Hindawi Publishing CorporationEvidence-Based Complementary and Alternative MedicineVolume 2013 Article ID 403251 7 pageshttpdxdoiorg1011552013403251

Research ArticleEffects of Aroma Massage on Home Blood PressureAmbulatory Blood Pressure and Sleep Quality in Middle-AgedWomen with Hypertension

Myeong-Sook Ju1 Sahng Lee2 Ikyul Bae3 Myung-Haeng Hur4

Kayeon Seong4 and Myeong Soo Lee5

1 Eulji University Hospital Daejeon 302-799 Republic of Korea2 Smart Hospital Daejeon 302-859 Republic of Korea3 Kunsan College of Nursing Gunsan 573-719 Republic of Korea4College of Nursing Eulji University 143-5 Yongdudong Jung-gu Daejeon 302-832 Republic of Korea5Medical Research Division Korea Institute of Oriental Medicine Daejeon 305-811 Republic of Korea

Correspondence should be addressed to Myung-Haeng Hur mhhureuljiackr

Received 22 October 2012 Revised 8 December 2012 Accepted 9 December 2012

Academic Editor Jenny M Wilkinson

Copyright copy 2013 Myeong-Sook Ju et al This is an open access article distributed under the Creative Commons AttributionLicense which permits unrestricted use distribution and reproduction in any medium provided the original work is properlycited

The purpose of this study was to evaluate the effects of aroma massage applied to middle-aged women with hypertension Theresearch study had a nonequivalent control group nonsynchronized design to investigate the effect on home blood pressure (BP)ambulatory BP and sleep The hypertensive patients were allocated into the aroma massage group (119899 = 28) the placebo group(119899 = 28) and the no-treatment control group (119899 = 27) To evaluate the effects of aroma massage the experimental group receiveda massage with essential oils prescribed by an aromatherapist once a week and body cream once a day The placebo group receiveda massage using artificial fragrance oil once a week and body cream once a day BP pulse rate sleep conditions and 24-hourambulatory BP were monitored before and after the experiment There was a significant difference in home systolic blood pressure(SBP) (119865 = 671119875 = 0002) between groups after interventionThere was also a significant difference in SBP (119865 = 1334119875 = 0001)and diastolic blood pressure (DBP) (119865 = 846 119875 = 0005) in the laboratory between aroma massage and placebo groups In sleepquality there was a significant difference between groups (119865 = 675 119875 = 0002) In conclusion aroma massage may help improvepatient quality of life and maintain health as a nursing intervention in daily life

1 Introduction

A chronic disease refers to a disease state progressing over along period of time and chronic diseases are responsible for63 of overall deaths worldwide [1] Of the chronic diseasesin SouthKorea the prevalence of hypertension in people overthe age of 30 increased from 246 in 2007 to 269 in 2008[2] In particular women show an increasing prevalence withage (43 of women in their 30s 150 in their 40s 326 intheir 50s and 502 in their 60s) to the extent that half of thewomen over the age of 60 had hypertension [2]

The first action for BP control is BP measurementBecause the results of BP measurement are influenced by

multiple factors including time of day location and activitylevel the accurate measurement and interpretation of BPare critical to diagnose and track hypertension Accordinglyhome BP measurements by the patient and 24-hour ambu-latory BP measurements in addition to simple office sittingBP measurements are meaningful [3] The measurement of24-hour ambulatory BP in hypertensive patients aims toidentify the degree of nocturnal decrease in BP leading tothe increased interest in quality of sleep sleep disorders andduration of sleep In general night-time BP decreases dueto increased parasympathetic nervous system activity anddecreased sympathetic nervous system activity during sleep[3] Thus the presence of sleep disorders the duration of

2 Evidence-Based Complementary and Alternative Medicine

sleep and the quality of sleep can influence hypertension[4]

The management of hypertension aims at preventing endorgan complications and mortality due to hypertension withthe target BP below 14090mmHg [3 5] The goal of nursingintervention is to increase patient understanding of thehypertension process and its treatment and increase patientinvolvement in self-management programs to ultimatelyprevent hypertension complications [5]

Recently there has been an increasing interest in holis-tic interventions combining traditional and complementarytherapies for health promotion andmaintenanceAromather-apy is a form of complementary therapy using essential oilextracted from plants The oil is applied through differentmeans to achieve various effects through its chemical prop-erties and application methods [6 7] Of the aromatherapyessential oils lavender (Lavandula officinalis) marjoram(Origanum majorana) ylang-ylang (Cananga odorata) andNeroli (Citrus aurantium) are used for hypertensive patientsLavender is the selective oil that balances the nervous systemand alleviates insomnia while marjoram activates parasym-pathetic nervous system and relaxes the sympathetic nervoussystem Ylang-ylang controls cardiac palpitations and hyper-tension andNeroli oil is effective in insomnia anddepressionThemain chemical ingredients of lavender marjoram ylang-ylang and neroli are linalyl acetate terpinen-4-ol benzylacetate and limonene respectively [6]

Aroma massage combines massage with essential oils tostimulate blood and lymphatic circulation and improve oxy-gen and nutrient supply and it is effective for the relaxation oftensemuscles pain relief and alleviation of emotional distur-bances [6 8 9] Women in middle age experience changes inthe autonomic nervous system such as increases in adrenalcortex hormones and catecholamines leading to increasedBP and unsuccessful psychological management which canhave effects such as depression anxiety and insomnia [10 11]Recent research on the effects of aromatherapy on BP andsleep has targeted menopausal women [12] prehypertensivemiddle-aged women [13] and stage 1 hypertensive patients[14] But there have been no studies using aromamassage andbody cream as a method of aromatherapy

Thus the aim of this study was to evaluate the effect ofaroma massage on home BP office BP ambulatory BP andsleep quality

2 Methods

21 Study Design This study is a nonequivalent controlgroup nonsynchronized study intended to compare theeffects of aroma massage on home BP office BP ambulatoryBP and sleep in middle-aged women with hypertension(Figure 1) To prevent the spread and contamination ofdata as a part of the nonsynchronized study design thecontrol group data were collected before the data from theintervention group (aroma massage group) and the placebogroup (artificial fragrance massage group)

22 Participants and Data Collection The participants wererecruited between March 15 and June 30 of 2011 at E

Control group

No treatment

April-May June-July July-August

Placebo group

Artificial fragrance massage

Experimental group

Aroma massage

Figure 1 Study design

University Hospital in D city outpatient clinic in the depart-ment of internal medicine Ethical approval was obtainedfrom the institutional review board (IRB) after submissionof the research plan A notice was sent to the departmentand the participants were recruited from patients diagnosedwith hypertension and receiving ongoing outpatient cardi-ology followup after consultation with an internal medicinespecialist The eligibility criteria included the following (1)a diagnosis of hypertension and ongoing followup treatmentor consultation at outpatient cardiology clinic (2) womenbetween the ages of 40 and 59 (3) ability to communicateand describe symptoms (4) not currently taking anxiolyticsor hypnotics (5) no presence of psychiatric disorders and (6)providing informed consent regarding the experiment

The participants were recruited from hypertensivepatients using a notice sent to the Internal MedicineOutpatient Clinic their gender medications and conformityto the eligibility criteria were reviewed The study inter-ventions measurement methods and the ability to enrolland drop out of the study were explained to participantsand consent was obtained from those in agreement Theparticipants were instructed to visit the research officeon the intervention day according to the schedule andavoid excessive exercise and diet during the study periodand to notify the researchers when there was a change inantihypertensive medication prescription

23 Sample Size Calculation The sample size of this studywas determined using the Glowast power program and by assign-ing alpha value power and effect size The effect size wasdetermined based on a prior aromatherapy study [14] andassigning mean sample size and pooled variance in the Glowastpower program To calculate the sample size we substituted120572(005) 1-120573 (080) group (3) and effect size (034) Thesample size was determined to be a total of 90 participantsin the three groups using Glowast power In addition estimatinga dropout rate of 10 33 participants were assigned tothe experimental group the control group and the placebogroup for a total of 99 participants

24 Interventions The intervention used in the experimentalgroup was the application of aroma massage and aromabody cream The placebo group received massage and bodycream with an artificial fragrance and the control groupdid not receive any intervention According to the schedulethere were a total of five sessions in the research office forfour weeks The aroma massage oil used contained essentialoils prescribed by an international aromatherapist preparedby blending lavender marjoram ylang-ylang and Neroli at

Evidence-Based Complementary and Alternative Medicine 3

a ratio of 20 10 15 2 followed by dilution to 3 with acarrier oil prepared by blending almond oil and jojoba oilat ratio of 9 1 Such prepared massage oil was preservedat room temperature for use The aroma body cream wassynthesized according to the prescription of an internationalaromatherapist The oil base was prepared by combining100mL of jojoba oil 100mL of sweet almond oil 100mL ofevening primrose oil and 30mL of olive wax The water basewas prepared by adding 700mL of rose water and 20 g ofvitamin E in a glass beaker and heating in boiling water untilthe temperature reached over 70sim75∘C at which point thewater basewas added to the oil baseThewater base combinedwith oil base was mixed using a blender for 10ndash15 minutesuntil the temperature reached below 40∘C at which point theblending oil used for massage (lavender marjoram ylang-ylang and Neroli blended in 20 10 15 2 ratio) was added toproduce a 3 diluted body cream

