Malaysian Journal of Medicine and Health Sciences (eISSN 2636-9346)

ORIGINAL ARTICLE

Comparing Effects Between Music Intervention and

Aromatherapy on Blood Pressure Among Hypertensive
Patients: A Feasibility Study Conducted in Indonesia
Zaqqi UBAIDILLAH1, Henik Tri RAHAYU1*, Faqih RUHYANUDIN1, Edi PURWANTO1, Titik
AGUSTIYANINGSIH1, Chairul Huda Al HUSNA1, Anis Ika Nur ROHMAH1, Cahyaningsih EFENDI2
1
Lecturer, Nursing Department, Faculty of Health Science, University of Muhammadiyah Malang, Indonesia, Jl. Bendungan
Sutami No.188, Sumbersari, Kec. Lowokwaru, Kota Malang, Jawa Timur 65145
2
Nursing Student, Faculty of Health Science, University of Muhammadiyah Malang, Indonesia, Jl. Bendungan Sutami No.188,
Sumbersari, Kec. Lowokwaru, Kota Malang, Jawa Timur 65145

ABSTRACT

Introduction: The primary purpose of this study was to investigate the effects of music therapy versus
aromatherapy on blood pressure among hypertensive patients in Indonesia. Methods: A quasi-experimental
with pretest-posttest control group design was used. A music therapy was delivered classical music Beethoven
symphony number 5 (the duration was 5 minutes) by using earphones and another group received dropped
lavender essential oil on cotton as many as three drops, then inhaled for 10 minutes and inhaled every 2-3 breaths.
The inclusion criteria were aged over 18 years old, stage I hypertension, and stage II. Results: A total of 44
subjects have participated in the study (22 in both music and aromatherapy). Subjects ranged from 31-60 years
old (mean= 54, SD=5.9), and most subjects were female (72.7 %). In the aromatherapy group, the average
delta systolic was significantly higher than in the music therapy group (p<.05). Despite not significant, the
delta diastolic of the music therapy group tended to higher compare to the aromatherapy group.
Conclusion: Patients with high blood pressure may benefit from both music and aromatherapy. Nurses
can employ music to create a healing environment and possibly lower blood pressure in hypertension patients
utilizing low-cost, non-invasive, and simple procedures.

Keywords: Aromatherapy, Blood pressure, Hypertension, Intervention, Music therapy

Corresponding Author: is rising in Indonesia, from 25.8 percent in 2013 to 34.1

Henik Tri Rahayu, PhD percent in 2018 (3). Interestingly, in Indonesia, some
Email: [email protected] people with hypertension are under the age of 30. The
Tel: +62 341 551 149 enforcement rates, however, is fairly low, about 32.3
percent do not take medications consistently, and only
INTRODUCTION 13.3 percent do not use antihypertension medication
at all. Many various challenges faced by hypertensive
Hypertension is a public health concern due to its high clients in Indonesia, including 59.8 percent feeling
prevalence and mortality. Approximately 7.5 million safe, 14.5 percent taking conventional medications, 8.1
people worldwide die each year from hypertension percent being effortless to regularly purchase drugs, and
complications (1). The number of people with 2 percent of drugs not available in health facilities (3).
hypertension is continuing to increase every year,
around 1.13 billion people in 2019; and by 2025 it Hypertension may cause various complications which
is predicted that 1.56 billion people worldwide will may increase morbidity and mortality risk (4). A
continually increase (1). Indonesia ranked 87th for the higher-than-average risk of cardiovascular disease and
world’s number of hypertension, which has caused death from any cause was found to be closely linked
25,868 or 1.54 percent of total deaths (2). The age- to high blood pressure (5,6). Besides, these conditions
adjusted death rate for the Indonesian population is usually include long-term treatment, medication use,
14.41 per 100,000 (2). Also, hypertension prevalence and health care costs, which can greatly raise family

