RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

NAME OF THE CANDIDATE SONIA N R

1st YEAR MSC NURSING STUDENT
1.
ADDRESS ST. JOHN’S COLLEGE OF NURSING
SARJAPURA ROAD,
BANGALORE – 34

2. NAME OF THE INSTITUTION ST. JOHN’S COLLEGE OF NURSING,

BANGALORE

3. COURSE OF STUDY MASTER OF SCIENCE ( NURSING)

SUBJECT COMMUNITY HEALTH NURSING

4. DATE OF ADMISSION TO 02-05-2012

COURSE
EFFECT OF CUCUMBER ON BLOOD
PRESSURE AMONG THE PRE-
5. TITLE OF THE TOPIC HYPERTENSIVE ADULTS IN A
SELECTED RURAL AREA,
BANGALORE.

6. BRIEF RESUME OF INTENDED WORK

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6.1 NEED FOR THE STUDY:

Hypertension is the commonest cardiovascular disorder affecting about 20% adult

population worldwide. Prevalence in the developing countries seems to be similar to that in

European or other developed societies ranging from 10 per cent among adults. The prevalence of

hypertension in India is reported ranging from 59.9 and 69.9 per 1000 males and females in

urban population and 35.5 and 35.9 per 1000 males and females in the rural population.1

Approximately 28% of Americans, or 59 million people, have pre-hypertension, which is

defined as a Systolic blood pressure of 120 to 139 or Diastolic blood pressure of 80 to 89. These

individuals are at high risk of developing hypertension. The prevalence of hypertension increases

with age. People who don’t have hypertension at age of 55yrs have a 90% chance of developing

hypertension in life. A Systolic BP of above 140mmHg is more important cardiovascular risk

factor for developing hypertension.2

During 2009-2010 a study done on prevalence of diagnosed and undiagnosed

hypertension in India (eight states) out of 15,662 patients, 7,212 patients had hypertension and

22.2% were newly diagnosed to be hypertensive.3

A study was conducted by the department of endocrinology and pathology, Sanjay

Gandhi Institute of Medical Sciences, Lucknow in India revealed a high prevalence of pre-

hypertension and hypertension was noted in urban north India. Among 1112 adults belonging to

above 30yrs age, the prevalence of pre-hypertension was 32.3 percent. It was significantly higher

in males (36%) compared to females (28.1%; p< 0.0001) and the prevalence of hypertension was

32.2%. Pre-hypertension was associated with an increased prevalence of cardiovascular risk

factors.4

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 Potassium is a mineral that provides support to the blood pressure system as the body

requires it for regulating fluid and electrolyte levels that regulate the amount of fluid in the

bloodstream. This function directly impacts the bloodpressure in the body. The Institute Of

Medicine recommends that all adults should consume at least 4,700mg of potassium per day.5

The National Heart Lung and Blood Institute created the Dietary Approaches to Stop

Hypertension, known as the DASH diet, as a dietary guide to help patients with high blood

pressure.5

The research group called DASH, conducted scientific studies to ascertain the value of

cucumber in the control of high blood pressure. Among pre-hypertensive individuals, the DASH

diet reduced Systolic BP by 3.5 and Diastolic BP by 2.1mmHg and in hypertensive individuals,

corresponding BP reductions were 11.4 and 5.5mmHg.6

Lifestyle modification has important role in hypertensive as well as non-hypertensive

individuals. An apparently small reduction in BP, if applied to an entire population, could have

an enormous beneficial effect on cardiovascular events. The reduction in Systolic BP of 3mmHg

should lead to an 8% reduction in stroke mortality and 5% reduction in mortality from coronary

heart disease.7

As a community health nurse, the researcher finds that cucumber which is easily

available in the market can be consumed as one of the primary preventive measure for pre-

hypertension in the community settings.

6.2 REVIEW OF LITERATURE

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Review of literature throws light on existing knowledge about the topic under study.

In this study the review of literature is focused under three aspects:

 SECTION 1: Studies on prevalence of pre-hypertension and hypertension.

 SECTION 2: Studies on cucumber.

 SECTION 3: Studies on the effect of cucumber on blood pressure.

SECTION 1: STUDIES ON PREVALENCE OF PRE-HYPERTENSION AND

HYPERTENSION:

A community based survey was conducted to estimate prevalence, awareness,

treatment, control and risk factors for hypertension in a rural population of south India. Cross-

sectional survey was done in 11 villages of Tamilnadu, by The National Institute of

Epidemiology (Indian Council of Medical Research, Chennai) of total 10,463 patients.