Four research assistants providing massage were taughtaroma massage theory and massage protocols (4 hours) andreceived practical training (4 hours) from an internationalaromatherapist The assistants performed practice massagesbefore providing massages to participants according tothe massage protocols Aroma massage was provided in aresearch office that was divided into a waiting room and amassage room for study purposes at E University Accordingto the schedule once the study participants arrived at theoffice they changed into a massage gown and relaxed in asupine position on the bed for 10 minutes followed by BPmeasurement using a digital sphygmomanometer (OmronHEM-780 Japan) as a preintervention measurement andmassage according to the massage protocol The massagewas performed in the order of back posterior legs anteriorlegs abdomen arms and shoulders The total amount of oilneeded for the massage was approximately 30mL and theduration of massage was approximately 1 hour Ten minutesafter the massage was completed another BP measurementwas taken as a postinterventional BP using the same methodas the preinterventional measurement and the participantswere provided with 150mL of lukewarm water to drink Atotal of 200mL of prepared aroma body cream was providedto the participants after the first massage with instructionsto apply approximately 10mL on arm legs and abdomenexcluding the chest and back after showering andbefore sleepevery day

Artificial fragrance massage oil and body cream wereprepared and used for the placebo group Almond oil andjojoba oil were blended in a 9 1 ratio to produce the carrieroil in which artificial fragrance was diluted to 3 Themassage oil was stored at room temperature for use Theartificial fragrance body cream was produced and applied bythe researchers and research assistants as the same methodof making a massage oil and body cream The control groupreceived no intervention

25 Outcome Measures

251 Blood Pressure HomeBPwasmeasured by participantsevery Tuesday and Friday at 10 AM after 10 minutes of restusing a home digital BP machine Two measurements were

performed on the left upper arm and the average of theBP measurements was calculated The 24-hour ambulatoryBP was measured using a 24-hour ambulatory BP monitor(AND TM-2430 Japan) Daytime BP was measured every 30minutes between 6 AM and 930 PM while the nighttime BPwas measured every hour between 10 PM and 6 AM the nextmorning These measurements were performed once beforeand once after the intervention

252 Sleep Quality To assess sleep quality in this study atranslated version ofVerran and Synder-Halpern (VSH) SleepScale (1987) by Kang (1992) was used The tool assesses fourcategories related to beginning of sleep and depth of sleep fora total of 8 questions each on a scale of 0ndash10 (a total rangeof 0ndash80) with higher score corresponding to a higher sleepsatisfaction

26 Data Collection and Analyses Prior to beginning thestudy the participants were asked to relax for 10 minutesbefore measuring their preinterventional BP and obtainingsleep status and 24-hour ambulatory BP measurements Totest the effects of aromatherapy essential oil massage theexperimental group received massage once a week usingdiluted blended essential oil and daily application of bodycream while the placebo group received a massage withcarrier oil with artificial fragrance once a week and dailyapplication of body cream The control group receivedno interventions To measure the postinterventional effecttwice-weekly home BP was measured until week 3 in thefourth week home BP 24-hour ambulatory BP and sleepstatus were evaluated

The statistical analysis of the data was performed usingSPSS 190 softwareThe general characteristics of participantswere analyzed in terms of frequency number and percentageusing 1205942-test and ANOVA The test for homogeneity onpreinterventional dependent variables between the experi-mental group the placebo group and the control group wasconducted using ANOVA The pre- and postinterventionalBP and the sleep status of the participants in the experimentalplacebo and control groups were analyzed using ANOVArepeated measures ANCOVA and 1205942-test while the post-hoc analysis was performed with the Tukey method Thereliability of the measurement tool for quality of sleep wasanalyzed using internal reliability Cronbachrsquos 120572 value

3 Results

31 Participants A total of 99 eligible participants wererecruited to the study Of them three patients were lost tofollowup in the experimental group due to home situationsone patient was admitted with psychiatric issues and onehad a change in BP medication leading to a final total of 28participants in the experimental group The placebo grouphad three patients lost to followup due to home situationsone due to antihypertensive medication changes and onehad mild pruritus and dropped out after two attempts forparticipation leading to a final total of 28 participants Thecontrol group had four participants lost to followup due to

4 Evidence-Based Complementary and Alternative Medicine

Table 1 Homogeneity between groups

Categories Aroma (119899 = 28) Placebo (119899 = 28) Control (119899 = 27) 1205942 or 119865 P

Mean plusmn SDAge (yr) 525 plusmn 46 541 plusmn 38 533 plusmn 46 101 37Height (cm) 1571 plusmn 69 1580 plusmn 49 1584 plusmn 38 044 68Weight (kg) 618 plusmn 74 636 plusmn 76 642 plusmn 70 081 45Age of menarche (yr) 156 plusmn 168 154 plusmn 19 156 plusmn 18 015 86Age of first birth (yr) 261 plusmn 43 258 plusmn 36 266 plusmn 45 022 80First SBP (mmHg) 1281 plusmn 122 1275 plusmn 144 1215 plusmn 131 206 13First DBP (mmHg) 797 plusmn 95 804 plusmn 113 801 plusmn 106 004 96First PR (bpm) 692 plusmn 87 710 plusmn 124 708 plusmn 86 026 77

119873 ()Marital status

Married 26 (929) 26 (929) 22 (815) 344 30Single 2 (71) 2 (71) 5 (185)

EducationMiddle school 4 (133) 8 (286) 5 (185) 284 58High school 13 (464) 12 (429) 15 (556)University 11 (393) 8 (286) 7 (259)

Presence of menopausePostmenopausal 14 (500) 15 (536) 17 (654) 379 47Intramenopausal 8 (286) 10 (357) 4 (154)No menopausal 6 (214) 3 (107) 5 (192)

DrinkingNo 18 (643) 18 (643) 17 (630) 001 99Yes 10 (357) 10 (357) 10 (370)

SmokingNo 27 (964) 28 (100) 25 (926) 217 34Yes 1 (36) 0 (00) 2 (74)

ExerciseNo exercise 5 (179) 8 (286) 7 (259) 213 71Less than two times per week 10 (357) 12 (429) 10 (370)More than three times per week 13 (464) 8 (286) 10 (370)

DBP diastolic blood pressure PR pulse rate SBP systolic blood pressure

home situation one patient who refused to participate dueto inability to perform 24-hour ambulatory BP monitoringat work and one patient who could not participate due tooverseas travelling leading to a final total of 27 participantsTherefore there were 83 members in the study analyzed asfinal eligible study participants

32 Homogeneity between the Groups The general character-istics of the participants in the experimental placebo andcontrol groups are shown in Table 1 No statistical differenceswere found between the groups with regards tomarital statuslevel of education presence of menopause drinking smok-ing and exercise There were also no significant differencesin age height weight age of menarche age of first birthbaseline SBP baseline DBP and baseline pulse rate

33 Effect of AromaMassage on Home BP The SBP and DBPweremeasured twice weekly for a total of eightmeasurementsto evaluate the effect of aroma massage on participant home

BP (Table 2) The SBP measurements over four weeks didnot show significant differences with time and there wasno interaction between the groups and time on repeatedmeasures ANCOVAusing initial SBP as a covariate Howeverthere were significant differences in repeated measurementsof SBP depending on the group (119865 = 671 119875 = 0002) Thepost-hoc analysis with the Tukey method showed that theexperimental group showed significant differences comparedto the placebo group and the control group (119875 lt 005)

The eight DBP measurements over four weeks did notshow significant differenceswith time and therewas no inter-action between the groups and time on repeated measuresANCOVA using initial DBP as a covariate There was nodifference in DBP measurements within the 3 groups

34 Effect of Aroma Massage on Office BP To determinethe immediate effect of aroma massage BP measurementswere taken before the massage in the office followed by SBPmeasurement 10 minutes after the massage to compare with

Evidence-Based Complementary and Alternative Medicine 5

Table 2 Aroma massage on home BP

Time Aroma (119899 = 28) Placebo (119899 = 28) Control (119899 = 27) 119865 119875

SBPBaseline 1281 plusmn 122 1275 plusmn 144 1215 plusmn 131 206 0131st week

Tue 1207 plusmn 141 1212 plusmn 124 1257 plusmn 123 124 029Fri 1185 plusmn 138 1228 plusmn 137 1233 plusmn 110 112 033

2nd weekTue 1206 plusmn 110 1216 plusmn 123 1224 plusmn 119 016 085Fri 1179 plusmn 101 1176 plusmn 134 1217 plusmn 113 106 035

3rd weekTue 1160 plusmn 125 1186 plusmn 127 1223 plusmn 118 177 018Fri 1147 plusmn 126 1195 plusmn 111 1219 plusmn 120 265 008

4th weekTue 1156 plusmn 93 1216 plusmn 121 1222 plusmn 111 321 005Fri 1133 plusmn 110a 1218 plusmn 113b 1209 plusmn 121b 466 001

Group 119865 = 671 119875 = 0002 time 119865 = 046 119875 = 086 group times time 119865 = 168 119875 = 007DBP

Baseline 797 plusmn 95 804 plusmn 113 801 plusmn 106 004 0961st week

Tue 790 plusmn 84 778 plusmn 91 815 plusmn 110 106 096Fri 788 plusmn 99 794 plusmn 101 815 plusmn 110 026 067

2nd weekTue 809 plusmn 66 787 plusmn 66 792 plusmn 98 052 036Fri 799 plusmn 83 770 plusmn 102 796 plusmn 91 086 021

3rd weekTue 794 plusmn 87 764 plusmn 115 810 plusmn104 145 013Fri 779 plusmn 95 768 plusmn 110 801 plusmn 76 091 040

4th weekTue 775 plusmn 91 782 plusmn 101 794 plusmn 86 029 090Fri 759 plusmn 81 774 plusmn 105 794 plusmn 101 089 066