Mal J Med Health Sci 18(SUPP17): 54-60, Dec 2022 54

Malaysian Journal of Medicine and Health Sciences (eISSN 2636-9346)

and society’s financial constraints (7). Consequently, systolic blood pressure before administration lavender
the main goal of hypertension care is to manage aromatherapy 154.44 mmHg and diastolic blood
controlled blood pressure of the patient to minimize pressure of 95 mmHg and after being given the lavender
the risk of cardiovascular disease and all-cause aromatherapy decreased (138.89 mm Hg systolic and
mortality (8). 85 mmHg diastolic) (21,22). However, most music
intervention studies (11–13,23,24) examined the effect
The definition of music therapy is “functions as a on psychological aspect and few studies investigate
distractor, diverting attention away from a negative the effect of music intervention and aromatherapy
catalyst and focusing awareness on soothing stimuli” on blood pressure in hypertensive patients. To help
(9). Music therapy and aromatherapy are used as part of clinicians make clinical decisions, this topic should be
a therapeutic approach to reducing preoperative anxiety examined further. Music intervention and aromatherapy
(10). Besides, the impact of music therapy on ICU both have low costs and minor side effects, making
patients’ reduced anxiety has been confirmed in various them excellent options for those on a budget (23).
clinical trials (11–13). Researches have shown that The primary purpose of this study was to investigate
music, alongside changes in heart rate, blood pressure, the effects of music therapy versus aromatherapy
and breathing, can effectively elicit and modulate on blood pressure among hypertensive patients in
feelings and emotions (14). Consequently, the research Indonesia.
results emerge from the literature: in response to exciting
music, the heart and respiratory levels are higher than MATERIALS AND METHODS
in the case of tranquilizing music. Furthermore, music
causes changes in behavior in brain structures assumed Research Design
to modulate heart function (14). Limbic system activation A quasi-experimental with pretest-posttest control
causes a person to relax when listening to music, so a group design was used to compare the effect of
relaxed state can lower blood pressure. The strains also aromatherapy and music therapy in lowering the
induce the body to create nitric oxide (NO) molecule blood pressures among individuals with hypertension.
(15). This molecule acts on a blood pressure-reducing This study has obtained an ethical review from the
vascular tone (15). Classical music is a music that has a Health Research Ethics Committee of an affiliated
calming impact at a tempo of about 60 beats/min (15). university (reference No. E.5.a/029/KEPK-UMM/
This musical stimulus stimulates different pathways III/2019). The data collection was conducted from
in various areas of the brain, such as the emotionally October to December 2019.
linked limbic system (15). Music has increased systolic
blood pressure relative to the control group, but there Intervention
has been no substantial change in diastolic blood In the classical music group, subjects were provided
pressure compared to the control group for Music group a classical music Beethoven symphony no.5 (the
participants (16). duration was 5 minutes) by using earphones. They
asked to listen to music for 15 minutes. While in the
Aromatherapy is a procedure used for psychological and lavender aromatherapy group, subjects were prepared
physical wellbeing, using essential oil (17,18). Aroma in a relaxed position and then dropped lavender
or scent and the good smell can induce the thalamus essential oil on cotton as many as three drops, then
to secrete enkephalin which is a hormone that can inhaled for 10 minutes and inhaled every 2-3 breaths.
spontaneously alleviate pain and relax or feel relaxed. In the current study, the music used for therapy was
Aromatherapy oils obtained from lavender flowers are classical music from Beethoven symphony no. 5, which
extracted. Lavender oil is a powerful oil that is ideally has a duration of 5 minutes. In the classical music
suited to treat sunburn, peeling, psoriasis, and also group, the researchers asked whether respondents
helps with insomnia (17,18). Lightly scented lavender liked classical music used these therapies, as well as
flowers and essential oils with aromatherapy are known researchers, scrutinize and examine whether hearing
to provide suicidal sedatives and anti-neuro depressive. the respondent has been reduced, if the respondent
Aromatherapy lavender also has a main linalool acetate does not like classical music and has a hearing
material, which can loosen and relax the nervous and loss, the patient will be in exclusion but a study
muscular functioning of the muscle (17,18). Inhaling conducted by researchers, respondents the classical
lavender raises the alpha wave frequency and the music group had a pretty good hearing and loved
conditions are correlated with exercise (relaxation) classical music.
by the stimulation of parasympathetic nerves which
then decreases blood pressure and pulse rate (17,18). The lavender aromatherapy used a pure lavender
Aromatherapy can also give the body, spirit, and mind essential oil Natural Gift that easily found in the local
a sense of peace and relaxation (19). Another advantage market. Both interventions were conducted in the
of the anti-inflammatory aromatherapy lavender, patients’ houses. In the classical music group, subjects
which reduces swelling, and can neutralize toxins (20). were provided with classical music by using earphones.
The previous study conducted by (21,22) found that They asked to listen to music for 15 minutes. While