Hypertension was coexistent in 2,247 patients. 1,682 patients were newly diagnosed with

hypertension. The study demonstrated the substantial burden of hypertension is on the rise in

India.8

A community based cross-sectional study was conducted in rural areas of central India.

The prevalence rate for hypertension was 19.04%. It was found to be higher in females (23.4%)

than males (14.4%).9

In an urban community based survey in West Bengal, 1662 participants of age 18 yrs and

above were screened. Participants (58.7%) were categorized in pre-hypertensive group according

to the JNC-VII criteria, who were young and needs special attention to avoid early progression to

hypertension and possibly coronary artery disease.10

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SECTION 2: STUDIES ON CUCUMBER:

A study on health benefits of cucumber conducted by Burhani Natural science

(2012).Cucumbers scientifically known as cucumissativus, are grown to be eaten fresh. 100

grams of cucumber contains 5.51mg Vitamin C, 5.20mcg Molybdenum, 223.60IU Vitamin A,

149.76mg potassium, 0.08mg manganese, 13.52mcgfolate, 0.83gm dietary fiber, 0.01g

tryptophan and 11.44mg magnesium.11

Cucumbers are a rich source of Vitamin C which is great in aiding a healthy immune

system. It also is a great source of dietary fiber, which is good for keeping digestive tract

functioning normally. It’s one of the easiest ways to increase fiber and water intake. It has natural

way to prevent water retention. Cucumbers have also been proven through research for DASH

(Dietary Approaches to stop Hypertension) to help in lowering blood pressure. Studies show that

adding foods high in potassium, magnesium and fiber can lower the systolic BP by 5.5 points

and the diastolic BP as much as over 3 points.12

Cucumber is a green vine vegetable related to the melon that provides a crisp, grassy

flavor. The nutrients that cucumber provides are closely related with the nutritional requirements

for regulating blood pressure. An 8-inch cucumber provides 444mg of potassium, or 13 percent

of the 3,500mg potassium according to The Food and Drug Administration daily value.

Potassium is a mineral that provides support to the blood pressure system because the body

requires it for regulating fluid and electrolyte levels that regulate the amount of fluid in the

bloodstream. This function directly impacts the blood pressure in the body.13

SECTION 3: STUDIES ON EFFECT OF CUCUMBER ON BLOOD

PRESSURE:

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 In one of the study conducted by professional cardiologist, it’s revealed that cucumbers

can be amazingly useful in controlling high blood pressure. In fact, drinking its juice can help in

lowering blood pressure without medications.14

Clinical and experimental study of tablet cucumber vine compound was conducted in

treating essential hypertension in Geriatrics Institute, 1 st Sanatorium, at Dalian. Patients (389)

with essential hypertension were divided into two groups randomly, 241 patients were treated by

tablet of cucumber vine compound as control. The marked effective rate in decrease of blood

pressure and total effective rate were 52.7%, 90.9% and 58.1%, 92.6% (P greater than 0.05)

respectively.15

6.3 PROBLEM STATEMENT

“A study to assess the effect of cucumber on blood pressure among Pre-hypertensive adults in a

selected rural area, Bangalore.”

6.4 OBJECTIVES OF THE STUDY

 To assess blood pressure before and after administration of cucumber among pre-

hypertensive adults

 To compare the effectiveness of cucumber on blood pressure among pre-hypertensive

adults

 To determine the association between the blood pressure and baseline variables after

administration of cucumber

6.5 OPERATIONAL DEFINITIONS

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PRE-HYPERTENSIVE ADULTS:

Pre hypertension is defined as a persistent Systolic blood pressure (SBP) 120-128 mmHg

and Diastolic blood pressure (DBP) 80-89mmHg, according to JNC (Joint National Committee)

classification of hypertension.16

In this study, pre-hypertensive adults refers to adults between age of 35 to 65yrs with

Systolic BP of 120 to 139mmHg or Diastolic BP of 80 to 89mmHg in three consecutive readings.

CUCUMBER:

Cucumbers are widely cultivated green fleshy fruit used in salads which is obtained

from the gourd family cucurbitaceous.17

In this study, 1 cup of cucumber which is approximately 100 grams is administered to pre-

hypertensive clients for 30 consecutive days.

