida, N., Haﬁdhah, ., Yahya, G. and Arumsari, I.

Effect of Potassium and Fiber Contains in Tomato (Solanum Lycopercium L) and Cucumber (Cucumis Sativus L) Juice to Lowering Blood Pressure of Hypertensive Patient at Primary Health

Care Kebayoran Lama.

DOI: 10.5220/0011662400003608

In Proceedings of the 4th International Conference on Social Determinants of Health (ICSDH 2022), pages 118-122

ISBN: 978-989-758-621-7; ISSN: 2975-8297

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

of the DASH diet (Dietary Approach to Stop

Hypertension) to reduce risk factors for increasing

blood pressure and prevent hypertension (Fung et al.,

2010).

Several studies demonstrate that oral

supplementation with tomato extract or tomato juice

significantly decreases BP (Ilma&Wirawanni, 2015;

Sabilu et.al., 2017). There are strong antioxidants

such as lycopene, β-carotene and the colorless

carotenoids phytoene and phytofluene, in addition to

a myriad of other active nutrients such as tocopherols

and polyphenols from tomato products or extracts.

The antioxidant is one of the mechanisms for the

cardiovascular protective effect. Other study showed

that cucumber has an impact to reduce blood pressure

(Sharmen et al., 2012; Yanti et al., 2017).

Tomatoes' potassium and lycopene content can

lower blood pressure by inhibiting renin release and

increasing sodium excretion. Potassium content can

increase intracellular fluid concentration so that blood

pressure drops, so it tends to draw fluid from the

extracellular part and lowers blood pressure due to the

vasodilating effect of blood vessels.

Cucumber and tomato are the fresh vegetables

that widely consumed by the people of Indonesia.

Cucumber and tomato can grow and spread in various

regions in Indonesia, so that it is easily obtained at

affordable prices. Those vegetables also have a good

nutritional content, especially a good source of

minerals and vitamins to maintain health. However,

based on the data in the preliminary study,

hypertension patient is rarely consuming those

vegetables. Thus, one of the major aims of the current

work was to compare whether combination juice

tomato-cucumber has an effect or not to lowering

blood pressure on patient of hypertension at Primary

Health Care Kebayoran Lama in 2020.

2 METHODS

The quasi pre-experiment with pretest-posttest

control group design was approved by the Ethics

Committee of Faculty of Health, UHAMKA

No.03/20.09/0650. The study was conducted at

Primary Health Care (PHC) or Puskesmas Kebayoran

Lama, DKI Jakarta Province in 2020. The research

subjects were thirty patients of hypertension

consecutively booked during health service visits in

PHC who meet the inclusion criteria from September

to October 2020. The inclusion criteria of this study

were: 1) hypertensive patient aged 18-45 years with

no complication diseases such as diabetes mellitus,

chronic heart disease, chronic kidney disease, etc., 2)

having systolic BP level of ≥120 mmHg and/or

diastolic BP level ≥80 mmHg, 3) consume anti

hypertension drugs routinely, 4) willing to be a

subject of research. As long as the duration of

intervention was given to the subject, then they failure

to follow the full intervention will be excluded of this

study. The subjects who fulfil the criteria of this study

were divided into two groups, the control and

intervention group.

The intervention group was given the treatment

tomato-cucumber juice and the control group was

given the placebo (simple syrup 0 calorie). The

composition of tomato-cucumber juice consisted of

blended fresh tomato 150-gram, cucumber 100-gram,

2-gram non-caloric sweetener and water 200 cc. The

placebo contains 5ml non-caloric syrup in 250 ml

water. The intervention was given for 7 consecutive

days before breakfast (07.00 – 08.00 WIB). Informed

consent was performed to the subject.

Information on age, gender, body mass index

(BMI), nutrition intake, and blood pressure was

assessed using a standard questionnaire and

procedure. Systolic and diastolic BP was performed

using sphygmomanometer digital. Intake of energy,

sodium, potassium, magnesium, and fiber was

assessed using 3 days 24-hour food recall non-

consecutively during intervention. Data were

analyzed using univariate and bivariate analysis.

Wilcoxon-Rank test was used to describe the

differences of blood pressure between pre-post

treatments in both group. The test of significance two

tailed with p ≤ 0.05 was considered to be statistically

significant. Mann Whitney test was used to see the

differentiate between control and intervention group.

