Effectiveness of Deep Breathing Against Reduction Blood Pressure in Elderly People with Hypertension in Elderly Compound

Old age is a process of gradual disappearance of tissue’s ability to repair itself or replace itself and maintain its normal structure and function. Degenerative diseases in the elderly for example were hypertension, arthrosclerosis, diabetes mellitus and cancer. This study aims to find out the effectiveness of deep breathing against decreased blood pressure in elderly people who have hypertension. This research uses one group pre-posttest method. The sample used as many as 13 people. This research uses Purposive Sampling technique and the tool used to obtain data is observation. This study used paired sample t-test with significance α = 0.05. The results of this study showed that there is an influence of deep breathing on the decrease in blood pressure in elderly people who have hypertension on the 1 st day pre and 3 rd day post with a value of p = 0.000< α = 0.05. There is an effect of deep breathing on the decrease in blood pressure in elderly people who have hypertension on the 4th day pre and day 6 post with a value of p = 0.000< α = 0.05. And there is an effect of deep breathing on the decrease in blood pressure in the elderly who have hypertension on the 7 th day pre and the 9 th day post with a value of p = 0.000< α = 0.05. It was concluded that there is an effect of deep breathing on the decrease in blood pressure in elderly people who have hypertension on days 1, 4, 7 pre and day 3, 6, 9 post. The conclusion of the study is that there is an effect of deep breathing effectiveness on the decrease in blood pressure in elderly people who have hypertension Deep Breathing Against Reduction Blood Pressure in Elderly People with Hypertension in Elderly Compound.


Introduction
Elderly or aging (getting old) is a process of gradual disappearance of tissues to repair themselves or replace themselves and maintain their normal structure and function so that it cannot be gradual to scart (including infections) and repair the damage that causes degenerative diseases e.g., hypertension, arteriosclerosis, diabetes mellitus and cancer [1,2]. According to Jubaidi (2008) In Sulastri [2] there are some physical changes in the elderly that can become an elderly condition affected by diseases, such as cardiovascular changes that are decreased elasticity of blood vessels, changes in respiration that is decreased strength of respiratory muscles, as well as changes in hearing and changes in vision. There are several kinds of diseases that commonly afflict on the occurrence of hypertension. Hypertension itself can be monitored through blood pressure measurement.
Hypertension is persistent high blood pressure where the systolic pressure is above 140mmHg and the diastolic pressure is above 90mmHg [3]. Nearly 1 billion or a quarter of the population of adults and the elderly has high blood pressure, and this number is likely to increase. In the elderly population, the number of people with high blood pressure is even higher, experienced by more than half of the population of people over the age of 60. In 2025 it is estimated that people with high blood pressure reach almost 1.6 billion people in the world [4]. Blood pressure is one of the things that affect the human body system. An increase or decrease in blood pressure will affect homeostasis in the body. Hypertension is found with several risk factors that can cause the occurrence of high blood pressure, namely old age and the presence of a history of high blood pressure in the family. In addition there are also so many causes of hypertension that it causes hypertension is a disease with many sufferers even referred to as the silent disease (Cold-blooded Killer) (Palmer, 2007) [4]. breathing until now has been an easy method of relaxation in its implementation. Relaxation therapy diaphragm breathing technique is very good to be done every day by people with high blood pressure, in order to help relax the muscles of the body, especially the muscles of the blood vessels so as to maintain the elasticity of arterial blood vessels so that it can help lower blood pressure (Evelyn,2011). According to Audah (2011) breathing in a good way and control is able to provide relaxation as well as reduce stress. Deep breath training is a form of non-pharmacological therapy, in which the nurse teaches the client how to do deep breaths, slow breaths (holding the maximum inspiration) and how to exhale slowly, in addition to lowering the intensity of pain can also improve pulmonary ventilation and increase blood

Method of Research
This research uses One-Group Pretest-Posttest Design research design. This design is a Preexperimental study in which researchers give treatment to the measured study group orin the next pretest after the treatment of the study group is measured or in the retest (Posttest) ( Table 1) forms related to data recording (Dharma, 2011). The data feeder instrument used in this study is an observation form sheet. The data used in this study are primary data and secondary data. Before data analysis, data processing is carried out using computerized SPSS (Statistical Product and Service Solution). Data Analysis is done using univariate analysis and bivariate analysis. The consent sheet is given to respondents who will be examined and meet the inclusion criteria. To the respondents explained about the benefits and risks of research that may arise. If the subject refuses then the researcher will not impose the will and respect the rights of the subject. The result of analysis of systolic blood pressure data before intervention was found that the average systolic blood pressure of respondents before intervention was 148.46mmHg.
The lowest systolic blood pressure is 140mmHg and the highest is 160mmHg. The result of diastolic blood pressure analysis before intervention was 89.23mmHg. The lowest diastolic blood pressure is 70mmHg and the highest is 100mmHg. While the result of analysis of systolic blood pressure data after intervention was 133.08mmHg. The lowest systolic blood pressure is 110mmHg and the highest is 160mmHg. The result of analysis of diastolic blood pressure data after intervention was 84.62mmHg. The lowest diastolic blood pressure is 70mmHg and the highest is 100mmHg (Table 2).