Group 119865 = 102 119875 = 037 time 119865 = 053 119875 = 081 group times time 119865 = 146 119875 = 013Values are expressed as mean plusmn standard deviationMeans for each group with different superscript (a or b) indicate a significant difference (Tukey test 119875 lt 005)BP blood pressure DBP diastolic blood pressure PR pulse rate SBP systolic blood pressure

the office BP The postintervention office SBP measured aftereach of the fivemassages did not show significant differencesbetween the two groups after the first massage The aromamassage group showed significantly reduced SBP after thesecond (119905 = minus3444 119875 = 0001) third (119905 = minus265 119875 = 001)fourth (119905 = minus333 119875 = 0002) and fifth sessions (119905 = minus487119875 lt 0001)There was statistical significance in groups times time(119865 = 363 119875 = 0007) and the groups (119865 = 1334 119875 = 0001)while there was not statistically significant in time

Postintervention office DBP after the first session didnot show significant differences between the two groupsHowever there were significant differences between groupsafter the second (119905 = minus309 119875 = 0003) third (119905 = minus208119875 = 004) fourth (119905 = minus238 119875 = 002) and fifth sessions(119905 = minus376 119875 lt 0001) in office DBP The results of repeatedmeasures ANOVA showed significant difference with time(119865 = 384 119875 = 0005) groups (119865 = 846 119875 = 0005) andgroup times time (119865 = 279 119875 = 003) (Table 3)

35 Effect of Aroma Massage on 24-Hour Ambulatory BPThe 24-hour ambulatory BP was measured before and afterthe intervention for the experimental placebo and controlgroupsThere were no significant differences between groupsin 24-hour ambulatory daytime BP and 24-hour ambulatorynocturnal BP (Table 4)

36 Effect of Aroma Massage on Sleep Quality There weresignificant differences between groups (119865 = 675 119875 = 0002)after intervention (Table 5)Therewere significant differencesin changes of sleep quality between groups (119865 = 932 119875 lt0001) In a post-hoc analysis the aroma massage groupshowed significant improvement in sleep quality comparedwith placebo and no-treatment groups (Tukey 119875 lt 005)

4 Discussion

This study investigated the effects of aroma massage onhome BP 24-hour ambulatory BP and sleep quality in

6 Evidence-Based Complementary and Alternative Medicine

Table 3 Aroma massage on office BP

Time Aroma (119899 = 28) Placebo (119899 = 28) 119905 119875

SBP1st session

Pre 1240 plusmn 111 1258 plusmn 157 minus049 063Post 1128 plusmn 124 1189 plusmn 152 minus163 011

2nd sessionPre 1190 plusmn 117 1214 plusmn 115 minus078 044Post 1085 plusmn 108 1197 plusmn 133 minus344 0001

3rd sessionPre 1182 plusmn 107 1223 plusmn 131 minus128 021Post 1097 plusmn 111 1186 plusmn 139 minus265 001

4th sessionPre 1190 plusmn 103 1251 plusmn 155 minus175 009Post 1111 plusmn 99 1229 plusmn 159 minus333 0002

5th sessionPre 1194 plusmn 121 1266 plusmn 157 minus193 006Post 1089 plusmn 97 1250 plusmn 146 minus487 lt0001

Group 119865 = 1334 119875 = 0001 time 119865 = 215 119875 = 008group times time 119865 = 363 119875 = 0007

DBP1st session

Pre 743 plusmn 77 760 plusmn 109 minus067 051Post 718 plusmn 84 747 plusmn 97 minus119 024

2nd sessionPre 721 plusmn 84 743 plusmn 80 minus101 032Post 678 plusmn 78 748 plusmn 93 minus309 0003

3rd sessionPre 727 plusmn 77 737 plusmn 80 minus050 062Post 702 plusmn 78 746 plusmn 83 minus208 004

4th sessionPre 731 plusmn 68 760 plusmn 98 minus127 021Post 720 plusmn 67 774 plusmn 101 minus238 002

5th sessionPre 726 plusmn 83 760 plusmn 99 minus138 018Post 695 plusmn 64 781 plusmn 103 minus376 lt0001

Group 119865 = 846 119875 = 0005 time 119865 = 384 119875 = 0005group times time 119865 = 279 119875 = 003

Values are expressed as mean plusmn standard deviationBP blood pressure DBP diastolic blood pressure SBP systolic blood pres-sure

middle-agedwomenwith hypertensionTheresults show thataroma massage significantly reduced home SBP comparedwith the placebo and no-treatment groups

The aromamassage group showed an approximate reduc-tion of 15mmHg for home SBP while the placebo groupshowed an approximate reduction of 6mmHg One previousstudy showed a reduction of 4mmHg in SBP using posteriorneck massage three times a week for six weeks with lavenderoil [15] Comparing with these results the effect observedwith once-weekly overall body massage in this study showsthat it is very effective in lowering BP The oils used inthis study (a blend of lavender ylang-ylang marjoram and

Table 4 Aroma massage on 24-hour ambulatory BP

Time Aroma Placebo Control119865 119875

(119899 = 28) (119899 = 28) (119899 = 27)SBP

DaytimePre 1348 plusmn 120 1362 plusmn 135 1285 plusmn 125 288 06Post 1303 plusmn 117 1284 plusmn 122 1339 plusmn 129 137 26

Night timePre 1222 plusmn 158 1249 plusmn 139 1191 plusmn 164 098 38Post 1175 plusmn 156 1190 plusmn 99 1229 plusmn 181 093 40

DBPDaytime

Pre 827 plusmn 86 836 plusmn 81 816 plusmn 94 037 69Post 814 plusmn 83 800 plusmn 81 834 plusmn 89 107 35

Night timePre 748 plusmn 99 764 plusmn 89 744 plusmn 111 030 74Post 736 plusmn 105 717 plusmn 68 746 plusmn 110 059 55

Values are expressed as mean plusmn standard deviationBP blood pressure DBP diastolic blood pressure SBP systolic blood pres-sure

Table 5 Aroma massage on sleep quality

Time Aroma Placebo Control119865 119875

(119899 = 28) (119899 = 28) (119899 = 27)Pre 510 plusmn 126 481 plusmn 158 556 plusmn 105 224 011Post 581 plusmn 113

a465 plusmn 138

b503 plusmn 109

b 675 0002Difference 71 plusmn 126

aminus16 plusmn 96

bminus53 plusmn 106

b 932 lt0001Values are expressed as mean plusmn standard deviationMeans for each group with different superscript (a b or c) indicate asignificant difference (Tukey test 119875 lt 005)

Neroli) are thought to have produced synergistic effects inlowering BP compared with a simple lavender oil [13] Inaddition previous research using inhalation therapy usinglavender ylang-ylang and bergamot showed a decrease of1910mmHg in BP and showed synergistic effects in loweringBP compared to this study [14]

The aroma massage may reduce BP by inducing thephysical relaxation and decreasing activation of sympatheticnervous system In this study the placebo groupwith artificialfragrance also showed decreased BP with massage This isthought to be due to the effect of massage rather than theartificial fragrance

In particular the office SBP decreased by 12mmHg afterthe first massage and 11mmHg after the fifth massage in thearoma massage group This shows the acute effect of aromamassage for immediate decreasing of BP The BP decreaseafter the firstmassage in the placebo groupwas approximately7mmHg However it did not show substantial reduction asmassage sessions progressed pointing to a temporary effectof massage with artificial fragrance

The home DBP decreased by approximately 4mmHg inthe experimental group 3mmHg in the placebo group and1mmHg in the control group showing no difference amongthe groups The office DBP before and after massage showed

Evidence-Based Complementary and Alternative Medicine 7

a reduction of approximately 5mmHg in the experimentalgroup as opposed to an elevation of 2mmHg in the placebogroup The effect of aroma massage in reducing DBP is lim-ited although there appears to be some immediate reducingeffect of aroma massage for office DBP

There was no difference in 24-hour ambulatory BPbetween groups A once-weekly intervention of aroma mas-sage and cream application does not appear to promotepositive 24-hour ambulatory BP Therefore further researchon the frequency of massage and the active ingredients andtypes of oils used is necessary

In terms of sleep quality the aroma massage groupshowed an improvement while the placebo and no-treatmentgroups failed to do so This result appears to be due to theeffect of the essential oil used in this study on the autonomicnervous system to increase the quality of sleep [7 9] Theseresults are in line with those of a study by Jung and Jeon[16] They used a mixture of lavender bergamot and clarysage in a 3 2 1 ratio applied to hemiplegic patients on thearm hand and the lower neck through aroma massage andshowed reduction of sleep disturbance score The results ofthis study are consistent with the other study of middle-agedwomen using a lavender essential oil necklace and one totwo drops of lavender essential oil on the pillow before sleep(instead of the necklace) [17] which showed improvement insleep quality

Our study did not take into account the preference ofparticipants for aroma fragrance Althoughmost participantsreported a good feeling toward the aroma some reportedpreference for another fragranceThus the psychological andphysical responses may vary depending on the fragrancepreference of the subject receiving the aromatherapy

In conclusion aroma massage was effective in reducinghome SBP and immediate office BP before and after theintervention as well as increasing sleep quality in middle-aged women with hypertension Further research comparingthe effects of various and convenient aromatherapy methodsincluding bathing topical application and foot washing isneeded

Conflict of Interests

The authors declare no conflict of interests

Acknowledgment

This work was supported by the National Research Founda-tion of Korea (NRF)Grant funded by the Korean governmentMEST (no 2008-0061658) M S Lee was supported by KoreaInstitute of Oriental Medicine (K12130)

References

[1] World Health Organization Chronic Diseases World HealthOrganization Geneva Switzerland 2012

[2] National Health Statistics ldquoNational health nutrition surveyquaternary period secondary sourcerdquo Approval Number Statis-tics 11702 The Ministry of Health and Welfare 2008

[3] B H LeeManual of Hypertension Deahanuihakseojeok SeoulKorea 2009

[4] P Bansil E V Kuklina R K Merritt and P W YoonldquoAssociations between sleep disorders sleep duration qualityof sleep and hypertension results from theNational Health andNutrition Examination Survey 2005 to 2008rdquo Journal of ClinicalHypertension vol 13 no 10 pp 739ndash743 2011