3 RESULTS

The age, gender, nutritional status of the subject was

described in the table 1. The proportion of gender in

the subject was similar between control and

intervention group. Otherwise, the age of subject in

the intervention group was 100% at the age of 35-45

years. According to BMI, the nutritional status in the

control group was the opposite of the intervention

group where more respondents who suffer

overweight and obesity in the intervention group.

The Mann Whitney test was used to see the

differences in the respondent’s nutritional intake such

as energy, sodium, potassium, magnesium, and fiber

during treatment period. There were significant

differences in potassium and fiber intake between the

control and intervention group (p<0,05). The results

showed that the average intake of those nutrient in the

Effect of Potassium and Fiber Contains in Tomato (Solanum Lycopercium L) and Cucumber (Cucumis Sativus L) Juice to Lowering Blood

Pressure of Hypertensive Patient at Primary Health Care Kebayoran Lama

119

* Wilcoxon-Rank Test, significantly difference (p<0,05)

intervention group was higher (1106,3 mg for

potassium and 14,8 g for fiber) than the control group

(624,1 mg for potassium and 10,7 g for fiber).

However, the intake of micronutrients that have been

scientifically proven to lower blood pressure is still

below the recommended dietary allowances (Kalium:

2400 mg). It concludes that the subject of this

research have poor eating habits in daily routine to

manage their health.

Table 2 shows the result of blood pressure (BP)

level in the two groups before and after treatment.

The average systolic BP in the control group of this

study before treatment was 143 (131-193) mmHg and

152,9±13,9 in the intervention group, whereas the

diastolic BP was 89 (77-121) mmHg in the control

group and 93,7±6,7 mmHg in the intervention group.

Based on the JNC 8 classification, the subjects are

classified as hypertension stage 1.

The main result of this study was that there is a

significant difference in systolic and diastolic BP of

the two groups (control and intervention).

Furthermore, the highest decrease was seen in the

intervention group compared to control group

consistently of both BP. The

Difference in the decrease in systolic BP was 9

mmHg of the control group while in the intervention

group it was 16 mmHg. The similar result is shown in

the diastolic BP, the difference in blood pressure

reduction of 5.2 mmHg in the control group and 7.2

mmHg in the intervention group.

4 DISCUSSION

The Hypertension is a multifactorial disease caused

by the interaction of various risk factors experienced

by a person. This study revealed that the respondents

are patient hypertension aged 18-45 years. The age

variable in this study has tried to be controlled by not

including the age above 45 years. Increasing age in

humans causes physiological changes in the body,

because aging is a progressive process that results in

decreased physiologic function such as thickening of

the uterine due to a build-up of collagen in the muscle

layer. Hence, blood vessels constrict and become stiff

starting at the age of 45 years (Buford, 2016).

* Wilcoxon-Rank Test, significantly difference (p<0,05)

Table 1: Characteristics of respondent.

Characteristic

Control Mean±SD/ Median

(Min-Max)

Intervention Mean± SD/ Median

(Min-Max)

p-value

n % n %

Gender

Men 6 40 7 46,7

Women 9 60 8 53,3

Age

18-24 years 1 6,7 0 0

25-34 years 4 26,7 0 0

35-45 years 10 66,7 15 100

BMI

Normal 9 60 6 40

Overwei

ht-obesit

6 40 9 60

Intake of Ener

Defisit 2 13,3 2125,5 (1592,6 – 3494,3)

kkal

5 33,3 2048,3 ± 383,6 kkal 0,855

Normal 12 80,0 9 60,0

Excess 1 6,7 1 6,7

Intake of Natrium

Defisit 12 80 1351,7 (1151,8–1973,8)

8 53,3 1491,1 ± 179,9 mg 0,057

Normal 3 20 7 46,7

Intake of Kalium

Defisit 15 100 624,13 ± 403,2 mg 15 100

106,3(541,9 - 2193) m

0,017*

Normal - - - -

Intake of Ma

nesium

Defisit 15 100 48,3 ± 19,4 mg 15 100 36,4 (19,6 – 90,9) mg 0,145

Normal - - - -

Intake of Fiber

Defisit 14 93,3 10,7 (4,13 – 44,5) g 15 100 14,8 ± 3,34 g 0,000*

Normal 1 6,7 - -

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In addition, there is also an increase in peripheral

resistance and sympathetic activity and a lack of

baroreceptor sensitivity (regulating blood pressure

and the role of the kidneys, blood flow and

glomerular filtration rate) (Zhongjie, 2015).

However, in this study showed that hypertension can

occur in any ages and there are other factors

influenced the blood pressure.