EFFECT:

Effectiveness means producing intended result.18

In this study, effectiveness refers to the changes in the blood pressure level after 30 days

of administration of 1 cup of cucumber (approx 100 grams weighed) for pre-hypertensive clients,

which is measured using a caliberated mercury Sphygmomanometer on 15 th and 30th day of

cucumber consumption.

6.6 ASSUMPTIONS

Consumption of cucumber may have an effect on blood pressure among pre-

hypertensive clients.

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6.7 DELIMITATIONS

The findings of study will be limited only to the pre-hypertensive clients in the selected

Kuguru village under Sarjapura PHC, Bangalore.

6.8 PROJECTED OUTCOME:

The findings of this study may highlight the effect of cucumber which is local dietary

supplement on blood pressure in pre-hypertension. As a community health nurse, investigator felt

that cucumber which is easily available in market can be used by the people as primary

preventive measure of Pre- hypertension.

6.9 HYPOTHESIS

H1: There will be significant variation in blood pressure before and after

administration of cucumber at 0.05 level of significance.

H2: There will be significant association between blood pressure and their baseline

variables after administration of cucumber at 0.05 level of significance.

7 MATERIAL AND METHOD:

7.1 SOURCE OF DATA:

7.1.1RESEARCH DESIGN:

Quasi Experimental Research Design (One group pretest- post-test design)

7.1.2SETTING:

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 The setting of this study is Kuguru village, which is under Sarjapura PHC, Anekkal

Taluk, Bangalore. In this village there are around 250 families covering a population of around

1000 – 1500.

7.1.3 POPULATION:

The population in this study comprises of all subjects with SBP of 120 to 139 or DBP of

80 to 89 in three consecutive readings both male and female between 35 and 65yrs in Kuguru

village under Sarjapura PHC, Anekal Taluk, Bangalore.

7.2METHOD OF DATA COLLECTION:

7.2.1 SAMPLING PROCEDURE:

All the prospective subjects meeting the inclusion criteria will be selected by purposive

sampling technique.

7.2.2 SAMPLE SIZE:

In this study the sample size is 53, which is calculated from the previous review, Lu.et.al

(reference) as to detect a reduction in blood pressure for 63% of the subjects marked

improvement with 13% precision and 95% confidence interval a sample size of 53 subjects is

required.

7.2.3 INCLUSION CRITERIA:

 All subjects with Systolic BP of 120 to 139mmHg or Diastolic BP of 80 to

89mmHg in three consecutive BP readings in the Kuguru village.

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  All subjects who are willing to take part in the study.

7.2.4 EXCLUSION CRITERIA:

 All subjects who are known case of renal disorders, cardiovascular and

respiratory disorders.

 All subjects with known history of hypertension and those under treatment with

anti- hypertensive medications.

 Those subjects who are allergic to cucumber

7.2.5 INSTRUMENTS:

Semi-structured interview will be used to elicit the baseline variables of selected subjects

and a caliberated mercury Sphygmomanometer will be used to measure consecutive BP readings

of selected subjects.

7.2.6 DATA COLLECTION METHOD:

Formal permission from the Sarjapur PHC will be taken to conduct the study in kuguru

village. The direction for sampling will be obtained in a randomized manner (pen rolling

technique ie., by standing in the center of the village and rolling down the pen and thereby

starting from the direction the pen is pointing). The individual subjects will be selected using

Purposive sampling technique based on inclusion criteria.

Door to door survey will be done to allocate pre-hypertensive subjects, which will be

obtained using a caliberated Sphygmomanometer by three consecutive readings. Informed

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consent will be obtained from the selected subjects. Baseline information will be collected using

a semi-structured interview schedule.

All subjects will be given 1 cup (approx. 100grams) of cucumber per day for 30

consecutive days. Log will be maintained by the investigator to assure that all the subjects in the

sample group take cucumber all 30 days. Blood pressure will be checked using caliberated

mercury Sphygmomanometer on the 15th and 30th day of intervention and the BP reading

assessed to know the effect of cucumber.

7.2.7 DATA ANALYSIS

Data will be analyzed using inferential statistics; paired t test to identify the effect of

cucumber on BP and Chi-square will be employed to determine the association between the

baseline variables and BP after administration of cucumber.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR

INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER

HUMANS OR ANIMALS? IF SO PLEASE DESCRIBE BRIEF:

Yes, the study consists of adults with pre-hypertension in Kuguru village. The selected

subjects will be given 1 cup (100grams) of cucumber for 30 consecutive days in order to assess

the effect on blood pressure.