55 Mal J Med Health Sci 18(SUPP17): 54-60, Dec 2022

 Malaysian Journal of Medicine and Health Sciences (eISSN 2636-9346)

in the lavender aromatherapy group, subjects were RESULTS

prepared in a relaxed position and provided with three
drops of lavender essential oil that applicated on cotton, Demographics characteristics
then asked to inhale for 10 minutes and inhaled every About 44 subjects have participated in the study (22
2-3 breaths. subject in each group y). Subjects ranged from 31-60
years old (mean= 54, SD=5.9), and most subjects were
To control the effect of therapy, the researchers female (72.7 %) (Table 1). Less than half (47.7%, n=21)
asked subjects about the previous medication uses, had an elementary school, and unemployed (68.2%).
including how many hours of the last consume the About 38.6% have used a diuretic as medication.
antihypertensive drugs. Evidence suggests that the effect Despite all subjects reporting hypertension, 20.5%
of antihypertensive drugs occurs within 1 to 2 hours, (n=9) continued to smoke. There were no significant
thus if the subjects were just taking the medication, then differences among demographic characteristics between
we wait for at least 2 hours for the intervention. Both the two groups.
in the music therapy and lavender aromatherapy, the
blood pressure measurements were taking pre-and post- The effects of music therapy and aromatherapy on
intervention for seven days, once a day. blood pressure
The data were collected from seven days of observation.
Sample The delta calculated from the differences in blood
The sample was patients diagnosed with hypertension in pressures in pre- and post-intervention were used in
three public health centers in East Java, Indonesia. The the analysis to evaluated and compares the effects of
inclusion criteria were aged over 18 years old, stage I interventions on blood pressures. In the aromatherapy
and II hypertension,. The determination of stage I and group, the average delta systolic was significantly
stage II hypertension based on the definition that stage higher than in the music therapy group (p<.05).
I hypertension is a systolic pressure of 140-159 mmHg However, despite not significant, the delta diastolic of
and a diastolic pressure of 90-99 mmHg and stage II is the music therapy group tended to higher compare to
a systolic pressure of 160-179 mmHg and a diastolic the aromatherapy group (Table 1). Figure 1 showed the
pressure of 100-109 mmHg. mean profiles of both interventions.

The sample size calculation using G-Power analysis DISCUSSION

software by assigning alpha 0.05, power 0.80, and
medium effect size (0.25) The samples were obtained Our Study found that systolic blood pressure was
in this research is 44 respondents who experienced significantly higher than in the music therapy group
hypertension; 2 respondents in the classical music than in the aromatherapy group. Empirically, listening
therapy group and 22 respondents in the group of to classical music will produce a sensation that was sent
lavender aromatherapy group. A convenience sampling to the axon fibers to the nerves of the reticular activating
was used to select a participant due to resource system (RAS), the signal will then be transferred by the
constraints. nucleus information of the thalamus transfer region of the
adrenal cortex, the limbic system and the corpus callus
Measures and the autonomous nervous system and endocrine
Data of age, gender, education level, working status, system neurons will transfer through the region (14).
medication, smoking status, and current blood pressure Though the mechanisms underlying by which music
were obtained. therapy works in the human body are unknown, music
The blood pressure was measured using a Riester manual therapy has been shown to reduce sympathetic nervous
sphygmomanometer. Any intervention on the classical system and increase endorphin release (25). Interestingly,
music group or a group of lavender aromatherapies, it is well recognized that hypertension physiopathology
then after the measurement of blood pressure back on entails the overstimulation of the sympathetic nervous
those days. system. Recent research found beneficial effects of
music therapy in people with prehypertension and
Data Analysis hypertension on heart rate variability (26), which
After obtaining descriptive statistics, bivariate analyses supports the impact of music therapy on the nervous
were conducted with an α level at 0.05. The General system. This intervention could be an alternative
Linear Model (GLM) Repeated Measure was used to to reduce blood pressure to hypertensive patients.
test the effect of interventions. Statistical analyses were However, future studies using more rigour method is
conducted using the Statistical Package for Social needed with large sample size and follow-up.
Sciences (SPSS) version 23.