[5] D D Smeltzer B G Bare J L Hinkle and K H CheeverBrunner amp Suddarthrsquos Textbook of Medical-Surgical NursingWolsters KluwerLippincott Williams amp Wilkins PhiladelphiaPa USA 2010

[6] S Battaglia The Complete Guide to Aromatherapy The Inter-national Centre of Holistic Aromatherapy Brisbane Australia2003

[7] B J Ha Aromatherapy Soo Moon Sa Seoul Korea 2006[8] P Daniel P Shirley and P Len Aromatherphy for Healt

Professionals Churchill Livingstone London UK 2001[9] S H Han M H Hur J H Park E J Lee and M K Park

Womenrsquos Health and Aromatherapy Hyun Moon Sa SeoulKorea 2002

[10] J F Owens and K A Matthews ldquoSleep disturbance in healthymiddle-aged womenrdquoMaturitas vol 30 no 1 pp 41ndash50 1998

[11] P Vara ldquoThe climacterium from the gynaecologist1015840s point ofviewrdquo Acta Obstetricia et Gynecologica Scandinavica Supple-ment vol 49 supplement 1 pp 43ndash55 1970

[12] MH Hur H OhM S Lee C Kim A N Choi andG R ShinldquoEffects of aromatherapy massage on blood pressure and lipidprofile in Korean climacteric womenrdquo International Journal ofNeuroscience vol 117 no 9 pp 1281ndash1287 2007

[13] Y J Jung Effects of Aromatherapy on Blood Pressure Heart RateVariability and Serum Catecholamines in the Pre-HypertensionMiddle AgedWomen Department of Nursing Catholic Univer-sity Seoul Korea 2007

[14] J H Hwang ldquoThe effects of the inhalation method usingessential oils on blood pressure and stress responses of clientswith essential hypertensionrdquo Journal of Korean Academy ofNursing vol 36 no 7 pp 1123ndash1134 2006

[15] Y K Choi and S Lee ldquoThe effect of posterior neck massageusing maychang oil on the blood pressure and componentsin elderly women who have hypertensionrdquo Journal of KoreanBeauty Society vol 17 no 2 pp 211ndash217 2011

[16] H M Jung and Y S Jeon ldquoEffects of the aroma massage onshoulder pain depression sleep disturbance in hemiparesispatientsrdquo The Korean Journal of Rehabilitation Nursing vol 7no 2 pp 231ndash237 2004

[17] G H Lee K M Park and M K Ryu ldquoThe effect of aro-matherapy with lavender essential oil on sleep disturbanceand depression on middle-aged womenrdquo Journal of the KoreanSociety of Maternal and Child Health vol 6 no 1 pp 23ndash372002

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Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

2 Evidence-Based Complementary and Alternative Medicine

sleep and the quality of sleep can influence hypertension[4]

The management of hypertension aims at preventing endorgan complications and mortality due to hypertension withthe target BP below 14090mmHg [3 5] The goal of nursingintervention is to increase patient understanding of thehypertension process and its treatment and increase patientinvolvement in self-management programs to ultimatelyprevent hypertension complications [5]

Recently there has been an increasing interest in holis-tic interventions combining traditional and complementarytherapies for health promotion andmaintenanceAromather-apy is a form of complementary therapy using essential oilextracted from plants The oil is applied through differentmeans to achieve various effects through its chemical prop-erties and application methods [6 7] Of the aromatherapyessential oils lavender (Lavandula officinalis) marjoram(Origanum majorana) ylang-ylang (Cananga odorata) andNeroli (Citrus aurantium) are used for hypertensive patientsLavender is the selective oil that balances the nervous systemand alleviates insomnia while marjoram activates parasym-pathetic nervous system and relaxes the sympathetic nervoussystem Ylang-ylang controls cardiac palpitations and hyper-tension andNeroli oil is effective in insomnia anddepressionThemain chemical ingredients of lavender marjoram ylang-ylang and neroli are linalyl acetate terpinen-4-ol benzylacetate and limonene respectively [6]

Aroma massage combines massage with essential oils tostimulate blood and lymphatic circulation and improve oxy-gen and nutrient supply and it is effective for the relaxation oftensemuscles pain relief and alleviation of emotional distur-bances [6 8 9] Women in middle age experience changes inthe autonomic nervous system such as increases in adrenalcortex hormones and catecholamines leading to increasedBP and unsuccessful psychological management which canhave effects such as depression anxiety and insomnia [10 11]Recent research on the effects of aromatherapy on BP andsleep has targeted menopausal women [12] prehypertensivemiddle-aged women [13] and stage 1 hypertensive patients[14] But there have been no studies using aromamassage andbody cream as a method of aromatherapy

Thus the aim of this study was to evaluate the effect ofaroma massage on home BP office BP ambulatory BP andsleep quality

2 Methods

21 Study Design This study is a nonequivalent controlgroup nonsynchronized study intended to compare theeffects of aroma massage on home BP office BP ambulatoryBP and sleep in middle-aged women with hypertension(Figure 1) To prevent the spread and contamination ofdata as a part of the nonsynchronized study design thecontrol group data were collected before the data from theintervention group (aroma massage group) and the placebogroup (artificial fragrance massage group)

22 Participants and Data Collection The participants wererecruited between March 15 and June 30 of 2011 at E

Control group

No treatment

April-May June-July July-August

Placebo group

Artificial fragrance massage

Experimental group

Aroma massage

Figure 1 Study design

University Hospital in D city outpatient clinic in the depart-ment of internal medicine Ethical approval was obtainedfrom the institutional review board (IRB) after submissionof the research plan A notice was sent to the departmentand the participants were recruited from patients diagnosedwith hypertension and receiving ongoing outpatient cardi-ology followup after consultation with an internal medicinespecialist The eligibility criteria included the following (1)a diagnosis of hypertension and ongoing followup treatmentor consultation at outpatient cardiology clinic (2) womenbetween the ages of 40 and 59 (3) ability to communicateand describe symptoms (4) not currently taking anxiolyticsor hypnotics (5) no presence of psychiatric disorders and (6)providing informed consent regarding the experiment

The participants were recruited from hypertensivepatients using a notice sent to the Internal MedicineOutpatient Clinic their gender medications and conformityto the eligibility criteria were reviewed The study inter-ventions measurement methods and the ability to enrolland drop out of the study were explained to participantsand consent was obtained from those in agreement Theparticipants were instructed to visit the research officeon the intervention day according to the schedule andavoid excessive exercise and diet during the study periodand to notify the researchers when there was a change inantihypertensive medication prescription

23 Sample Size Calculation The sample size of this studywas determined using the Glowast power program and by assign-ing alpha value power and effect size The effect size wasdetermined based on a prior aromatherapy study [14] andassigning mean sample size and pooled variance in the Glowastpower program To calculate the sample size we substituted120572(005) 1-120573 (080) group (3) and effect size (034) Thesample size was determined to be a total of 90 participantsin the three groups using Glowast power In addition estimatinga dropout rate of 10 33 participants were assigned tothe experimental group the control group and the placebogroup for a total of 99 participants

24 Interventions The intervention used in the experimentalgroup was the application of aroma massage and aromabody cream The placebo group received massage and bodycream with an artificial fragrance and the control groupdid not receive any intervention According to the schedulethere were a total of five sessions in the research office forfour weeks The aroma massage oil used contained essentialoils prescribed by an international aromatherapist preparedby blending lavender marjoram ylang-ylang and Neroli at

Evidence-Based Complementary and Alternative Medicine 3

a ratio of 20 10 15 2 followed by dilution to 3 with acarrier oil prepared by blending almond oil and jojoba oilat ratio of 9 1 Such prepared massage oil was preservedat room temperature for use The aroma body cream wassynthesized according to the prescription of an internationalaromatherapist The oil base was prepared by combining100mL of jojoba oil 100mL of sweet almond oil 100mL ofevening primrose oil and 30mL of olive wax The water basewas prepared by adding 700mL of rose water and 20 g ofvitamin E in a glass beaker and heating in boiling water untilthe temperature reached over 70sim75∘C at which point thewater basewas added to the oil baseThewater base combinedwith oil base was mixed using a blender for 10ndash15 minutesuntil the temperature reached below 40∘C at which point theblending oil used for massage (lavender marjoram ylang-ylang and Neroli blended in 20 10 15 2 ratio) was added toproduce a 3 diluted body cream

Four research assistants providing massage were taughtaroma massage theory and massage protocols (4 hours) andreceived practical training (4 hours) from an internationalaromatherapist The assistants performed practice massagesbefore providing massages to participants according tothe massage protocols Aroma massage was provided in aresearch office that was divided into a waiting room and amassage room for study purposes at E University Accordingto the schedule once the study participants arrived at theoffice they changed into a massage gown and relaxed in asupine position on the bed for 10 minutes followed by BPmeasurement using a digital sphygmomanometer (OmronHEM-780 Japan) as a preintervention measurement andmassage according to the massage protocol The massagewas performed in the order of back posterior legs anteriorlegs abdomen arms and shoulders The total amount of oilneeded for the massage was approximately 30mL and theduration of massage was approximately 1 hour Ten minutesafter the massage was completed another BP measurementwas taken as a postinterventional BP using the same methodas the preinterventional measurement and the participantswere provided with 150mL of lukewarm water to drink Atotal of 200mL of prepared aroma body cream was providedto the participants after the first massage with instructionsto apply approximately 10mL on arm legs and abdomenexcluding the chest and back after showering andbefore sleepevery day

Artificial fragrance massage oil and body cream wereprepared and used for the placebo group Almond oil andjojoba oil were blended in a 9 1 ratio to produce the carrieroil in which artificial fragrance was diluted to 3 Themassage oil was stored at room temperature for use Theartificial fragrance body cream was produced and applied bythe researchers and research assistants as the same methodof making a massage oil and body cream The control groupreceived no intervention

