Hipertensi Effect of Therapy Classic Music Mozart and Murotal Ar Rahman on Decreasing Systolic Blood Pressure in Women Hypertension

The prevalence of hypertension in Indonesia still high. Safe and effective nonpharmacological therapy needed, namely Mozart music and Ar Rahman murotal. The research design was a Quasi Experimental with a Pretest-Posttest Control Group Design approach. The sample consisted of 40. Data were analyzed using t test and unpaired t test. The results : there was a decrease systolic blood pressure before and after treatment and a significant difference in the mean reduction systolic blood pressure between the murotal group and mozart group. Conclusion : listening murotal Ar Rahman more effective to reducing systolic blood pressure hypertensive women than Mozart's music.

of someone who listens to it. Music with a gentle rhythm heard through the ear will immediately enter the brain and be processed immediately so as to produce a very good effect on one's health. Sound with a medium frequency of 750-3000 Hertz can provide blood pressure control in hypertensive patients. The sound of the rhythmic music that vibrates forms patterns and creates an energy field and recionation movements in the surrounding space. Energy will be absorbed by the human body and can subtly change breathing, heart rate, blood pressure, muscle tension, skin temparature and pain. Music is a unique stimulus that can affect the physical and psychological response of a person in hearing and is an effective intervention to improve physiological relaxation to reduce pulse, respiration, blood pressure and pain (Triyanto, 2015 in Siauta, Yusuf andSuprajitno, 2017). While one of the letters in the Qur'an that can be used as murotal therapy is Ar Rahmaan (Salim, 2012). Surat Ar Rahmaan has many verses that are read repeatedly so that they can distract and function as hypnosis which lowers the patient's brain waves. In this condition, the brain will produce serotonin and endorphins which make a person feel comfortable, calm and happy (Gunawan, 2009). In recent years, there has been a lot of research on Mozart's music. Mozart's music has also been recommended as relaxation music. Hughes, et al. Conducted a computer analysis of the characteristics of composition and found that Mozart's music has a periodicity above the average (Trappe and Voit, 2016). Research by Trappe and Voit (2016) also shows that Mozart and Strauss's music can reduce blood pressure. However, as far as the knowledge of the researcher, the results of research from several similar studies that have been carried out also vary among different populations. This is because the intervention mechanism is also diverse.
In addition, a previous study by Pratiwi L, Hasneli Y and Ernawaty J (2015) found that the Al-Qur'an benson and murottal relaxation techniques were effective in reducing blood pressure in patients with primary hypertension. Hernawan, Alamsyah D and Sari M (2017) studies also found that there were significant differences in systolic and diastolic blood pressure before and after being given treatment for low impact aerobic exercise and murottal quran therapy. The research conducted by Pratiwi L, Hasneli Y and Ernawaty J (2015), Benson relaxation given to respondents was not clearly stated how, how long and when it was given while in Hernawan, Alamsyah D and Sari M (2017) research respondents age in the elderly category so that lack of enthusiasm for exercising is added to the difficulty of low impact aerobic exercise to be followed by the elderly. Based on this, the researchers assumed the use of Ar Rahman Mozart and Murotal music therapy as appropriate for hypertensive patients in this study because Mozart and Murotal therapy are both easy audio therapy that does not require special training.
This study aims to identify the effects of Mozart's classical music therapy and murotal Ar Rahman against the decrease in systolic blood pressure of hypertension women. METHODOLOGY This research uses quasi experiment design with approach of two group pre and post test design. The variables observed were blood pressure performed before and after respondents were given treatment. This research was conducted in Sumampir Village of North Purwokerto Subdistrict on March 12 -May 13, 2018. The subjects were all hypertension women patients in Sumampir District of North Purwokerto in accordance with the inclusion criteria established by the researcher.
