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Ikit Netra Wirakhmi1, Tin Utami1, Iwan Purnawan2

1. Universitas Harapan Bangsa, Purwokerto

2. Jurusan Keperawatan, Fikes, Universitas Jenderal Soedirman

The number of people with hypertension is increasing over time. The most frequest complaint
experienced by people with hypertension is pain. Complications of pain can be avoided through correct
pain management. Listening to music and murotal Al Quran on some researches can provide a
relaxation effect that potentially reduces pain. This study was aimed to identify differences effect in
listening mozart music with murotal Al Quran in order to purifying pain of hypertensive sufferers. This
research was quasi experiment with pre-test and post-test with two groups design. Data were collected
using consecutive sampling technique with 15 respondents for each group. Pain measurement was
taken twice before and after listening to music mozart or murotal Al Quran for 15 minutes. Statistic test
using mann whitney showed that there was significant mean difference of pain before and after
treatment in the murotal group of Al Quran (value p = 0,002). While in the mozart group the difference of
pain before and after treatment was not significant (p = 0,051). Listening to murotal Al Quran is more
effective in reducing pain in hypertensive sufferers compared to that in mozart music.

Keywords: hypertension, mozart music, murotal Al Quran, pain

Jumlah penerita hipertensi terus mengalmi peningkatan. Salah satu keluhan yang sering dialami oleh
penderita hipertensi adalah rasa sakit. Komplikasi dari nyeri dapat dihindari melalui manajemen nyeri
yang benar. Mendengarkan musik dan murotal Al Quran pada beberapa penelitian dapat memberikan
efek relaksasi yang berpotensi mengurangi rasa sakit. Penelitian ini bertujuan untuk mengidentifikasi
perbedaan dalam efek mendengarkan musik mozart dengan murotal Al Quran dalam memurnikan rasa
sakit penderita hipertensi. Penelitian ini merupakan eksperimen semu dengan pre test dan post test
dengan dua desain kelompok. Data dikumpulkan menggunakan teknik consecutive sampling dengan 15
responden untuk setiap kelompok. Data nyeri masing-masing responden diambil dua kali sebelum dan
sesudah mendengarkan musik mozart atau murotal Al Quran selama 15 menit. Uji statistik
menggunakan mann whitney menunjukkan bahwa ada perbedaan rerata nyeri sebelum dan sesudah
perlakuan pada kelompok murotal Al Quran (nilai p = 0,002). Sedangkan pada kelompok mozart
perbedaan nyeri sebelum dan sesudah perlakuan tidak signifikan (p = 0,051). Mendengarkan murotal Al
Quran lebih efektif dalam mengurangi rasa sakit penderita hipertensi dibandingkan dengan musik

Kata kunci : hipertensi, musik mozart, murotal Al Quran, nyeri

Corresponding Author : Ikit Netra Wirakhmi ISSN : 1907-6637

Email : e-ISSN : 2579-9320

Wirakhmi, Utami, Purnawan DOI : 10.20884/1.jks.2018.13.3.813
Jurnal Keperawatan Soedirman 13 (3) 2018 : 100 – 106