Mal J Med Health Sci 18(SUPP17): 54-60, Dec 2022 56

Malaysian Journal of Medicine and Health Sciences (eISSN 2636-9346)

Figure 1 : Mean profiles of delta blood pressures in Figure 2 : Mean profiles of delta blood pressures in
the aromatherapy group. the music therapy group.

Table 1 : Demographic Characteristics (n=44)

Variables Aromatherapy Music therapy Total (n=44) p-value
Group Group
(n=22, 50 %) (n=22, 50%)
Age
Range 31 – 60 49 - 60 31 – 60 0.172
Mean (SD) 52.5 (7.3) 55.5(3.4) 54 (5.9)

Gender
Male 6 (27.3) 6 (27.3) 12 (27.3) 0.087
Female 16 (72.7) 16 (72.7) 32 (72.7)

Education level
0.573
Elementary school 11 (50.0) 10 (45.5) 21 (47.7)
Junior high school 4 (18.2) 7 (31.8) 11 (25.0)
Senior high school 6 (27.3) 3 (13.6) 9 (20.5)
University 1(4.5) 2 (9.1) 3 (6.8)

Occupation
Employment 14 (63.6) 16 (72.7) 14 (31.8) 0.057
Unemployment 8 (36.4) 6 (27.3) 30 (68.2)

Medication
0.714
ACEI 5 (22.7) 6 (27.3) 11 (25.0)
Diuretik 8 (36.4) 9 (40.9) 17 (38.6)
Ca Blocker 6 (27.3 6 (27.3) 12 (27.3)
ARB 3 (13.6) 1 (4.5) 4 (9.1)

Smoking
Yes 5 (22.7) 4 (18.2) 9 (20.5)
0.421
No 17 (77.3) 18 (81.8) 35 (79.5)

systolic
Mean ±SD 9.2 ± 4.9 8.1 ± 4.6 8.7 ± 4.7 0.043

diastolic
Mean ±SD 6.0 ± 3.6 6.2 ± 4.2 6.2 ± 3.9 0.357

57 Mal J Med Health Sci 18(SUPP17): 54-60, Dec 2022

 Malaysian Journal of Medicine and Health Sciences (eISSN 2636-9346)

Table II : Correlation between age, gender, medication, smoking status, and blood pressures changes

blood pressures

systolic diastolic

Analysis p-value Analysis p- value

Age r = 0.004 0.673 r = -0.030 0.223

Gender
Male t = -0.218 0.453 t = 0.748 0.056
Female

Medication
ACEI
Diuretic F= 0.688 0.459 F= 4.879 0.003
Ca blocker
ARBs

Smoking t = -2.371* 0.020 t = 2.77 0.320

Table III : Linear mixed models of blood pressures changes

estimate SE t value p-value

Fixed effect to systolic

Intercept 8.12 .46 17.746 .000

Aromatherapy 1.1 .64 1.707 .095

Aromatherapy 0b 0 0 0

Fixed effect to diastolic

Intercept 6.28 .37 16.941 .000

Aromatherapy -.189 .53 -.362 .718

Aromatherapy 0b 0 0 0
Note: based on a linear mixed model using covariance structure ARH1

According to the findings of this study, aromatherapy the Labiatae family, is widely used. Lavender oil
may be useful in lowering blood pressure. The use of contains linalyl (51% ) and linalyl acetate (35 %) (30).
lavender aromatherapy in an intermediate care unit Implementing some amounts of essential Lavender
has been shown to improve patients’ health status oil to the handkerchief and inhaling it helps treat
and quality of sleep in a previous study (27). insomnia, tiredness, tension, and anxiety. In particular,
Compared to the control group, treatment participants’ strategies have been vigorously explored in nursing
blood pressure was considerably lower. Researchers to scientifically demonstrate the benefits of
discovered that inhaling essential oils can reduce aromatherapy as a therapeutic technique, and as a
blood pressure, stress, and cortisol levels in patients relaxation mediator (31).
with essential hypertension (28). However, another
study on the effects of aromatherapy did not have The research has certain limitations to it. First, this
any significant on hypertension (29). Lavender, from research wasn’t rigorous because we didn’t use