The equipment to conduct the intervention used in this study are Omron brand digital tensimeter, mp3 player and head phone. Respondents were divided into two groups. The group that was given Ar Rahman murotal therapy was 19 respondents while 21 people were given Mozart therapy. Each group was given therapy at different times Each group measured blood pressure before and after treatment. Blood pressure is measuring the patient's blood pressure using Omron brand digital tensimeter. Classical music used is Mozart and murotal Al Rahman. Mozart classical music therapy used is classical music created by Wolgang Amadeus Mozart who has a tempo of 114.79 beats per minute which is played through digital media players and earphones for 15 minutes. Murotal therapy is Ar Rahman with qory Muzammil Hasballah which has been validated at the Mathematics and Natural Sciences Faculty of Jenderal Soedirman University physics laboratory which has a tempo of 95.99 per minute which is played through digital media players and earphones for 15 minutes.
The hypothesis formula of this research is if the value of p <0,05 then hypothesis zero (Ho) rejected and hypothesis one (H1) received. This shows that there is a significant difference in mean blood pressure reduction before and after treatment in murotal group of Al Quran and mozart music group.
The sampling technique used is consequtive sampling. Roscoe in Sugiono (2012) suggested the number of samples for experimental research using the experimental group and the control group, respectively between 10 -20. Respondents were divided into two groups. The group that was given Ar Rahman murotal therapy was 19 respondents while 21 people were given Mozart therapy according to the inclusion and exclusion criteria.
The inclusion criteria in this study included: (a) systolic blood pressure >140 mmHg and / or diastolic blood pressure >90 mmHg; (b) ages ≥ 45 years. While the exclusion criteria include: (a) getting another compelementer therapy, (b) the patient refuses (c) there are complications of hypertension experienced.
Differences of blood pressure before and after treatment in mozart group and murotal group of Al Quran were analyzed using t test because data were normally distributed despite data transformation process (Sopiyudin, 2012 Table 2 shows that all respondents in both groups, both mozart and murotal, experienced a significant decrease in systolic blood pressure. This can be shown by the value of p < 0.05 in the t test in all groups. Thus, both listening to the Quranic murotal and listening to mozart music can reduce systolic blood pressure.  Table 3 shows that there is a significant difference in systolic blood pressure reduction (p value = 0,013).

Characteristics of Respondents
The results showed that both groups had a homogeneous mean age. The mean age of the two groups was in the age range of 68.3 years for the murotal group and 66.6 years for the mozart group. One risk factor for hypertension is age. The prevalence of hypertension increases dramatically after the age of 50 years, but also the incidence of hypertension in women exceeds that of men in their 60s (Sook Lim et al, 2016). This is consistent with the research of Liu et al (2017) which states that the prevalence of hypertension increases with age. Although age affects blood pressure in hypertensive patients, the age characteristics in both groups are homogeneous. So that the age factor does not result in bias results, because the age distribution in both groups is the same. This is in accordance with the statement of Widharto (2007) in Pratiwi L, Hasneli Y and Ernawaty J (2015) stating that the incidence of hypertension increases in women after menopause. Women are more at risk of developing hypertension due to a decrease in estrogen which can increase blood pressure (Sugiharto, 2007 in Pratiwi L, Hasneli Y andErnawaty J, 2015). This result is also consistent with the research of Awaludin, Upoyo, & Purnawan (2013), where the number of female respondents dominating hypertension was 81.2% of 16 respondents. After entering menopause, the prevalence of hypertension in women increases. After the age of 65 years, the occurrence of hypertension in women is increased compared to men caused by hormonal factors (Linda, 2017). In addition, the use of contraceptives, especially those containing estrogen can affect blood pressure. Estrogen affects the renin system of angiotensin aldosterone resulting in vasoconstriction and decreased flow to the kidneys, causing renin release. Renin stimulates the formation of angiotensin I which is then converted to angiotensin II which in turn stimulates aldosterone secretion by the adrenal cortex. This hormone causes sodium and water retention by the renal tubules, causing an increase in intravascular volume that affects blood pressure (Wiknjosastro, 2005in Haryuti, et al, 2017. This is reinforced also by research that states that the prevalence of hypertension in adults <45 years is lower in women than men, but hypertension is becoming more prevalent and higher in postmenopausal women than men after the age of 55 years (Bushnell, 2014). Other studies also mention blood pressure is generally higher in men than in women regardless of age. Systolic blood pressure overall increases progressively throughout adult life in men and women. During early adulthood means systolic blood pressure is higher for men than for women, but the rate of increase in blood pressure is higher for women than for men. As women age, the prevalence and severity of hypertension also increases, so that after 65 years the percentage of women having high blood pressure is greater than that of men (Pimenta, 2012).