BACKGROUND will trigger the release of stress hormones

Hypertension has become a which stimulates the sympathetic nervous
global problem and is one of the important system. Both mechanisms will trigger the
factors as the trigger of Non occurrence of vasoconstriction that further
Communicable Diseases such as heart worsen the condition of hypertension.
disease, stroke and others that are Thus, the management of pain in people
currently the number one cause of death with hypertension is very important
in the world (Budiyanto, 2015). To date, (Awaludin, Upoyo, & Purnawan, 2013).
hypertension is still a big challenge in The use of pharmacological
Indonesia with a prevalence of 25.8% methods in the treatment of pain has
(Depkes RI, 2013). proven to reduce or eliminate pain quickly.
Hypertension or high blood However, there are side effects that are
pressure is an increase in systolic blood bad for health and will increase weight if
pressure of more than 140 mmHg and used continuously in the long term.
diastolic blood pressure of more than 90 Therefore, non-pharmacologic methods
mmHg in two measurements with an are needed to reduce or eliminate pain
interval of five minutes in a moderately complaints in hypertension patients. Non-
restful state. Hypertension is a silent killer pharmacological therapy that can be used
where symptoms can vary with each as a complementary therapy to reduce
individual and are almost identical to other pain is music therapy and murotal Al
diseases such as headache / heaviness in Quran (Joke, Cheryl, & Noah, 2013; Taha,
the back of the neck, vertigo, palpitations, Alshaikhli, Yahya, Pammusu, & Alarabi,
fatigue, blurred vision, ringing ears 2014).
(tinnitus) and epistaxis (Badan Penelitian van Dyck et al. (2017) stated that
dan Pengembangan Kesehatan, 2013). classical music (mozart) is believed to
Headache is one of the most have positive effects on human life
common symptoms in patients with through the strains of the tone mechanism.
hypertension. Symptoms that are often The influence of classical music (mozart)
experienced hypertension sufferers in are as entertaining effect, learning support
America include headaches (40%), effect and as an enriching effect. Classical
palpitations (28.5%), pain (20.4%), music (mozart) with a gentle rhythm can
dizziness (20.8%) and tinitus (13.8%) affect the heart rate so that it creates
(Syiddatul B, 2017). Based on the survey calmness that is heard through the ear.
conducted by Rizaldy (2013) in Syiddatul This will immediately enter the brain and
(2017), among people over 60 years old, immediately processed so as to produce a
the most frequent symptoms experienced very good effect on one's health (Aini,
is neck pain. Pain management in elderly Hariyanto, & Ardiyani, 2017).
hypertension is a matter that needs Murotal therapy can provide
attention because a correct pain serenity, calmness and reduce anxiety.
management can control pain and may This peaceful and comfortable condition
avoid complications. stimulates expenditure neurotransmitter
Inadequate treatment of analgesia (endorphin, enkhepalin,
hypertension can trigger damage to dinorphin) there by reducing pain (J
various organs of the body such as heart, Elzaky, 2011; Abu-Ras & Laird, 2011).
brain, and kidneys. Stroke, kidney failure Giving reading verses holy Quran
and heart attack are some serious health (murottal) by reading Juz 'Amma by the
problems that can appear in people with Sheikh Al-Ghomidy from The Middle East
hypertension. Therefore, a proper handling played through tape recorder and
of hypertensive patients is needed (Annesi earphone to patient post hernia surgery
et al., 2014). every 6 hours for three times with 15
One complaint that is often felt by minutes each after obtaining analgesic
people with hypertension and that can administration can be used as spiritual
exacerbate hypertension is pain or healing for moslem patients to reduce pain
discomfort in the body. This pain sensation post hernia surgery (Sodikin, 2012).
Wirakhmi, Utami, Purnawan DOI : 10.20884/1.jks.2018.13.3.813
Jurnal Keperawatan Soedirman 13 (3) 2018 : 100 – 106

This study aimed to compare variables observed were pain scale

influence of listening to mozart music and performed before and after respondents
Quran in reducing pain in hypertension were given treatment. The pain scale used
patients. Murottal therapy surah Ar- is Visual Analog Scale (VAS) as previous
Rahman can lower blood pressure in research has been done by Awaludin et al
patients with hypertension. Murottal (2013).
therapy Surah Ar Rahman is also free of Instruments used in this study are
side effects which is safe and is easy patient identity data questionnaires, Visual
conducted (Mayrani and Hartati, 2013 in Analog Scale (VAS), Omron brand digital
Widyastuti, Hastuti, & Adiningsih, 2015). tensimeter, mp3 player and head phone.
Al-Qur'an chants physically contains an Classical music used is Mozart and
element of human voice which is an murotal Al Rahman. Mozart classical
amazing healing instrument that can easily music therapy used is classical music
be accessed. Its sound can reduce created by Wolgang Amadeus Mozart who
hormones stress, activate natural has a tempo of 114.79 beats per minute
endorphins, increase feeling of relaxation, which is played through digital media
and distract from fear, anxiety and tension, players and earphones for 15 minutes.
improve body chemical system so that Murotal therapy is Ar Rahman with qory
lower blood pressure as well slow Muzammil Hasballah which has been
breathing, heart beating, pulse and brain validated at the Mathematics and Natural
wave activity (Siswatinah, 2011). Sciences Faculty of Jenderal Soedirman
According to Campbell (2001) in Salim University physics laboratory which has a
(2013) various tempo musics have tempo of 95.99 per minute which is played
physiological effects on the body, including through digital media players and
on heart rate and blood pressure by earphones for 15 minutes. Pain was
beating following the frequency, tempo measured using the VAS values consist of
and volume of music. The heart tends to : 0 - 3 = mild pain, 4 - 6 = moderate pain
follow and try to match the tempo of a and 7 - 10 = severe pain. Blood pressure
sound. was measured using Omron brand digital
Surah Ar-Rahman used in the tensimeter.
research of Widyastuti, Hastuti and The hypothesis formula of this
Adiningsih (2015) has a duration of 11 research was if the value of p <0,05 then
minute 19 seconds with a tempo of 79.8 hypothesis zero (Ho) rejected and
beats per minute (bpm). Tempo 79.8 bpm hypothesis one (H1) accepted. This
is a slow tempo with ranges between 60 to showed a significant difference in mean
120 bpm. Slow tempo is the same tempo pain reduction before and after treatment
with a human heartbeat, so the heart will in murotal group of Al Quran and mozart
synchronize the beats according to the music group.
tempo of the sound (Mayrani & Hartati, The sampling technique used
2013). This is in line with research was consequtive sampling. Roscoe in
conducted by Salim (2013) about the Sugiyono (2012) suggested the number of
influence of tempo and fast music slow to samples for experimental research using
blood pressure and heart rate, which the experimental group and the control
results that fast tempo can increase blood group, respectively between 10 - 20.
pressure and heart rate frequency, Researchers determined the number of
whereas slow tempo music has an effect samples 15 for each group according to
the opposite can be lower blood pressure the inclusion and exclusion criteria. The
and frequency heart rate and brain waves inclusion criteria in this study included: (a)
(van Dyck et al., 2017). systolic blood pressure >140 mmHg and /
or diastolic blood pressure >90 mmHg; (b)
METHOD ages ≥ 45 years. While the exclusion
This research used quasi criteria include: (a) getting another
experiment design with approach of two complementary therapy, (b) the patient
groups pre & posttest design. The refuses to participate (c) the presence of
Wirakhmi, Utami, Purnawan DOI : 10.20884/1.jks.2018.13.3.813
Jurnal Keperawatan Soedirman 13 (3) 2018 : 100 – 106