25 Outcome Measures

251 Blood Pressure HomeBPwasmeasured by participantsevery Tuesday and Friday at 10 AM after 10 minutes of restusing a home digital BP machine Two measurements were

performed on the left upper arm and the average of theBP measurements was calculated The 24-hour ambulatoryBP was measured using a 24-hour ambulatory BP monitor(AND TM-2430 Japan) Daytime BP was measured every 30minutes between 6 AM and 930 PM while the nighttime BPwas measured every hour between 10 PM and 6 AM the nextmorning These measurements were performed once beforeand once after the intervention

252 Sleep Quality To assess sleep quality in this study atranslated version ofVerran and Synder-Halpern (VSH) SleepScale (1987) by Kang (1992) was used The tool assesses fourcategories related to beginning of sleep and depth of sleep fora total of 8 questions each on a scale of 0ndash10 (a total rangeof 0ndash80) with higher score corresponding to a higher sleepsatisfaction

26 Data Collection and Analyses Prior to beginning thestudy the participants were asked to relax for 10 minutesbefore measuring their preinterventional BP and obtainingsleep status and 24-hour ambulatory BP measurements Totest the effects of aromatherapy essential oil massage theexperimental group received massage once a week usingdiluted blended essential oil and daily application of bodycream while the placebo group received a massage withcarrier oil with artificial fragrance once a week and dailyapplication of body cream The control group receivedno interventions To measure the postinterventional effecttwice-weekly home BP was measured until week 3 in thefourth week home BP 24-hour ambulatory BP and sleepstatus were evaluated

The statistical analysis of the data was performed usingSPSS 190 softwareThe general characteristics of participantswere analyzed in terms of frequency number and percentageusing 1205942-test and ANOVA The test for homogeneity onpreinterventional dependent variables between the experi-mental group the placebo group and the control group wasconducted using ANOVA The pre- and postinterventionalBP and the sleep status of the participants in the experimentalplacebo and control groups were analyzed using ANOVArepeated measures ANCOVA and 1205942-test while the post-hoc analysis was performed with the Tukey method Thereliability of the measurement tool for quality of sleep wasanalyzed using internal reliability Cronbachrsquos 120572 value

3 Results

31 Participants A total of 99 eligible participants wererecruited to the study Of them three patients were lost tofollowup in the experimental group due to home situationsone patient was admitted with psychiatric issues and onehad a change in BP medication leading to a final total of 28participants in the experimental group The placebo grouphad three patients lost to followup due to home situationsone due to antihypertensive medication changes and onehad mild pruritus and dropped out after two attempts forparticipation leading to a final total of 28 participants Thecontrol group had four participants lost to followup due to

4 Evidence-Based Complementary and Alternative Medicine

Table 1 Homogeneity between groups

Categories Aroma (119899 = 28) Placebo (119899 = 28) Control (119899 = 27) 1205942 or 119865 P

Mean plusmn SDAge (yr) 525 plusmn 46 541 plusmn 38 533 plusmn 46 101 37Height (cm) 1571 plusmn 69 1580 plusmn 49 1584 plusmn 38 044 68Weight (kg) 618 plusmn 74 636 plusmn 76 642 plusmn 70 081 45Age of menarche (yr) 156 plusmn 168 154 plusmn 19 156 plusmn 18 015 86Age of first birth (yr) 261 plusmn 43 258 plusmn 36 266 plusmn 45 022 80First SBP (mmHg) 1281 plusmn 122 1275 plusmn 144 1215 plusmn 131 206 13First DBP (mmHg) 797 plusmn 95 804 plusmn 113 801 plusmn 106 004 96First PR (bpm) 692 plusmn 87 710 plusmn 124 708 plusmn 86 026 77

119873 ()Marital status

Married 26 (929) 26 (929) 22 (815) 344 30Single 2 (71) 2 (71) 5 (185)

EducationMiddle school 4 (133) 8 (286) 5 (185) 284 58High school 13 (464) 12 (429) 15 (556)University 11 (393) 8 (286) 7 (259)

Presence of menopausePostmenopausal 14 (500) 15 (536) 17 (654) 379 47Intramenopausal 8 (286) 10 (357) 4 (154)No menopausal 6 (214) 3 (107) 5 (192)

DrinkingNo 18 (643) 18 (643) 17 (630) 001 99Yes 10 (357) 10 (357) 10 (370)

SmokingNo 27 (964) 28 (100) 25 (926) 217 34Yes 1 (36) 0 (00) 2 (74)

ExerciseNo exercise 5 (179) 8 (286) 7 (259) 213 71Less than two times per week 10 (357) 12 (429) 10 (370)More than three times per week 13 (464) 8 (286) 10 (370)

DBP diastolic blood pressure PR pulse rate SBP systolic blood pressure

home situation one patient who refused to participate dueto inability to perform 24-hour ambulatory BP monitoringat work and one patient who could not participate due tooverseas travelling leading to a final total of 27 participantsTherefore there were 83 members in the study analyzed asfinal eligible study participants

32 Homogeneity between the Groups The general character-istics of the participants in the experimental placebo andcontrol groups are shown in Table 1 No statistical differenceswere found between the groups with regards tomarital statuslevel of education presence of menopause drinking smok-ing and exercise There were also no significant differencesin age height weight age of menarche age of first birthbaseline SBP baseline DBP and baseline pulse rate

33 Effect of AromaMassage on Home BP The SBP and DBPweremeasured twice weekly for a total of eightmeasurementsto evaluate the effect of aroma massage on participant home

BP (Table 2) The SBP measurements over four weeks didnot show significant differences with time and there wasno interaction between the groups and time on repeatedmeasures ANCOVAusing initial SBP as a covariate Howeverthere were significant differences in repeated measurementsof SBP depending on the group (119865 = 671 119875 = 0002) Thepost-hoc analysis with the Tukey method showed that theexperimental group showed significant differences comparedto the placebo group and the control group (119875 lt 005)

The eight DBP measurements over four weeks did notshow significant differenceswith time and therewas no inter-action between the groups and time on repeated measuresANCOVA using initial DBP as a covariate There was nodifference in DBP measurements within the 3 groups

34 Effect of Aroma Massage on Office BP To determinethe immediate effect of aroma massage BP measurementswere taken before the massage in the office followed by SBPmeasurement 10 minutes after the massage to compare with

Evidence-Based Complementary and Alternative Medicine 5

Table 2 Aroma massage on home BP

Time Aroma (119899 = 28) Placebo (119899 = 28) Control (119899 = 27) 119865 119875

SBPBaseline 1281 plusmn 122 1275 plusmn 144 1215 plusmn 131 206 0131st week

Tue 1207 plusmn 141 1212 plusmn 124 1257 plusmn 123 124 029Fri 1185 plusmn 138 1228 plusmn 137 1233 plusmn 110 112 033

2nd weekTue 1206 plusmn 110 1216 plusmn 123 1224 plusmn 119 016 085Fri 1179 plusmn 101 1176 plusmn 134 1217 plusmn 113 106 035

3rd weekTue 1160 plusmn 125 1186 plusmn 127 1223 plusmn 118 177 018Fri 1147 plusmn 126 1195 plusmn 111 1219 plusmn 120 265 008

4th weekTue 1156 plusmn 93 1216 plusmn 121 1222 plusmn 111 321 005Fri 1133 plusmn 110a 1218 plusmn 113b 1209 plusmn 121b 466 001

Group 119865 = 671 119875 = 0002 time 119865 = 046 119875 = 086 group times time 119865 = 168 119875 = 007DBP

Baseline 797 plusmn 95 804 plusmn 113 801 plusmn 106 004 0961st week

Tue 790 plusmn 84 778 plusmn 91 815 plusmn 110 106 096Fri 788 plusmn 99 794 plusmn 101 815 plusmn 110 026 067

2nd weekTue 809 plusmn 66 787 plusmn 66 792 plusmn 98 052 036Fri 799 plusmn 83 770 plusmn 102 796 plusmn 91 086 021

3rd weekTue 794 plusmn 87 764 plusmn 115 810 plusmn104 145 013Fri 779 plusmn 95 768 plusmn 110 801 plusmn 76 091 040

4th weekTue 775 plusmn 91 782 plusmn 101 794 plusmn 86 029 090Fri 759 plusmn 81 774 plusmn 105 794 plusmn 101 089 066

Group 119865 = 102 119875 = 037 time 119865 = 053 119875 = 081 group times time 119865 = 146 119875 = 013Values are expressed as mean plusmn standard deviationMeans for each group with different superscript (a or b) indicate a significant difference (Tukey test 119875 lt 005)BP blood pressure DBP diastolic blood pressure PR pulse rate SBP systolic blood pressure

the office BP The postintervention office SBP measured aftereach of the fivemassages did not show significant differencesbetween the two groups after the first massage The aromamassage group showed significantly reduced SBP after thesecond (119905 = minus3444 119875 = 0001) third (119905 = minus265 119875 = 001)fourth (119905 = minus333 119875 = 0002) and fifth sessions (119905 = minus487119875 lt 0001)There was statistical significance in groups times time(119865 = 363 119875 = 0007) and the groups (119865 = 1334 119875 = 0001)while there was not statistically significant in time

Postintervention office DBP after the first session didnot show significant differences between the two groupsHowever there were significant differences between groupsafter the second (119905 = minus309 119875 = 0003) third (119905 = minus208119875 = 004) fourth (119905 = minus238 119875 = 002) and fifth sessions(119905 = minus376 119875 lt 0001) in office DBP The results of repeatedmeasures ANOVA showed significant difference with time(119865 = 384 119875 = 0005) groups (119865 = 846 119875 = 0005) andgroup times time (119865 = 279 119875 = 003) (Table 3)