Mal J Med Health Sci 18(SUPP17): 54-60, Dec 2022 58

Malaysian Journal of Medicine and Health Sciences (eISSN 2636-9346)

randomized trials randomized. Second, there was Apparent Treatment Resistance, and Outcomes
little in the way of music or aromatherapy selections in the Elderly Population With Chronic Kidney
to choose from only one form of music for the music Disease. Kidney Int Reports. 2017 Mar;2(2):180–
and aromatherapy types). Music stimulation and 91.
aromatherapy may be less effective because patients 8. Bundy JD, Li C, Stuchlik P, Bu X, Kelly TN, Mills
may not have chosen their favorite music or oil. The KT, et al. Systolic Blood Pressure Reduction and
generalizability of our findings may be limited because Risk of Cardiovascular Disease and Mortality: A
all participants were recruited from the same institution, Systematic Review and Network Meta-analysis.
and similar demographic characteristics may have been JAMA Cardiol. 2017 Jul;2(7):775–81.
shared. 9. Gooding L, Swezey S, Zwischenberger JB. Using
music interventions in perioperative care. South
CONCLUSION Med J. 2012 Sep;105(9):486–90.
10. Setzer WN. Essential oils and anxiolytic
Among hypertensive patients, both a music intervention aromatherapy. Nat Prod Commun. 2009
and aromatherapy can reduce blood pressure. Sep;4(9):1305–16.
Both treatments can be used as an alternative to 11. Chan MF, Chung YFL, Chung SWA, Lee OKA.
non pharmaceuticals by healthcare professionals. Investigating the physiological responses of
Clinical nurses will be able to use music as a tool to patients listening to music in the intensive care
promote a curative atmosphere and possibly reduce unit. J Clin Nurs. 2009 May;18(9):1250–7.
blood pressure among hypertensive patients using 12. Han L, Li JP, Sit JWH, Chung L, Jiao ZY, Ma WG.
low-cost, non-invasive, and easy-to-administer Effects of music intervention on physiological
treatments. Although aromatherapy does have stress response and anxiety level of mechanically
promising results, appropriate education is essential. ventilated patients in China: a randomised
Hence, we recommend that clinical nurses can controlled trial. J Clin Nurs. 2010 Apr;19(7–
understand and develop the procedure if appropriate. 8):978–87.
A future study using a robust method is needed to 13. Korhan EA, Khorshid L, Uyar M. The effect of
confirm these findings. music therapy on physiological signs of anxiety
in patients receiving mechanical ventilatory
ACKNOWLEDGEMENT support. J Clin Nurs. 2011 Apr;20(7–8):1026–34.
14. Montinari MR, Giardina S, Minelli P, Minelli S.
All author would like to thanks to all participant in this History of Music Therapy and Its Contemporary
study. All author declare no funding for this study, and Applications in Cardiovascular Diseases. South
no conflict of interest. Med J. 2018 Feb;111(2):98–102.
15. Hidayah N’., Damanik SRH, Elita V’. Comparison
REFERENCES of the Effectiveness of Classical Music Therapy
with Aromatherapy of Roses on Blood Pressure
1. WHO. World Hypertension Day 2019. 2019. in Patients with Hypertension. J Online Mhs
2. WHO. Global Health Observatory (GHO) data. Progr Stud Ilmu Keperawatan Univ Riau.
2017. 2016;2(2):1317–26.
3. Riskesdas. https://www.kemkes.go.id/resources/ 16. do Amaral MAS, Neto MG, de Queiroz JG,
download/info-terkini/hasil-riskesdas-2018.pdf. Martins-Filho PRS, Saquetto MB, Oliveira
2018; Carvalho V. Effect of music therapy on blood
4. Forouzanfar MH, Liu P, Roth GA, Ng M, pressure of individuals with hypertension: A
Biryukov S, Marczak L, et al. Global Burden of systematic review and Meta-analysis. Int J Cardiol.
Hypertension and Systolic Blood Pressure of at 2016 Jul;214:461–4.
Least 110 to 115 mm Hg, 1990-2015. JAMA. 17. Ali B, Al-Wabel PDN, Shams S, Ahmad A, Khan
2017 Jan;317(2):165–82. S, Anwar F. Essential oils used in aromatherapy, A
5. Zhou D, Xi B, Zhao M, Wang L, Veeranki SP. systemic review. Asian Pac J Trop Biomed. 2015
Uncontrolled hypertension increases risk of all- Jul;5:589–98.
cause and cardiovascular disease mortality in US 18. Koulivand PH, Khaleghi Ghadiri M, Gorji A.
adults: The NHANES III Linked Mortality Study. Lavender and the nervous system. Evid Based
Sci Rep. 2018;8(1):9418. Complement Alternat Med. 2013;2013:681304.
6. Pierdomenico SD, Pierdomenico AM, Coccina F, 19. Astuti R, Nugrahwati F. Intervention using rose
Clement DL, De Buyzere ML, De Bacquer DA, aromatherapy to lowering blood pressure of
et al. Prognostic value of masked uncontrolled elderly with hypertension. Int J Sci Technol Res.
hypertension systematic review and meta- 2018 Apr;7:246–50.
analysis. Hypertension. 2018 Oct;72(4):862–9. 20. Silva GL da, Luft C, Lunardelli A, Amaral RH,
7. Kaboré J, Metzger M, Helmer C, Berr C, Tzourio Melo DA da S, Donadio MVF, et al. Antioxidant,
C, Drueke TB, et al. Hypertension Control, analgesic and anti-inflammatory effects of

