Hypertension is the most common non-communicable disease found during pregnancy, childbirth and postpartum. Hypertension during puerperium is an increase in blood pressure ≥ 140/90 mmHg with or not accompanied by proteinuria or edema. Postpartum hypertension has a very large role in maternal and perinatal morbidity and mortality [1].

Data from the World Health Organization (WHO) 2015 shows that around 1.13 billion people in the world suffer from hypertension. That is, 1 in 3 people in the world are diagnosed with hypertension. The number of people with hypertension in the world continues to increase every year, estimated that by 2025 there will be 1.5 billion people affected by hypertension and every year 9.4 million people die from hypertension and complications. In Indonesia, the 2016 National Health Indicator Survey (Sirkesnas) data showed an increase in the prevalence of hypertension in people aged 18 years and over by 32.4%. To control it, the Government implemented a Healthy Indonesia Program with a Family Approach (PIS-PK) and the Healthy Living Society Movement (Germas) [2].

The World Health Organization estimates that around 830 women die every day due to complications of pregnancy and childbirth. Most of these deaths occur in developing countries and should be preventable[3]. In 2015, the Maternal Mortality Rate (MMR) in Indonesia was 305 per 100,000 live births (KH). Despite the decline from previous years, this figure is still very high when compared to the target of the Sustainable Development Goals (SDGs) of the AKI not more than 70 per 100,000 KH in 2030. The cause of maternal death in Indonesia is currently still dominated by bleeding (30 %), hypertension (25%), infection (6%) and pregnancy comorbidities (39%)[4].

The dangers of hypertension include chest pain, metabolic syndrome, tend to be irritable, kidney problems, hypertensive retinopathy, stroke, resulting in an increased risk of increasing morbidity and mortality although this condition is still not a direct cause of pain and death. During this period, the risk of hypertensive complications such as eclampsia, hemorrhagic stroke, Hemolysis Elevated Liver enzyms Low Platelet (HELLP) Syndrome and even death, is also increasing[1],[5]. Therefore, postpartum hypertension requires adequate treatment[6].

The standard way of handling carried out throughout the world is relatively almost the same. That is, by giving the same medication as the treatment of pre-eclampsia and eclampsia in pregnancy. The types of drugs used include magnesium sulfate given intravenously and benzodiazepines to treat symptoms of seizures. As for lowering blood pressure, injections are usually given labelatol, nicardipine, nifedipine, or hidralazin[3]. The side effects of using hypertension drugs with a total of 34 incidents, which included captopril side effects as many as 9 events (8.9%), furosemide as many as 4 events (3.9%), amlodipine as many as 11 events (11.9%), nifedipine as much 1 event (1%), vasaltran 2 events (2%), irbesartan 2 events (2%), losartan 3 events (2.9%), clonidine 2 events (2%)[7].

Pharmacological treatment methods, namely the administration of antihypertensive chemical drugs such as diuretics, ace-inhibitors, beta blockers and ca blockers, while nonfarmacological treatment is to provide natural ingredients with very minimal negative effects or called complementary therapy. Treatment using natural ingredients that are economical and have minimal negative effects is the best solution to overcome health problems. One of the natural ingredients of medicinal plants for hypertension is red gedi leaf extract (Abelmoschus manihot L)[8].

This plant contains isoquercitrin, hyperoside, hibifolin, quercetin-3'-0-glucoside, quercetin and isorhamnetin which have an antidepressant effect[9]. Another study by Chumbhale (2013), about the phenolic content found in red gedi leaves (Abelmoschus manihot L) reported the presence of flavonoids namely flavones, flavonols, isoflavones, anthocyanins and proanthocyanins[10]. Flavonoid compounds in food have antihypertensive effects, because flavonoids can inhibit the conversion enzyme angiotensin I to angiotensin II [11]. Treatment of hypertension using medicinal plants is carried out based on a concept that includes four sides, namely a reduction in blood pressure, repair of organ damage or irregularities that causes blood pressure rise, treatment or prevention of complications and participation, and maintenance of the body environment under normal blood pressure conditions[12] .

Red gedi leaves contain flavonoids from flavanones and flavanols which act as antihypertensive agents. The compounds of red gedi leaves include: flavonoids, glycosides, isoku-cetins, kaemperon glycosides, ramnetine glycosides, canabestine, quersimeritin. The results of the study by Suoth et al. (2013) showed that the total content of flavonoids and polyphenols in gedi merah leaves was very high, namely 722.5 mg/kg and 1003.5 mg/kg [13],[14],[15].

The incidence of hypertension both during pregnancy, childbirth and childbirth has not been well controlled.6 Therefore a new breakthrough is needed to combine non-pharmacological (herbal) therapy in addition to pharmacological (medical) therapy. So the researcher was interested in conducting a study entitled "The Potential of Red Gedi Leaf Extract (Abelmoschusmanihot L) as an Alternative Change in Blood Pressure in Postpartum Mothers With Hypertension"

This research is a quantitative study with a quasi-experimental design with a pre-test and post-test controlled group design. The number of samples is 30 respondents. The respondents of the intervention group were 15 respondents and the control group was 15 respondents. In the intervention group the administration of red gedi leaf extract (Abelmoschus manihot L) dose of 480 mg, 1x2 capsules (each capsule 240 mg) and antihypertensive drugs nifedipine dose 10 mg, 3x1 tablets for 7 days in the intervention group. Whereas in the control group administration of antihypertensive drugs nifedipine dose 10 mg, 3x1 tablets and placebo 1x2 capsules for 7 days.

Table 2 Differences in systolic blood pressure and diastolic blood pressure in the treatment and control groups afte r intervention

Table 2 The results of bivariate analysis of the value of pvalue of systolic blood pressure before treatment were p = 0.595 (> 0.05), meaning that there was no difference in systolic blood pressure in the treatment and control groups. There were differences in systolic blood pressure in the two groups after being given intervention on day 4 of p = 0.000 (<0.005). The bivariate analysis of the p value of Diastolic blood pressure before being given treatment p = 0.897 (> 0.05) means that there is no difference in Diastolic blood pressure in the treatment and control groups. There were differences in Diastolic blood pressure in the two groups after being given intervention on day 3 the value of p = 0.000 (<0.005).

Figure 1 Average systolic blood pressure in the treatment and control groups.

Figure 2 Average diastolic blood pressure in the treatment and control groups.