35 Effect of Aroma Massage on 24-Hour Ambulatory BPThe 24-hour ambulatory BP was measured before and afterthe intervention for the experimental placebo and controlgroupsThere were no significant differences between groupsin 24-hour ambulatory daytime BP and 24-hour ambulatorynocturnal BP (Table 4)

36 Effect of Aroma Massage on Sleep Quality There weresignificant differences between groups (119865 = 675 119875 = 0002)after intervention (Table 5)Therewere significant differencesin changes of sleep quality between groups (119865 = 932 119875 lt0001) In a post-hoc analysis the aroma massage groupshowed significant improvement in sleep quality comparedwith placebo and no-treatment groups (Tukey 119875 lt 005)

4 Discussion

This study investigated the effects of aroma massage onhome BP 24-hour ambulatory BP and sleep quality in

6 Evidence-Based Complementary and Alternative Medicine

Table 3 Aroma massage on office BP

Time Aroma (119899 = 28) Placebo (119899 = 28) 119905 119875

SBP1st session

Pre 1240 plusmn 111 1258 plusmn 157 minus049 063Post 1128 plusmn 124 1189 plusmn 152 minus163 011

2nd sessionPre 1190 plusmn 117 1214 plusmn 115 minus078 044Post 1085 plusmn 108 1197 plusmn 133 minus344 0001

3rd sessionPre 1182 plusmn 107 1223 plusmn 131 minus128 021Post 1097 plusmn 111 1186 plusmn 139 minus265 001

4th sessionPre 1190 plusmn 103 1251 plusmn 155 minus175 009Post 1111 plusmn 99 1229 plusmn 159 minus333 0002

5th sessionPre 1194 plusmn 121 1266 plusmn 157 minus193 006Post 1089 plusmn 97 1250 plusmn 146 minus487 lt0001

Group 119865 = 1334 119875 = 0001 time 119865 = 215 119875 = 008group times time 119865 = 363 119875 = 0007

DBP1st session

Pre 743 plusmn 77 760 plusmn 109 minus067 051Post 718 plusmn 84 747 plusmn 97 minus119 024

2nd sessionPre 721 plusmn 84 743 plusmn 80 minus101 032Post 678 plusmn 78 748 plusmn 93 minus309 0003

3rd sessionPre 727 plusmn 77 737 plusmn 80 minus050 062Post 702 plusmn 78 746 plusmn 83 minus208 004

4th sessionPre 731 plusmn 68 760 plusmn 98 minus127 021Post 720 plusmn 67 774 plusmn 101 minus238 002

5th sessionPre 726 plusmn 83 760 plusmn 99 minus138 018Post 695 plusmn 64 781 plusmn 103 minus376 lt0001

Group 119865 = 846 119875 = 0005 time 119865 = 384 119875 = 0005group times time 119865 = 279 119875 = 003

Values are expressed as mean plusmn standard deviationBP blood pressure DBP diastolic blood pressure SBP systolic blood pres-sure

middle-agedwomenwith hypertensionTheresults show thataroma massage significantly reduced home SBP comparedwith the placebo and no-treatment groups

The aromamassage group showed an approximate reduc-tion of 15mmHg for home SBP while the placebo groupshowed an approximate reduction of 6mmHg One previousstudy showed a reduction of 4mmHg in SBP using posteriorneck massage three times a week for six weeks with lavenderoil [15] Comparing with these results the effect observedwith once-weekly overall body massage in this study showsthat it is very effective in lowering BP The oils used inthis study (a blend of lavender ylang-ylang marjoram and

Table 4 Aroma massage on 24-hour ambulatory BP

Time Aroma Placebo Control119865 119875

(119899 = 28) (119899 = 28) (119899 = 27)SBP

DaytimePre 1348 plusmn 120 1362 plusmn 135 1285 plusmn 125 288 06Post 1303 plusmn 117 1284 plusmn 122 1339 plusmn 129 137 26

Night timePre 1222 plusmn 158 1249 plusmn 139 1191 plusmn 164 098 38Post 1175 plusmn 156 1190 plusmn 99 1229 plusmn 181 093 40

DBPDaytime

Pre 827 plusmn 86 836 plusmn 81 816 plusmn 94 037 69Post 814 plusmn 83 800 plusmn 81 834 plusmn 89 107 35

Night timePre 748 plusmn 99 764 plusmn 89 744 plusmn 111 030 74Post 736 plusmn 105 717 plusmn 68 746 plusmn 110 059 55

Values are expressed as mean plusmn standard deviationBP blood pressure DBP diastolic blood pressure SBP systolic blood pres-sure

Table 5 Aroma massage on sleep quality

Time Aroma Placebo Control119865 119875

(119899 = 28) (119899 = 28) (119899 = 27)Pre 510 plusmn 126 481 plusmn 158 556 plusmn 105 224 011Post 581 plusmn 113

a465 plusmn 138

b503 plusmn 109

b 675 0002Difference 71 plusmn 126

aminus16 plusmn 96

bminus53 plusmn 106

b 932 lt0001Values are expressed as mean plusmn standard deviationMeans for each group with different superscript (a b or c) indicate asignificant difference (Tukey test 119875 lt 005)

Neroli) are thought to have produced synergistic effects inlowering BP compared with a simple lavender oil [13] Inaddition previous research using inhalation therapy usinglavender ylang-ylang and bergamot showed a decrease of1910mmHg in BP and showed synergistic effects in loweringBP compared to this study [14]

The aroma massage may reduce BP by inducing thephysical relaxation and decreasing activation of sympatheticnervous system In this study the placebo groupwith artificialfragrance also showed decreased BP with massage This isthought to be due to the effect of massage rather than theartificial fragrance

In particular the office SBP decreased by 12mmHg afterthe first massage and 11mmHg after the fifth massage in thearoma massage group This shows the acute effect of aromamassage for immediate decreasing of BP The BP decreaseafter the firstmassage in the placebo groupwas approximately7mmHg However it did not show substantial reduction asmassage sessions progressed pointing to a temporary effectof massage with artificial fragrance

The home DBP decreased by approximately 4mmHg inthe experimental group 3mmHg in the placebo group and1mmHg in the control group showing no difference amongthe groups The office DBP before and after massage showed

Evidence-Based Complementary and Alternative Medicine 7

a reduction of approximately 5mmHg in the experimentalgroup as opposed to an elevation of 2mmHg in the placebogroup The effect of aroma massage in reducing DBP is lim-ited although there appears to be some immediate reducingeffect of aroma massage for office DBP

There was no difference in 24-hour ambulatory BPbetween groups A once-weekly intervention of aroma mas-sage and cream application does not appear to promotepositive 24-hour ambulatory BP Therefore further researchon the frequency of massage and the active ingredients andtypes of oils used is necessary

In terms of sleep quality the aroma massage groupshowed an improvement while the placebo and no-treatmentgroups failed to do so This result appears to be due to theeffect of the essential oil used in this study on the autonomicnervous system to increase the quality of sleep [7 9] Theseresults are in line with those of a study by Jung and Jeon[16] They used a mixture of lavender bergamot and clarysage in a 3 2 1 ratio applied to hemiplegic patients on thearm hand and the lower neck through aroma massage andshowed reduction of sleep disturbance score The results ofthis study are consistent with the other study of middle-agedwomen using a lavender essential oil necklace and one totwo drops of lavender essential oil on the pillow before sleep(instead of the necklace) [17] which showed improvement insleep quality

Our study did not take into account the preference ofparticipants for aroma fragrance Althoughmost participantsreported a good feeling toward the aroma some reportedpreference for another fragranceThus the psychological andphysical responses may vary depending on the fragrancepreference of the subject receiving the aromatherapy

In conclusion aroma massage was effective in reducinghome SBP and immediate office BP before and after theintervention as well as increasing sleep quality in middle-aged women with hypertension Further research comparingthe effects of various and convenient aromatherapy methodsincluding bathing topical application and foot washing isneeded

Conflict of Interests

The authors declare no conflict of interests

Acknowledgment

This work was supported by the National Research Founda-tion of Korea (NRF)Grant funded by the Korean governmentMEST (no 2008-0061658) M S Lee was supported by KoreaInstitute of Oriental Medicine (K12130)

References

[1] World Health Organization Chronic Diseases World HealthOrganization Geneva Switzerland 2012

[2] National Health Statistics ldquoNational health nutrition surveyquaternary period secondary sourcerdquo Approval Number Statis-tics 11702 The Ministry of Health and Welfare 2008

[3] B H LeeManual of Hypertension Deahanuihakseojeok SeoulKorea 2009

[4] P Bansil E V Kuklina R K Merritt and P W YoonldquoAssociations between sleep disorders sleep duration qualityof sleep and hypertension results from theNational Health andNutrition Examination Survey 2005 to 2008rdquo Journal of ClinicalHypertension vol 13 no 10 pp 739ndash743 2011

[5] D D Smeltzer B G Bare J L Hinkle and K H CheeverBrunner amp Suddarthrsquos Textbook of Medical-Surgical NursingWolsters KluwerLippincott Williams amp Wilkins PhiladelphiaPa USA 2010

[6] S Battaglia The Complete Guide to Aromatherapy The Inter-national Centre of Holistic Aromatherapy Brisbane Australia2003

[7] B J Ha Aromatherapy Soo Moon Sa Seoul Korea 2006[8] P Daniel P Shirley and P Len Aromatherphy for Healt

Professionals Churchill Livingstone London UK 2001[9] S H Han M H Hur J H Park E J Lee and M K Park

Womenrsquos Health and Aromatherapy Hyun Moon Sa SeoulKorea 2002

[10] J F Owens and K A Matthews ldquoSleep disturbance in healthymiddle-aged womenrdquoMaturitas vol 30 no 1 pp 41ndash50 1998