59 Mal J Med Health Sci 18(SUPP17): 54-60, Dec 2022

 Malaysian Journal of Medicine and Health Sciences (eISSN 2636-9346)

lavender essential oil. An Acad Bras Cienc. 2015 editors. Bandung: Mizan Pustaka; 2010. 378 p.
Aug;87(2 Suppl):1397–408. 26. Battaglia S. The Complete Guide to
21. Gultom A, Ginting S, Silalahi E. The Influence of Aromatherapy. International Centre of Holistic
Lavender Aroma Therapy on Decreasing Blood Aromatherapy; 2003.
Pressure in Hypertension Patients. Int J Public 27. Lytle J, Mwatha C, Davis KK. Effect of lavender
Heal Sci. 2016 Dec;5:470. aromatherapy on vital signs and perceived quality
22. Kim I-H, Kim C, Seong K, Hur M-H, Lim HM, Lee of sleep in the intermediate care unit: a pilot
MS. Essential Oil Inhalation on Blood Pressure study. Am J Crit care an Off Publ Am Assoc Crit
and Salivary Cortisol Levels in Prehypertensive Nurses. 2014 Jan;23(1):24–9.
and Hypertensive Subjects. Mischoulon D, 28. Hwang J-H. [The effects of the inhalation
editor. Evidence-Based Complement Altern Med. method using essential oils on blood pressure
2012;2012:984203. and stress responses of clients with essential
23. Lee C-H, Lee C-Y, Hsu M-Y, Lai C-L, Sung Y-H, hypertension]. Taehan Kanho Hakhoe Chi. 2006
Lin C-Y, et al. Effects of Music Intervention Dec;36(7):1123–34.
on State Anxiety and Physiological Indices in 29. Cho M-Y, Min ES, Hur M-H, Lee MS. Effects
Patients Undergoing Mechanical Ventilation of aromatherapy on the anxiety, vital signs,
in the Intensive Care Unit. Biol Res Nurs. 2017 and sleep quality of percutaneous coronary
Mar;19(2):137–44. intervention patients in intensive care units. Evid
24. Lee OKA, Chung YFL, Chan MF, Chan WM. Based Complement Alternat Med. 2013/02/17.
Music and its effect on the physiological 2013;2013:381381.
responses and anxiety levels of patients receiving 30. Prashar A, Locke IC, Evans CS. Cytotoxicity of
mechanical ventilation: a pilot study. J Clin Nurs. lavender oil and its major components to human
2005 May;14(5):609–20. skin cells. Cell Prolif. 2004 Jun;37(3):221–9.
25. Kowalski RE. Terapi hipertensi: Program 31. Lee E. The Effects of Aroma Hand Massage on
delapan minggu mengurangi tekanan darah dan Anxiety and Sleep in Cancer Patients during
mengurangi risiko serangan jantung dan stroke Hospitalization. 2011;42–3.
secara alami. Rahmani Astuti, Rani S. Ekawati,

Mal J Med Health Sci 18(SUPP17): 54-60, Dec 2022 60