Day 2:
The result of analysis of systolic blood pressure data before intervention was found that the average systolic blood pressure of respondents before intervention was 147.62mmHg.
The lowest systolic blood pressure is 140mmHg and the highest is 150mmHg. The result of diastolic blood pressure analysis before intervention was 82.31mmHg. The lowest diastolic blood pressure is 60mmHg and the highest is 90mmHg. While the result of analysis of systolic blood pressure data after intervention was 140.23mmHg.
The lowest systolic blood pressure is 130mmHg and the highest is 149mmHg. The result of analysis of diastolic blood pressure data after intervention was 80.77mmHg. The lowest diastolic blood pressure is 60mmHg and the highest is 90mmHg (Table 3). Day 3: The result of analysis of systolic blood pressure data before intervention was found that the average systolic blood pressure of respondents before intervention was 148.15mmHg.
The lowest systolic blood pressure is 140mmHg and the highest is 159mmHg. The result of diastolic blood pressure analysis before intervention was 80.77mmHg. The lowest diastolic blood pressure is 70mmHg and the highest is 90mmHg. While the result of analysis of systolic blood pressure data after intervention was 139.69mmHg.
The lowest systolic blood pressure is 130mmHg and the highest is 150mmHg. The result of analysis of diastolic blood pressure data after intervention was 79.23mmHg. The lowest diastolic blood pressure is 70mmHg and the highest is 90mmHg (Table 4).

Day 4:
The result of analysis of systolic blood pressure data before intervention was found that the average systolic blood pressure of respondents before intervention was 147.62mmHg.
The lowest systolic blood pressure is 140mmHg and the highest is 150mmHg. The result of diastolic blood pressure analysis before intervention was 86.92mmHg. The lowest diastolic blood pressure is 70mmHg and the highest is 100mmHg. While the result of analysis of systolic blood pressure data after intervention is 136.85mmHg.
The lowest systolic blood pressure is 120mmHg and the highest is 150mmHg. The result of analysis of diastolic blood pressure data after intervention was 85.35mmHg. The lowest diastolic blood pressure is 70mmHg and the highest is 100mmHg (Table 5).

Day 5:
The result of analysis of systolic blood pressure data before intervention was found that the average systolic blood pressure of respondents before intervention was 148.23mmHg.
The lowest systolic blood pressure is 140mmHg and the highest is 150mmHg. The result of diastolic blood pressure analysis before intervention was 84.62mmHg. The lowest diastolic blood pressure is 70mmHg and the highest is 90mmHg. While the result of analysis of systolic blood pressure data after intervention was 138.23mmHg.
The lowest systolic blood pressure is 120mmHg and the highest is 150mmHg. The result of analysis of diastolic blood pressure data after intervention was 81.54mmHg. The lowest diastolic blood pressure is 70mmHg and the highest is 90mmHg (Table 6).

Day 6:
The result of analysis of systolic blood pressure data before intervention was found that the average systolic blood pressure of respondents before intervention was 149.69mmHg.
The lowest systolic blood pressure is 140mmHg and the highest is 159mmHg. The result of diastolic blood pressure analysis before intervention was 84.62mmHg. The lowest diastolic blood pressure is 70mmHg and the highest is 90mmHg. While the result of analysis of systolic blood pressure data after intervention was 136.08mmHg.
The lowest systolic blood pressure is 120mmHg and the highest is 150mmHg. The result of analysis of diastolic blood pressure data after intervention was 80.77mmHg. The lowest diastolic blood pressure is 70mmHg and the highest is 90mmHg (Table 7).