complications. Min-
Variable n Median p
Differences of pain before and Max
after treatment in mozart group and Murotal
15 2 0–6 0.00
murotal group of Al Quran were analyzed Before
15 2 0–3 2
using Wilcoxon test since data were not After
normally distributed despite data
transformation process (Sopiyudin, 2012). Table 3 shows that respondents
This research has earned the certificate of who listened to mozart music did not
passing ethical test from Medical Faculty experience a significant pain decrease (p
of Sebelas Maret University and RSUD = 0.051). Different things experienced by
Moewardi Surakarta with number 218 / II / the group of respondents who listen
HREC / 2018 dated February 20, 2018. murotal Al Quran for 15 minutes who
experienced a significant pain decrease.
RESULT This was evidenced by the value of p =
This research was conducted in 0.002. These results proved that listening
Sumampir Village of North Purwokerto to murotal Al Quran was considered more
Subdistrict on March 12 - May 13, 2018. effective in reducing hypertensive pain
The subjects were hypertension patients in compared to listening to mozart music.
Sumampir Village of North Purwokerto
Subdistrict in accordance with the DISCUSSION
inclusion criteria established by the Age of respondents
researcher. The results showed that both
groups had a homogeneous age average.
Table 1. Age of Respondent The mean age of the two groups was in
Group Mean SD p the elderly age range, ie 73 years for the
Mozart 73 11.86 0.871 murotal group and 64.6 years in the
mozart group. One of the risk factors for
Murotal 64.6 11.33
hypertension is age. The high incidence of
hypertension in the elderly associated with
Table 1 showed that the mean
the presence of increasingly severe
age of hypertensive patients in the murotal
atherosclerosis with age. Atherosclerosis
group Ar Rahman was 73 years and in the
which is accompanied by thickening of
Mozart music group was 64.6 years. The
blood vessels causes decreased elasticity
age characteristics of the respondents of
of blood vessels. The stiffness of these
both groups are homogeneous. This was
blood vessels is then one of the factors of
indicated by the p value = 0.871 (> 0.05)
high blood pressure in the elderly (Potter &
Perry, 2005).
Table 2. Gender Characteristics
Charact Treatment Control
In addition to being associated
p with an increased risk of hypertension, age
eristics n % n %
Man 4 26.7 2 13.3 is also associated with a person's
Woman 11 73.3 13 86.7 0.99 susceptibility to experience pain. Old age
Total 15 100 15 100 is related to the vulnerability to things that
cause pain. Similarly, an early age is at
Table 2 showed that both groups higher risk of painful exposure resulting
have the same or homogeneous sex from the inability to protect the pain and
characteristics. This was indicated by the express it (Potter & Perry, 2005). Although
value p = 0.999. age affects blood pressure in hypertension
patients, age characteristics in both
Table 3. Differences Of Pain Before and groups are homogeneous. So the age
After Treatment factor does not result in bias results,
Min- because the age distribution in both
Variable n Median p
Max groups is the same.
15 2 0 – 4 0.05
15 1 0–3 1
Wirakhmi, Utami, Purnawan DOI : 10.20884/1.jks.2018.13.3.813
Jurnal Keperawatan Soedirman 13 (3) 2018 : 100 – 106