Nutritional status was described by BMI in this

study. Half of the respondents were classified as

overweight-obesity (BMI>25.0 kg/m

). Obesity is a

major risk for essential hypertension. It mainly

increases tubular reabsorption to impair pressure

natriuresis and cause volume expansion via the

activation of the SNS (Sympathetic nervous system)

SNS and the RAS (Renin-angiotensin system)

(Aronow, 2017). There is a mechanism for blood

pressure reduction with weight loss in overweight

hypertensive persons. A person who reduces calories

without reducing sodium intake can reduce

sympathetic activity caused by decreased RAS

activity, natriuresis, and contraction of plasma

volume. It can increase the blood pressure (Aronow,

2017; Palmer and Williams, 2016).

Dietary intakes play an important role in

increasing blood pressure in this study. The main

finding of this study showed that there was a

significant effect of tomato-cucumber juice in

lowering blood pressure. In line with previous

studies, this indicated that systolic BP was decreased

after consuming the treatment of tomato (Ilma and

Wirawani, 2015; Wolak et al., 2019) and cucumber

juice (Lebalado dan Mulyati, 2014; Ilma and

Wirawani, 2015; Yanti et al., 2017). Cucumber has

hypotensive and diuretic effect that decreases the

volume of the fluid in the bloodstream. It can reduce

the workload of the heart. Potassium, magnesium,

and fibber contained cucumber have a role in

maintaining the stability of the body.

The explanation of tomato can reduce blood

pressure that is the active nutrients in the tomato (e.g.,

lycopene, phytoene, and Phyto fluence).

Bioflavonoids can increase the level of endothelial

nitric oxide synthase (eNOS). The eNOs have a

function in the formation nitric oxide (NO). NO is

released from endothelial cells into vascular smooth

muscle cells to reduce the tension (Sharmin et al.,

2012; Yusuf et al., 2017). Because there are receptor

substances, such as acetylcholine, bradykinin,

serotonin circulates in the blood. The concentration

of intracellular cyclic guanosine monophosphate and

induce vascular smooth muscle relaxation can cause

the vasodilatation of the capillaries. It is the role of

NO when emerged condition in the body.

Vasodilatation of the capillaries can reduce total

peripheral resistance and blood pressure (Houston,

2011; Yusuf et al., 2017).

Cucumber contains a magnesium, which in

addition to potassium content, can lower blood

pressure by improving blood flow, relaxing the heart

muscle, and calming nerves. A variety of

cardiovascular diseases and disorders have been

linked to fiber consumption. The main soluble fibber

component of oat grains, β-glucan, was initially

linked to a decrease in plasma cholesterol.

Cholesterol-lowering therapy has been shown to

reduce arterial stiffness in hypercholesterolemic

patients and may thus be beneficial in blood pressure

(Aleixandre and Miguel, 2016).

5 CONCLUSIONS

Consuming adequate portions of potassium can

increase its concentration in the intracellular fluid so

that it tends to draw fluid from the extracellular space

and lowers blood pressure. Therefore, diet

modification can be suggested by personal health

such as nutritionist as the alternative treatment for

hypertensive patient. Tomato and cucumber are

available and affordable food to consume.

Table 2: o Differentiate of Pre-post test blood pressure on control and intervention group.

Blood Pressure

Pre-tes

Pos

-test

Mean ± SD/Median

(min-max)

Mean ± SD/Median

(min-max)

Difference

Control Group

stolic (mmH

) 143 (131-193)

134,9±4,3

0,003* 9 mmHg

Diastolic (mmH

) 89 (77-121)

85±3,6

0,0038* 5,2 mmHg

Intervention Group

stolic (mmH

) 152,9±13,9

132,6±13,5

0,001* 16 mmHg

Diastolic (mmHg) 93,7±6,7

86,4±4,4

0,001* 7,2 mmHg

Effect of Potassium and Fiber Contains in Tomato (Solanum Lycopercium L) and Cucumber (Cucumis Sativus L) Juice to Lowering Blood

Pressure of Hypertensive Patient at Primary Health Care Kebayoran Lama

121

REFERENCES

James PA, Oparil S, Carter BL, et al. (2014). Evidence-

Based Guideline for the Management of High Blood

Pressure in Adults: Report From the Panel Members

Appointed to the Eighth Joint National Committee

(JNC 8). JAMA. 2014;311(5):507–520. https://doi:

10.1001/jama.2013.284427

Singh, S., Shankar, R., & Singh, G. P. (2017). Prevalence

and Associated Risk Factors of Hypertension: A Cross-

Sectional Study in Urban Varanasi. International

journal of hypertension, 2017, 5491838. https://

doi.org/10.1155/2017/5491838.

