Potential of Flavonoid in Mahkota Dewa to Reduce Sistolic and Diastolic Blood Pressure in Patient with Hypertension

Treating hypertension by using antihypertensive drugs and diuretics has many harmful side effects. Mahkota Dewa fruit can be used as alternative treatment with minimal side effects. As generallly known that blood pressure increases slowly with age, which makes hypertension a critical disease to the elderly. This disease could be treated using flavonoid compounds that is contained in Mahkota Dewa fruit because it is effective in reducing blood pressure.


Introduction
Hypertension is generally known as one of the degenerative disease, as it often occurs on elderly.
It is an increase in systolic blood pressure of more than 140 mmHg and a diastolic blood pressure of more than 90 mmHg on two measurements with the interval of five minutes in a adequate state. Based on JNC (Join National Commit) 7, hypertension is divided into four types: normal, pre-hypertensive, hypertension 1 and hypertension 2. [1,2] According to the data taken from World Health   [2,3,4] Treatment of hypertension is growing in this millennium era and in general the treatment of hypertension is divided into two, namely non- bronchospasm. [1,2] Hyperkalemia due to ACE inhibitors due to decreased aldosterone production.

ARTICLE INFO
Other side effects caused by ACE inhibitors such as bradycardia, myocardial contractile disorders and cold hands due to beta-2 receptor blockade in peripheral vascular smooth muscle. Therefore, alternative treatments are needed to reduce blood pressure with minimal side effects. [2,3] Research continues to grow and leads to the use of herbal medicines in reducing blood pressure, one of which is the potential of the god's crown in lowering blood pressure. Mahkota dewa (Phaleria macrocarpa) is a plant that tastes from Papua which can be used as an alternative treatment for lowering blood pressure. The flavonoid content in the god's crown has benefits in reducing blood pressure. [1,3,4]

Discussion
Hypertension is a condition where the systolic blood pressure is more than 140 mmHg and the diastolic blood pressure is more than 90 mmHg on two measurements with an interval of five minutes in a state of adequate rest / calm. Hypertension is also often referred to as the silent killer because it is a deadly disease. Hypertension is also a degenerative disease; generally blood pressure slowly increases with age. [2,3,4] [4,5,6] . Blockers. [2,6,7,8,9,10] The many side effects caused by antihypertensive drugs and diuretics make alternative treatments an option in reducing blood pressure in hypertensive patients. Research leads to the treatment of herbs.
One of them is the use of the crown of god (Phaleria macrocarpa). [5,6,7,11] Mahkota dewa is an herbal plant originating from Papua. Research on the efficacy of the crown of gods has been started since the beginning of the millennium in 2000. The compounds contained therein such as antihistamines, alkaloids, flavonoids, phenols, saponins, lignans, essential oils and sterols in fruit flesh work as hepatoptrectors, help treat leukemia, control sugar blood and lower blood pressure with minimal side effects. [7,8,10,11,12] Flavonoid compounds contained in the crown of god have an effect in lowering blood pressure.
Flavonoids are compounds consisting of 15 carbon atoms, where two benzene rings (C6) are bound to a propane chain (C3) to form a C6-C3-C6 arrangement. Flavonoids are a phenolic compound that is found in nature. These compounds are red, purple and blue as well as yellow substances found in plants. [5,6,8,12,13] In  [8,9,10,14,15] The mechanism of flavonoids in reducing blood pressure is associated with ACE and acts as a diuretic. Flavonoids have the ability to inhibit ACE.
ACE is known to play an important role in the process of hypertension, namely forming angiotensin II from angiotensin I. Angiotensin II causes blood vessels to narrow, which can raise blood pressure. In this case, flavonoids act as ACE inhibitors which cause blood vessels to dilate so much blood flow to the heart and decreases blood pressure. [1,2,6,7,16] March 2020 | Vol 1 | Article 5  [9,12,13] . Flavonoids can also activate the Endothelium Derived Relaxing Factor (EDRF), causing vasodilation of blood vessels and can reduce blood pressure. [5,6,13,15,16] Flavonoids also work as a diuretic, flavonoids work to increase urine production and electrolyte output, which functions like potassium, which absorbs liquid electrolyte ions such as sodium in the intracellular to extracellular entry into the kidney tubules.
Flavonoids also work by increasing the Glomerular Filtration Rate (GFR) so as to cause the kidneys to be able to release waste products quickly. In addition, flavonoids also have a protective effect on endothelium and inhibit platelet aggregation by reducing levels of prostacyclin (a substance produced by vascular endothelial cells) and leukotirene levels, thereby reducing the risk of coronary heart disease. [4,5,7,8,15]

Conclusion
Hypertension is often called the silent killer because it is a deadly disease. Hypertension is also a degenerative disease, generally blood pressure increases slowly with age. Pharmacological therapy using antihypertensive drugs and diuretics has side effects that are very detrimental to the body.
Alternative medicine using the crown of god (Phaleria macrocarpa) has the effect of lowering blood pressure with minimal side effects.
Flavonoids in the crown of god have a mechanism to reduce blood pressure associated with ACE and act as a diuretic. Thus it is expected that the mortality rate due to hypertension can decrease in the future by using the crown of gods with minimal side effects.