Difference in Systolic Blood Pressure Decreases in Mozart and Murotal Groups
The results of the t test showed p value <0.05 in all groups. Thus, both listening to the Quranic murotal and listening to mozart music can reduce systolic blood pressure. The results of unpaired t test showed a significant difference in systolic blood pressure (p = 0,000).
Blood pressure is the pressure of the blood pumped by the heart against the artery wall. In humans, blood is pumped through two separate circulatory systems in the heart, namely the pulmonary circulation and systemic circulation. The right ventricle of the heart pumps less O2 blood into the lungs through the pulmonary circulation where CO2 is released and O2 enters the blood. Blood that contains O2 returns to the left side of the heart and is pumped out of the left Ikit Netra Wirakhmi, Iwan Purnawan, Tin Utami ventricle into the aorta through the systemic circulation where O2 is supplied throughout the body. Blood containing O2 will pass through the arteries to the body's tissues, while less blood O2 will pass through the veins from the body's tissues to the heart. Systolic blood pressure occurs when the ventricles contract and bleed into the arteries (Barbeau, 2004 in Amiruddin, Danes andLintong, 2015). The decrease in systolic blood pressure in respondents in both groups was triggered by the relaxation effect of listening to murotal or listening to music (Allanson and Fairclough, 2004). When murottal is played, the beautiful murottal harmonization will enter the ear in the form of sound (audio), vibrate the ear drum, shake the fluid in the inner ear and vibrate the hair cells in the cochlea for further through the cochlear nerve to the brain and create imagination of beauty in the brain right and left brain. This will have the effect of feeling and changing feelings. This change in feeling was caused by murattal being able to reach the left region of the cerebri cortex (Purna, 2006 in Hernawan, Alamsyah andSari, 2017).
There are two things that make listening to the Murotal Al Quran have better results than listening to Mozart music. Tempo murotal Al Quran in this study is lower than the tempo of Mozart music. Murotal Al Quran in the study is a recording of Surat Ar Rahman with qori Muzamil Hasbalah. This Murotal has a tempo of 95.99. While relaxation music in the form of Mozart has a tempo of 114.79. The faster the tempo, the faster the heart rate of a person which results in a decrease in relaxation conditions. Conversely, the lower the tempo, the heart rate will decrease to the normal limit which is accompanied by a more relaxed feeling (Bernardi, 2005).
Humans are both holistic and physical and psychological beings, who influence each other. If something happens in a physical condition it will also affect psychological conditions (Halminton, 1995in Anggraeni, 2011. This shows that when a person suffers from illness, it is necessary to get treatment not only in terms of psychology but also in terms of the psychological condition of the patient. Anwar (2010) in Pratiwi, Hasneli and Ernawaty (2015) stated that murottal Al-Qur'an will provide a calming effect in the body because of the elements of meditation, autosuggestion and relaxation contained therein. This sense of calm will then provide a positive emotional response that is very influential in bringing positive perception. According to Mustamir (2009) positive perceptions obtained from the Murottal Al-Qur'an's Ar Rahman letter will further stimulate the hypothalamus to release endorphins which are hormones that make a person feel happy. Parasympathetic nerves function to supply the heart and slow down the heart rate. Controlled autonomic nerve stimulation will cause the secretion of epinephrine and norepinephrine will inhibit the formation of angiotensin which can further reduce blood pressure.
The effectiveness of listening to the Murotal Al Quran better than listening to Mozart music is supported by other research (Zulkurnaini et al., 2012). This study shows that the alpha waves produced when listening to the Murotal Al Quran are more than when listening to classical music. People who start light meditation also produce alpha waves. Alpha frequency is also the conscious and subconscious frequency (Mustajib, 2010).