Day 7:
The result of analysis of systolic blood pressure data before intervention was found that the average systolic blood pressure of respondents before intervention was 147.62mmHg.
The lowest systolic blood pressure is 140mmHg and the highest is 159mmHg. The result of diastolic blood pressure analysis before intervention was 81.54mmHg. The lowest diastolic blood pressure is 70mmHg and the highest is 90mmHg. While the result of analysis of systolic blood pressure data after intervention was 133.85mmHg.
The lowest systolic blood pressure is 120mmHg and the highest is 150mmHg. The result of analysis of diastolic blood pressure data after intervention was 80.77mmHg. The lowest diastolic blood pressure is 70mmHg and the highest is 90mmHg (Table 8). Day 8:The result of analysis of systolic blood pressure data before intervention was found that the average systolic blood pressure of respondents before intervention was 146.92mmHg.
The lowest systolic blood pressure is 140mmHg and the highest is 158mmHg. The result of diastolic blood pressure analysis before intervention was 78.46mmHg. The lowest diastolic blood pressure is 70mmHg and the highest is 90mmHg. While the result of analysis of systolic blood pressure data after intervention was 132.46mmHg.
The lowest systolic blood pressure is 110mmHg and the highest is 150mmHg. The result of analysis of diastolic blood pressure data after intervention was 78.46mmHg. The lowest diastolic blood pressure is 70mmHg and the highest is 90mmHg (Table 9).

Day 9:
The result of analysis of systolic blood pressure data before intervention was found that the average systolic blood pressure of respondents before intervention was 149.15mmHg.
The lowest systolic blood pressure is 140mmHg and the highest is 159mmHg. The result of diastolic blood pressure analysis before intervention was 87.69mmHg. The lowest diastolic blood pressure is 70mmHg and the highest is 100mmHg. While the result of analysis of systolic blood pressure data after intervention was 136.15mmHg. The lowest systolic blood pressure is 130mmHg and the highest is 150mmHg. The result of analysis of diastolic blood pressure data after intervention was 82.31mmHg. The lowest diastolic blood pressure is 70mmHg and the highest is 90mmHg After the statistical test obtained p value = 0.108 > α = 0.05 which means there is no effect of giving Deep Breathing to decrease blood pressure (Table 10).

Discussion
In this discussion, researchers will discuss about the effectiveness of Deep Breathing against decreased blood pressure in elderly people who have hypertension.

Deep breathing also affects tidal volume increase, activating
Hering-Breuer reflex which has an impact on decreasing chemo reflex activity and ultimately increasing bar reflex sensitivity. This mechanism can decrease sympathetic activity and blood pressure. can lower blood pressure in hypertension sufferers. Diaphragm breathing until now has been an easy method of relaxation in its implementation. Therapy techniques relaxation deep breath is very good to be done every day by hypertension sufferers, in order to help the body, especially the blood vessels so as to maintain elasticity of elastic blood vessels Researchers assumed that after the action of giving deep breathing techniques in the 1st to 9 th day can be known the effectiveness of deep breathing against decreased blood pressure in elderly people who have hypertension. This can be seen in the provision of deep breathing techniques on the first to the 9 th day. Thus it is known that deep breath relaxation techniques are effective to lower blood pressure in the elderly. According to the assumptions of researchers with relaxation techniques that are easy to do and without any side effects for the elderly, it is very important to be applied in everyday life and can be done alone by respondents to lower blood pressure because with this relaxation technique helps the body to stay relaxed, can supply oxycalyan with the necessary levels of the body and help relieve the work of the heart, as well as maintain the depletion of blood vessels [6][7][8][9][10][11][12][13][14][15].

Research Limitation
The limitations in this study are: 1. Difficulty in communicating with the elderly.

2.
The time used by researchers is in the morning but some respondents are still sleeping, so they have to wait until the elderly wake up with different hours.

Summary
After the research conducted under the title "Effectiveness of Deep Breathing Against Decreased Blood Pressure in Elderly People Who Have Hypertension" it can be concluded that:

1.
It can be known that the average pre-day systolic blood pressure is 148.46 with a standard deviation of 6,887. The average post-day blood pressure of 9 is 136.15 with a standard deviation of 6,504. After the statistical test obtained the value of p value = 0.000 < α = 0.05 which means there is an effect of giving Deep Breathing to the decrease in blood pressure.

2.
It can be known the average diastolic blood pressure pre day 1 is 89.23 with a standard deviation of 11,875. The average diastolic blood pressure post day 9 is 82.31 with a standard deviation of 9,268. After the statistical test obtained p value = 0.108 > α = 0.05 which means there is no effect of giving Deep Breathing to the decrease in blood pressure.

Suggestion
The results of this study can be used for the development of nursing science on the Effectiveness of Deep Breathing against Decreased Blood Pressure in Elderly People Who Have Hypertension.