[11] P Vara ldquoThe climacterium from the gynaecologist1015840s point ofviewrdquo Acta Obstetricia et Gynecologica Scandinavica Supple-ment vol 49 supplement 1 pp 43ndash55 1970

[12] MH Hur H OhM S Lee C Kim A N Choi andG R ShinldquoEffects of aromatherapy massage on blood pressure and lipidprofile in Korean climacteric womenrdquo International Journal ofNeuroscience vol 117 no 9 pp 1281ndash1287 2007

[13] Y J Jung Effects of Aromatherapy on Blood Pressure Heart RateVariability and Serum Catecholamines in the Pre-HypertensionMiddle AgedWomen Department of Nursing Catholic Univer-sity Seoul Korea 2007

[14] J H Hwang ldquoThe effects of the inhalation method usingessential oils on blood pressure and stress responses of clientswith essential hypertensionrdquo Journal of Korean Academy ofNursing vol 36 no 7 pp 1123ndash1134 2006

[15] Y K Choi and S Lee ldquoThe effect of posterior neck massageusing maychang oil on the blood pressure and componentsin elderly women who have hypertensionrdquo Journal of KoreanBeauty Society vol 17 no 2 pp 211ndash217 2011

[16] H M Jung and Y S Jeon ldquoEffects of the aroma massage onshoulder pain depression sleep disturbance in hemiparesispatientsrdquo The Korean Journal of Rehabilitation Nursing vol 7no 2 pp 231ndash237 2004

[17] G H Lee K M Park and M K Ryu ldquoThe effect of aro-matherapy with lavender essential oil on sleep disturbanceand depression on middle-aged womenrdquo Journal of the KoreanSociety of Maternal and Child Health vol 6 no 1 pp 23ndash372002

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Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

Evidence-Based Complementary and Alternative Medicine 3

a ratio of 20 10 15 2 followed by dilution to 3 with acarrier oil prepared by blending almond oil and jojoba oilat ratio of 9 1 Such prepared massage oil was preservedat room temperature for use The aroma body cream wassynthesized according to the prescription of an internationalaromatherapist The oil base was prepared by combining100mL of jojoba oil 100mL of sweet almond oil 100mL ofevening primrose oil and 30mL of olive wax The water basewas prepared by adding 700mL of rose water and 20 g ofvitamin E in a glass beaker and heating in boiling water untilthe temperature reached over 70sim75∘C at which point thewater basewas added to the oil baseThewater base combinedwith oil base was mixed using a blender for 10ndash15 minutesuntil the temperature reached below 40∘C at which point theblending oil used for massage (lavender marjoram ylang-ylang and Neroli blended in 20 10 15 2 ratio) was added toproduce a 3 diluted body cream

Four research assistants providing massage were taughtaroma massage theory and massage protocols (4 hours) andreceived practical training (4 hours) from an internationalaromatherapist The assistants performed practice massagesbefore providing massages to participants according tothe massage protocols Aroma massage was provided in aresearch office that was divided into a waiting room and amassage room for study purposes at E University Accordingto the schedule once the study participants arrived at theoffice they changed into a massage gown and relaxed in asupine position on the bed for 10 minutes followed by BPmeasurement using a digital sphygmomanometer (OmronHEM-780 Japan) as a preintervention measurement andmassage according to the massage protocol The massagewas performed in the order of back posterior legs anteriorlegs abdomen arms and shoulders The total amount of oilneeded for the massage was approximately 30mL and theduration of massage was approximately 1 hour Ten minutesafter the massage was completed another BP measurementwas taken as a postinterventional BP using the same methodas the preinterventional measurement and the participantswere provided with 150mL of lukewarm water to drink Atotal of 200mL of prepared aroma body cream was providedto the participants after the first massage with instructionsto apply approximately 10mL on arm legs and abdomenexcluding the chest and back after showering andbefore sleepevery day

Artificial fragrance massage oil and body cream wereprepared and used for the placebo group Almond oil andjojoba oil were blended in a 9 1 ratio to produce the carrieroil in which artificial fragrance was diluted to 3 Themassage oil was stored at room temperature for use Theartificial fragrance body cream was produced and applied bythe researchers and research assistants as the same methodof making a massage oil and body cream The control groupreceived no intervention

25 Outcome Measures

251 Blood Pressure HomeBPwasmeasured by participantsevery Tuesday and Friday at 10 AM after 10 minutes of restusing a home digital BP machine Two measurements were

performed on the left upper arm and the average of theBP measurements was calculated The 24-hour ambulatoryBP was measured using a 24-hour ambulatory BP monitor(AND TM-2430 Japan) Daytime BP was measured every 30minutes between 6 AM and 930 PM while the nighttime BPwas measured every hour between 10 PM and 6 AM the nextmorning These measurements were performed once beforeand once after the intervention

252 Sleep Quality To assess sleep quality in this study atranslated version ofVerran and Synder-Halpern (VSH) SleepScale (1987) by Kang (1992) was used The tool assesses fourcategories related to beginning of sleep and depth of sleep fora total of 8 questions each on a scale of 0ndash10 (a total rangeof 0ndash80) with higher score corresponding to a higher sleepsatisfaction

26 Data Collection and Analyses Prior to beginning thestudy the participants were asked to relax for 10 minutesbefore measuring their preinterventional BP and obtainingsleep status and 24-hour ambulatory BP measurements Totest the effects of aromatherapy essential oil massage theexperimental group received massage once a week usingdiluted blended essential oil and daily application of bodycream while the placebo group received a massage withcarrier oil with artificial fragrance once a week and dailyapplication of body cream The control group receivedno interventions To measure the postinterventional effecttwice-weekly home BP was measured until week 3 in thefourth week home BP 24-hour ambulatory BP and sleepstatus were evaluated

The statistical analysis of the data was performed usingSPSS 190 softwareThe general characteristics of participantswere analyzed in terms of frequency number and percentageusing 1205942-test and ANOVA The test for homogeneity onpreinterventional dependent variables between the experi-mental group the placebo group and the control group wasconducted using ANOVA The pre- and postinterventionalBP and the sleep status of the participants in the experimentalplacebo and control groups were analyzed using ANOVArepeated measures ANCOVA and 1205942-test while the post-hoc analysis was performed with the Tukey method Thereliability of the measurement tool for quality of sleep wasanalyzed using internal reliability Cronbachrsquos 120572 value

3 Results

31 Participants A total of 99 eligible participants wererecruited to the study Of them three patients were lost tofollowup in the experimental group due to home situationsone patient was admitted with psychiatric issues and onehad a change in BP medication leading to a final total of 28participants in the experimental group The placebo grouphad three patients lost to followup due to home situationsone due to antihypertensive medication changes and onehad mild pruritus and dropped out after two attempts forparticipation leading to a final total of 28 participants Thecontrol group had four participants lost to followup due to

4 Evidence-Based Complementary and Alternative Medicine

Table 1 Homogeneity between groups

Categories Aroma (119899 = 28) Placebo (119899 = 28) Control (119899 = 27) 1205942 or 119865 P

Mean plusmn SDAge (yr) 525 plusmn 46 541 plusmn 38 533 plusmn 46 101 37Height (cm) 1571 plusmn 69 1580 plusmn 49 1584 plusmn 38 044 68Weight (kg) 618 plusmn 74 636 plusmn 76 642 plusmn 70 081 45Age of menarche (yr) 156 plusmn 168 154 plusmn 19 156 plusmn 18 015 86Age of first birth (yr) 261 plusmn 43 258 plusmn 36 266 plusmn 45 022 80First SBP (mmHg) 1281 plusmn 122 1275 plusmn 144 1215 plusmn 131 206 13First DBP (mmHg) 797 plusmn 95 804 plusmn 113 801 plusmn 106 004 96First PR (bpm) 692 plusmn 87 710 plusmn 124 708 plusmn 86 026 77

119873 ()Marital status

Married 26 (929) 26 (929) 22 (815) 344 30Single 2 (71) 2 (71) 5 (185)

EducationMiddle school 4 (133) 8 (286) 5 (185) 284 58High school 13 (464) 12 (429) 15 (556)University 11 (393) 8 (286) 7 (259)

Presence of menopausePostmenopausal 14 (500) 15 (536) 17 (654) 379 47Intramenopausal 8 (286) 10 (357) 4 (154)No menopausal 6 (214) 3 (107) 5 (192)

DrinkingNo 18 (643) 18 (643) 17 (630) 001 99Yes 10 (357) 10 (357) 10 (370)

SmokingNo 27 (964) 28 (100) 25 (926) 217 34Yes 1 (36) 0 (00) 2 (74)

ExerciseNo exercise 5 (179) 8 (286) 7 (259) 213 71Less than two times per week 10 (357) 12 (429) 10 (370)More than three times per week 13 (464) 8 (286) 10 (370)

DBP diastolic blood pressure PR pulse rate SBP systolic blood pressure

home situation one patient who refused to participate dueto inability to perform 24-hour ambulatory BP monitoringat work and one patient who could not participate due tooverseas travelling leading to a final total of 27 participantsTherefore there were 83 members in the study analyzed asfinal eligible study participants

32 Homogeneity between the Groups The general character-istics of the participants in the experimental placebo andcontrol groups are shown in Table 1 No statistical differenceswere found between the groups with regards tomarital statuslevel of education presence of menopause drinking smok-ing and exercise There were also no significant differencesin age height weight age of menarche age of first birthbaseline SBP baseline DBP and baseline pulse rate

33 Effect of AromaMassage on Home BP The SBP and DBPweremeasured twice weekly for a total of eightmeasurementsto evaluate the effect of aroma massage on participant home

