The Effect of Java Langgam Music Therapy As Adjuvant Therapy Towards Changes Blood Pressure in Hypertension Patients

The prevalence of hypertension in Sleman Regency in 2015 was 33.2%, where hypertension was ranked second from the top ten outpatient diseases in the Puskesmas in Sleman Regency. Hypertension requires regular and continuous treatment to prevent further complications. Therefore, it is necessary to have complementary therapies as adjuvants such as Javanese music therapy as a therapeutic choice. Langgam Javanese music is classical music that has been well known by the people in Yogyakarta. The purpose of this study was to determine the effect of Javanese style music therapy on changes in blood pressure in hypertension patients in the control group and intervention group. This study was a quasi-experimental study that compared changes in blood pressure in the intervention group and the control group. The sample used was hypertensive patients who routinely treated in Depok II Health Center, as many as 60 people, 30 people in the intervention group and 30 people in the control group. The results showed that there difference in systolic and dyastolic blood pressure significantly in the intervention group compared to the control group with a value of P = 0,000 (<0.05). Langgam Jawa music therapy can be chosen as an adjuvant therapy for hypertensive patients in DI Yogyakarta.


INTRODUCTION
The prevalence of hypertension is predicted to continue to increase in both developed and developing countries. Based on data from basic health research in 2013, the prevalence of hypertension in Indonesia was 26.5% and the Special Region of Yogyakarta (DIY) ranked third in the prevalence of hypertension based on the diagnosis of health workers (14). The prevalence of hypertension in Sleman Regency, which is one of the regencies in the DIY Province in 2015 was 33.2%, where hypertension was ranked second from the top ten of outpatient diseases in the Community Health Center (Puskesmas) in Sleman Regency.
T h e i n c r e a s e i n t h e i n c i d e n c e o f hypertension has a high risk in an increase in the number of complications such as cardiovascular disease, strokes and even lead to death. The increase in the incidence of hypertension is more prevalent at the age above 50, this is based on research conducted by Manandhar, Roju, Sinha & Humagain (2012) which showed that the incidence of hypertension at the age above 50 is as much as 44.9%. Therefore, it is necessary to control blood pressure both pharmacologically and non-pharmacologically (11). According to the National Comitte Joint Guideline 8, pharmacological management and implementation for hypertensive patients is to provide ACE inhibitor classes, angiotensin receptor blockers, β blockers, calcium channel blockers, thiazide type diuretics (4). However, special attention needs to be paid to the provision of pharmacological therapy in the elderly based on the prevalence of hypertension which is most prevalent in the elderly group (12). The administration of pharmacological therapy in the elderly has side effects on kidney function so that the administration of antihypertensive drugs with low doses is recommended. Therefore, there is a need for complementary therapy as an adjuvant of phamacological therapy to help control blood pressure so as to increase the effectiveness of primary therapy, reduce the risk of hypertensive complications and reduce discomfort due to side effects of antihypertensive drugs. (12).
Based on a systematic review, it was found that one of the interventions of several adjuvant therapies recommended for hypertensive patients and has proven useful in some of the results of the research is the provision of music therapy (9). Music therapy is an intervention that is often used because music therapy is an easy therapy to do. In addition, there is no need for special preparation and can be practiced at any time and easily accepted by the general public (15). Music therapy is recommended as an independent nursing intervention because music therapy is simple and easy to apply by nurses in providing independent nursing care (13).
Music therapy has a positive effect because its working mechanism influences the nervous system and stress hormones such as cortisol. blood pressure, as well as a decrease in heart rate and respiratory rate.
Classical music has proven to be beneficial for health, but this classical music still sounds foreign to the people of Indonesia. This is evident from the results of research conducted by Soeraya and Sarifah (2015) which showed that there was no difference in the effectiveness of classical music in reducing blood pressure.
Traditional and murottal music has been shown to be effective in helping to lower blood pressure. In bivariate analysis, measurements were taken to determine the difference in blood pressure from each group, namely between Langgam Jawa music group and the control group. If the results of normality data calculations were known to be normal data distribution, parametric test was conducted. Data analysis using paired t-test with a significance level of 5% was conducted to compare the differences in blood pressure before and after treatment.

Table1. Distribution of systolic blood pressure before music therapy in the intervention group
Blood pressure F(n) % Systolic 140-159 mmHg  18  60  >160 mmHg  12  40  Total  30  100 Primary data source Table 1 presents that more than half of the respondents in the intervention group had systolic blood pressure in the range of 140-159 mmHg before the administration of music therapy.    Primary data source Table 4 shows that most of the control group's respondents had systolic blood pressure in the range of 140-159 mmHg before resting.     Table 7 demonstrates that more than half of the respondents in the intervention group had systolic blood pressure in the range of 140-159 mmHg after the administration of music therapy.            (3). Blood pressure that tended to be high in hypertensive patients even though they regularly consume anti-hypertensive drugs was also influenced by the duration of hypertension. The longer the time the patients were suffering from hypertension, the coping mechanism was increasingly adaptive and the stress level also decreased. Therefore, in long-term hypertensive patients, blood pressure tended to be stable while consuming anti-hypertensive drugs (1).

Langgam Jawa Music Therapy
The results showed that, blood pressure in the intervention group after given Javanese  (2013) showed that there was no decrease in blood cortisol. In fact, there was an increase in blood cortisol in groups that were not given classical music and were only given a time for rest. There are many factors that affect whether or not the blood pressure or blood cortisol experienced an increase due to differences in psychological conditions, adaptation period for sleeping/ resting in a strange place, and the possibility of respondents having different perceptions because they have to wait a long time so that they affect the feeling of comfort.
However, different findings were found in the case group. The results showed that there were differences in the mean systolic and diastolic blood pressure between before and after the administration of music therapy in the case group. Langgam Jawa music therapy used in the study was the type of keroncong. Keroncong was very familiar and popular in Java, especially in Yogyakarta, so that type of music is perceived easily by respondents and results comfort.
The comfort felt by the respondents triggers an increase in endorphins and encephalins resulting in a decrease in catecholamines which affects a decrease in blood pressure. The perceived comfort of the respondent results relaxation so that the heart rate, breathing of the body becomes maximal. This process has an effect on the relaxation of blood vessels so that blood pressure decreases to normal or stable limits (7). Listening to Langgam Jawa music produced relaxation so that it could activate soluble Guanylyl Cyclase (sGC) so as to increase the level of nitric oxcide (NO). Relaxation was also able to predict respondents' hemodynamics, relaxation conditions also restore the body's heart rate and breathing back to normal, so that oxygen in the body was fulfilled (14). Langgam Jawa music therapy was used as adjuvant therapy in the research plan in Depok II Community Health Center because it was in accordance with the culture and habits of the respondents, most of which were familiar with Javanese culture, which was expected to increase the effectiveness of standard therapy so that blood pressure can be controlled.

CONCLUSION AND RECOMMENDATION
There is the effect of Langgam Jawa music therapy on changes in blood pressure in elderly people who are suffering from hypertension (p 0.000). Langgam Jawa music therapy can be one of the options for adjuvant therapy to control blood pressure which can be done in the service unit closest to the community, namely the