Gender quiet condition, the frequency of heart rate

The results showed that is lower than when listening to music.
respondents in both groups were Checking the tempo of mozart
dominated by women. However, according music and murotal Al Quran is done by
to Potter & Perry (2005), theoretically the using mix master BPM analyzer computer
incidence of hypertension between men application. The app serves to measure
and elderly women is relatively the same. the speed of beats per minute or the
This is because in women no longer tempo of an audio file. Murotal Al Quran
produce adequate hormone estrogen as used in this research is a surah Ar
before menopause. This estrogen Rahman with qori (reader) Muzamil
hormone has an effect on blood-staining Hasbalah. The tempo of murotal Al Quran
elastic. If the hormone is reduced, the is 95.99. While the relaxation music of
blood vessels become stiff that leads to an Mozart has a tempo of 114.79. Music with
increase in blood pressure. The a slow tempo produces a relaxation effect
dominance of elderly women in this study so that it can reduce heart rate, breathing
is merely because they are more active in frequency, blood pressure, and anxiety.
social activities such as Prolanis (The This condition will inhibit the release of
Chronic Disease Management Program) stress hormones while stimulating
at Puskesmas. This data is consistent with parasympathetic nervous system and
research by Awaludin, Upoyo, & trigger the release of beta endorphin. A
Purnawan (2013), where the number of decrease in heart rate and dilation of blood
female respondents was 81,2% out of 16 vessels cause a decrease in blood
respondents. pressure while the release of endorphin
The results showed that the hormones is useful in reducing the
decrease of pain significantly occurred in sensation of pain (Van Dyck et al., 2017).
the group of respondents who listen to The analgesic effect of listening
murotal Al Quran for 15 minutes (p value = to Qur'an has been demonstrated in
0.002). While the group of respondents Wahida, Nooryanto, & Andarini (2015)
who listened to music mozart for 15 research. The study was conducted on
minutes has p value = 0.51, so it can be active phase maternity mothers by
concluded that there was no significant whispering murotal Al Quran for 15
difference in this group (Sopiyudin, 2012). minutes. The study reinforced evidence
In previous studies, music therapy is that listening to murotal Al Quran can
actually proven to reduce pain in some stimulate beta endorphin hormone. This
conditions. A research conducted by hormone has an important role in inhibiting
Zulkhairi, Hendra, & Fauzan (2015) excitatory pain (Berry, Chapman,
showed that music therapy can reduce Covington, Dahl, & Katz, 2010).
pain in patients after suturing the wound. Endorphins are endogenous opium
However, in other studies, music therapy peptides that act as neurotransmitters.
did not have an effect on the improvement Endorphin has the same structure with
of pain and anxiety in birth patients who morphin so it is used as a pain reliever
received epidural injections (Drzymalski et (Rokade, 2011).
al., 2017).
The difference in influence RESEARCH LIMITATIONS
between listening to murotal and listening To create a better relaxation
to music may caused by two things, effect, murotal surah Ar Rahmaan therapy
namely differences in tempo and spiritual requires concentration and confidence,
effects produced by both methods. however, in this study researchers were
According to van Dyck et al. (2017) there not able to measure the level of
is a musical tempo as the main factor concentration and confidence that
considered to be associated with respondents had during therapy.
relaxation effects or arousal effects. The
lower the musical tempo the stronger the CONCLUSION
effect of relaxation. It is proven that in Listening to murotal surah Ar
Wirakhmi, Utami, Purnawan DOI : 10.20884/1.jks.2018.13.3.813
Jurnal Keperawatan Soedirman 13 (3) 2018 : 100 – 106

Rahman is more effective in reducing pain

due to hypertension compared with room/health+care+issues/pm+mono
listening to music mozart. Listening to graphs.htm
murotal surah Ar Rahman can be
recommended as a complementary Depkes RI. (2013). Riset kesehatan dasar
therapy option and non pharmacology in 2013. Retrieved November 5, 2017,
reducing pain of patients with from
Drzymalski, Tsen, Palanisamy, Zhou,
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