7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR

INSTITUTIONIN CASE OF 7.3

Yes, administrative and ethical clearance would be obtained from the respective authority.

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7.5 REFERENCES

1) Park K. Textbook of preventive and social medicine. 21st edition. India:

M/S Banarsidas bhanot publishers; 2011. 346, 279-280

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2) Lewis S L. Medical Surgical Nursing. 7th edition. New Delhi:Elsevier

publishers. 2007. 761

3) Libert MA, Prevalence of hypertension. Inc publishers. (Internet) 2012.

Available from URL: http://online.liebertpub.com/dia. Accessed on 4/08/12

4) Indian J Med RES 128. Available from URL

http://icmr.nic.in/ijmr/2008/december/1207-pdf. Accessed on 5/8/12

5) Chandler S, Lance Armstrong Foundation. Available from URL

http://www.livestrong.com/article/448171-increased-potassium-blood-

pressure. Accessed on 7/7/12

6) Available from URL http://www.helium.com/items/1891894-secreat-

health-benefits-of-cucumbers. Accessed on 22/8/12

7) Stamler J, Rose G, Stamler R, Elliott P, Dyer A, Marmot Michael.

INTERSALT study findings. Public health and medical care implications.

Hypertension 14: 570-577, 1989

8) Available from URL http://www.ncbi.nlm.nih.gov/pubmed/21947549.

Accessed on 19/7/12

9) Available from URL http://www.longwoods.com/content/1765. Accessed

on 12/8/12

10) International Journal of medical sciences. Available from URL

http://www.medsci.org/V02p0070.htm. Accessed on 27/8/12

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11) Natures can cure-Herbal health care. Available from URL

http://bnsc52.blogspot.in/2012/05/health-benefits-of-cucumber.html.

Accessed on 3/8/12

12) Available from URL http://holyjeans.30.hubpages.com/hub/cucumbers-

usesandbenefits-on-health-and-skin. Accessed on 24/8/12

13) Carson T, Cucumber for high blood pressure. Available from URL

http://www.livestrong.com/article/422118-cucumber-for-high-

bloodpressure. Accessed on 17/7/12

14) Riaz A. High blood pressure symptoms causes diet treatment.

AvailablefromURL:http://www.highbloodpressuremed.com/cucumber-

juice-lowers-high-bloopressure.html. Accessed on 24/7/12

15) GL Lu, WX Yuan, YJ Fan. Clinical and experimental study of tablet

cucumber vine compound in treating essential hypertension. Geriatrics

institute, Dalian. Available from URL

http://www.ncbi.nlm.nih.gov/pubmed/1879030. Accessed on 22/7/12

16) Lewis S L, Heitkemper M M, Dirksen S R, Bucher L. Medical Surgical

Nursing. 7th edition, Elsevier publishers: p 761

17) Cucumber. Available from URL http://www.memidex.com/cucumber.

Accessed on 23/07/12

18) Oxford.dict(Internet) Available from URL http.//www.oxforddic.online.in//

Accessed on 22/8/12

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19) Polit and Beck’s. Nursing research principles and methods. 7 th edition.

Philadelphia Lippincott Williams and wilkins company publishers; p254-

256

20) Sharma S K. Nursing research and statistics. Elsevier publishers;2011.p

101, 145, 365

21) Web references: Accessed on 24/07/2012 Available from URL

 http://www.sciencedirect.com/science/article/pii/5135951130700

2346

 http://www.ehow.com/how-8221807-juice-cucumbers.html

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8 SIGNATURE OF CANDIDATE

9 REMARKS OF THE GUIDE

10 NAME AND DESIGNATION

10.1 GUIDE:
MRS. PADMA PRIYA DEVI. T
SENIOR LECTURER
DEPT OF COMMUNITY HEALTH
NURSING
10.2 SIGNATURE: ST JOHNS COLLEGE OF NURSING

10.3 CO-GUIDE:

DR. PRETESH R KIRAN

ASSISTANT PROFESSOR
DEPT OF COMMUNITY HEALTH
10.4 SIGNATURE:
MEDICINE
ST JOHNS MEDICAL COLLEGE
HOSPITAL

11 11.1 HEAD OF THE MRS. MERCY P J

DEPARTMENT: PROFESSOR, HOD
COMMUNITY HEALTH NURSING
ST. JOHNS COLLEGE OF NURSING

11.2 SIGNATURE:

16
12 12.1 REMARKS OF THE
CHAIRMAN AND PRINCIPAL

12.2 SIGNATURE:

17