World Health Organisation. (2021). Hypertension.

Newsroom. https://www.who.int/news-room/fact-

sheets/detail/hypertension

Kemenkes RI. (2013). Penyajian Pokok-Pokok Hasil Riset

Kesehatan Dasar 2013. www.litbang.depkes.go.id

Kemenkes RI. (2018). Hasil Utama Riset Kesehatan Dasar

(Riskesdas).

Wolak, T., Sharoni, Y., Levy, J., Linnewiel-Hermoni, K.,

Stepensky, D., & Paran, E. (2019). Effect of Tomato

Nutrient Complex on Blood Pressure: A Double Blind,

Randomized Dose⁻Response Study. Nutrients, 11(5),

950. https://doi.org/10.3390/nu11050950

Fung, T.T., F.B. Hu, K. Wu, S.E. Chiuve, C.S. Fuchs and

E. Giovannucci. (2010). The Mediterranean and

Dietary Approaches to Stop Hypertension (DASH)

diets and colorectal cancer. The American Journal of

Clinical Nutrition, 92(6): 1429-35.

Buford T. W. (2016). Hypertension and aging. Ageing

research reviews, 26, 96–111. https://doi.org/

10.1016/j.arr.2016.01.007

Zhongjie Sun. (2015). Aging, Arterial Stiffness, and

Hypertension. American Heart Association, Volume 65

(2), 252 – 256. https://doi.org/10.1161/HYPERTE

NSIONAHA.114.03617

Aronow W. S. (2017). Association of obesity with

hypertension. Annals of translational medicine, 5(17),

350. https://doi.org/10.21037/atm.2017.06.69

Reisin, E., & Frohlich, E. D. (1982). Effects of weight

reduction on arterial pressure. Journal of chronic

diseases, 35(12), 887–891. https://doi.org/10.

1016/0021-9681(82)90119-9

Palmer, A., & Williams, B. (2016). Tekanan Darah Tinggi.

Blood Pressure, Stadium 1, 6–41. Http://p2p

tm.kemkes.go.id/uploads/2016/10/Tekanan-Darah-

Tinggi-Hipertensi.pdf

Ilma, A. D., & Wirawanni, Y. (2015). Pengaruh Pemberian

Jus Mentimun Dan Tomat Terhadap Tekanan Darah

Perempuan Overweight Dan Obesitas. Journal Of

Nutrition College, 4(3), 281–287. https://doi.org/

10.14710/Jnc.V4i3.10094

Lebalado LP, Mulyati T. (2014). Pengaruh Pemberian Jus

Mentimun (Cucumis sativus L.) terhadap Tekanan

Darah Sistolik dan Diastolik pada Penderita Hipertensi

Diponegoro University; 2014.

Yanti, E., Niken, & Andriyani, D. (2017). Pengaruh

Pemberian Jus Mentimun (Cucumis Sativus L)

Terhadap Tekanan Darah Pada Penderita Hupertensi.

Jurnal Kesehatan Saintika Meditory, 2, 1–12.

Sabilu, Yusuf., Nuziyati., Fachlevi, Andi F., Saptaputra,

Syawal K., Hidayanty, H. (2017). Tomato Juice

(Lycopersicum commune) Reduces Blood Pressure in

Elderly Hypertensive Indonesians in Kulisusu, North

Buton. Asian Journal of Clinical Nutrition, 9: 111-117.

Houston, M. C. (2011). The Importance of Potassium In

Managing Hypertension. Current Hypertension

Reports, 13(4), 309–317. https://doi.org/

10.1007/s11906-011-0197-8

Sharmin, R., Khan, M. R. I., Akhtar, M. A., Alim, A., Islam,

M. A., Anisuzzaman, A. S. M., & Ahmed, M. (2012).

Hypoglycemic And Hypolipidemic Effects Of

Cucumber, White Pumpkin And Ridge Gourd In

Alloxan Induced Diabetic Rats. Journal Of Scientific

Research,5(1),161170.Https://Doi.Org/10.3329/Jsr.V5

i1.10252

Aleixandre, A., Migule, M. (2016). Dietary Fibber and

Blood Pressure Control. Food Funct. Apr;7(4):1864-71/

doi: 10.1039/c5fo00950b. PMID: 26923351.

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