BP (Table 2) The SBP measurements over four weeks didnot show significant differences with time and there wasno interaction between the groups and time on repeatedmeasures ANCOVAusing initial SBP as a covariate Howeverthere were significant differences in repeated measurementsof SBP depending on the group (119865 = 671 119875 = 0002) Thepost-hoc analysis with the Tukey method showed that theexperimental group showed significant differences comparedto the placebo group and the control group (119875 lt 005)

The eight DBP measurements over four weeks did notshow significant differenceswith time and therewas no inter-action between the groups and time on repeated measuresANCOVA using initial DBP as a covariate There was nodifference in DBP measurements within the 3 groups

34 Effect of Aroma Massage on Office BP To determinethe immediate effect of aroma massage BP measurementswere taken before the massage in the office followed by SBPmeasurement 10 minutes after the massage to compare with

Evidence-Based Complementary and Alternative Medicine 5

Table 2 Aroma massage on home BP

Time Aroma (119899 = 28) Placebo (119899 = 28) Control (119899 = 27) 119865 119875

SBPBaseline 1281 plusmn 122 1275 plusmn 144 1215 plusmn 131 206 0131st week

Tue 1207 plusmn 141 1212 plusmn 124 1257 plusmn 123 124 029Fri 1185 plusmn 138 1228 plusmn 137 1233 plusmn 110 112 033

2nd weekTue 1206 plusmn 110 1216 plusmn 123 1224 plusmn 119 016 085Fri 1179 plusmn 101 1176 plusmn 134 1217 plusmn 113 106 035

3rd weekTue 1160 plusmn 125 1186 plusmn 127 1223 plusmn 118 177 018Fri 1147 plusmn 126 1195 plusmn 111 1219 plusmn 120 265 008

4th weekTue 1156 plusmn 93 1216 plusmn 121 1222 plusmn 111 321 005Fri 1133 plusmn 110a 1218 plusmn 113b 1209 plusmn 121b 466 001

Group 119865 = 671 119875 = 0002 time 119865 = 046 119875 = 086 group times time 119865 = 168 119875 = 007DBP

Baseline 797 plusmn 95 804 plusmn 113 801 plusmn 106 004 0961st week

Tue 790 plusmn 84 778 plusmn 91 815 plusmn 110 106 096Fri 788 plusmn 99 794 plusmn 101 815 plusmn 110 026 067

2nd weekTue 809 plusmn 66 787 plusmn 66 792 plusmn 98 052 036Fri 799 plusmn 83 770 plusmn 102 796 plusmn 91 086 021

3rd weekTue 794 plusmn 87 764 plusmn 115 810 plusmn104 145 013Fri 779 plusmn 95 768 plusmn 110 801 plusmn 76 091 040

4th weekTue 775 plusmn 91 782 plusmn 101 794 plusmn 86 029 090Fri 759 plusmn 81 774 plusmn 105 794 plusmn 101 089 066

Group 119865 = 102 119875 = 037 time 119865 = 053 119875 = 081 group times time 119865 = 146 119875 = 013Values are expressed as mean plusmn standard deviationMeans for each group with different superscript (a or b) indicate a significant difference (Tukey test 119875 lt 005)BP blood pressure DBP diastolic blood pressure PR pulse rate SBP systolic blood pressure

the office BP The postintervention office SBP measured aftereach of the fivemassages did not show significant differencesbetween the two groups after the first massage The aromamassage group showed significantly reduced SBP after thesecond (119905 = minus3444 119875 = 0001) third (119905 = minus265 119875 = 001)fourth (119905 = minus333 119875 = 0002) and fifth sessions (119905 = minus487119875 lt 0001)There was statistical significance in groups times time(119865 = 363 119875 = 0007) and the groups (119865 = 1334 119875 = 0001)while there was not statistically significant in time

Postintervention office DBP after the first session didnot show significant differences between the two groupsHowever there were significant differences between groupsafter the second (119905 = minus309 119875 = 0003) third (119905 = minus208119875 = 004) fourth (119905 = minus238 119875 = 002) and fifth sessions(119905 = minus376 119875 lt 0001) in office DBP The results of repeatedmeasures ANOVA showed significant difference with time(119865 = 384 119875 = 0005) groups (119865 = 846 119875 = 0005) andgroup times time (119865 = 279 119875 = 003) (Table 3)

35 Effect of Aroma Massage on 24-Hour Ambulatory BPThe 24-hour ambulatory BP was measured before and afterthe intervention for the experimental placebo and controlgroupsThere were no significant differences between groupsin 24-hour ambulatory daytime BP and 24-hour ambulatorynocturnal BP (Table 4)

36 Effect of Aroma Massage on Sleep Quality There weresignificant differences between groups (119865 = 675 119875 = 0002)after intervention (Table 5)Therewere significant differencesin changes of sleep quality between groups (119865 = 932 119875 lt0001) In a post-hoc analysis the aroma massage groupshowed significant improvement in sleep quality comparedwith placebo and no-treatment groups (Tukey 119875 lt 005)

4 Discussion

This study investigated the effects of aroma massage onhome BP 24-hour ambulatory BP and sleep quality in

6 Evidence-Based Complementary and Alternative Medicine

Table 3 Aroma massage on office BP

Time Aroma (119899 = 28) Placebo (119899 = 28) 119905 119875

SBP1st session

Pre 1240 plusmn 111 1258 plusmn 157 minus049 063Post 1128 plusmn 124 1189 plusmn 152 minus163 011

2nd sessionPre 1190 plusmn 117 1214 plusmn 115 minus078 044Post 1085 plusmn 108 1197 plusmn 133 minus344 0001

3rd sessionPre 1182 plusmn 107 1223 plusmn 131 minus128 021Post 1097 plusmn 111 1186 plusmn 139 minus265 001

4th sessionPre 1190 plusmn 103 1251 plusmn 155 minus175 009Post 1111 plusmn 99 1229 plusmn 159 minus333 0002

5th sessionPre 1194 plusmn 121 1266 plusmn 157 minus193 006Post 1089 plusmn 97 1250 plusmn 146 minus487 lt0001

Group 119865 = 1334 119875 = 0001 time 119865 = 215 119875 = 008group times time 119865 = 363 119875 = 0007

DBP1st session

Pre 743 plusmn 77 760 plusmn 109 minus067 051Post 718 plusmn 84 747 plusmn 97 minus119 024

2nd sessionPre 721 plusmn 84 743 plusmn 80 minus101 032Post 678 plusmn 78 748 plusmn 93 minus309 0003

3rd sessionPre 727 plusmn 77 737 plusmn 80 minus050 062Post 702 plusmn 78 746 plusmn 83 minus208 004

4th sessionPre 731 plusmn 68 760 plusmn 98 minus127 021Post 720 plusmn 67 774 plusmn 101 minus238 002

5th sessionPre 726 plusmn 83 760 plusmn 99 minus138 018Post 695 plusmn 64 781 plusmn 103 minus376 lt0001

Group 119865 = 846 119875 = 0005 time 119865 = 384 119875 = 0005group times time 119865 = 279 119875 = 003

Values are expressed as mean plusmn standard deviationBP blood pressure DBP diastolic blood pressure SBP systolic blood pres-sure

middle-agedwomenwith hypertensionTheresults show thataroma massage significantly reduced home SBP comparedwith the placebo and no-treatment groups

The aromamassage group showed an approximate reduc-tion of 15mmHg for home SBP while the placebo groupshowed an approximate reduction of 6mmHg One previousstudy showed a reduction of 4mmHg in SBP using posteriorneck massage three times a week for six weeks with lavenderoil [15] Comparing with these results the effect observedwith once-weekly overall body massage in this study showsthat it is very effective in lowering BP The oils used inthis study (a blend of lavender ylang-ylang marjoram and

Table 4 Aroma massage on 24-hour ambulatory BP

Time Aroma Placebo Control119865 119875

(119899 = 28) (119899 = 28) (119899 = 27)SBP

DaytimePre 1348 plusmn 120 1362 plusmn 135 1285 plusmn 125 288 06Post 1303 plusmn 117 1284 plusmn 122 1339 plusmn 129 137 26

Night timePre 1222 plusmn 158 1249 plusmn 139 1191 plusmn 164 098 38Post 1175 plusmn 156 1190 plusmn 99 1229 plusmn 181 093 40

DBPDaytime

Pre 827 plusmn 86 836 plusmn 81 816 plusmn 94 037 69Post 814 plusmn 83 800 plusmn 81 834 plusmn 89 107 35

Night timePre 748 plusmn 99 764 plusmn 89 744 plusmn 111 030 74Post 736 plusmn 105 717 plusmn 68 746 plusmn 110 059 55

Values are expressed as mean plusmn standard deviationBP blood pressure DBP diastolic blood pressure SBP systolic blood pres-sure

Table 5 Aroma massage on sleep quality

Time Aroma Placebo Control119865 119875

(119899 = 28) (119899 = 28) (119899 = 27)Pre 510 plusmn 126 481 plusmn 158 556 plusmn 105 224 011Post 581 plusmn 113

a465 plusmn 138

b503 plusmn 109

b 675 0002Difference 71 plusmn 126

aminus16 plusmn 96

bminus53 plusmn 106

b 932 lt0001Values are expressed as mean plusmn standard deviationMeans for each group with different superscript (a b or c) indicate asignificant difference (Tukey test 119875 lt 005)

Neroli) are thought to have produced synergistic effects inlowering BP compared with a simple lavender oil [13] Inaddition previous research using inhalation therapy usinglavender ylang-ylang and bergamot showed a decrease of1910mmHg in BP and showed synergistic effects in loweringBP compared to this study [14]

The aroma massage may reduce BP by inducing thephysical relaxation and decreasing activation of sympatheticnervous system In this study the placebo groupwith artificialfragrance also showed decreased BP with massage This isthought to be due to the effect of massage rather than theartificial fragrance

In particular the office SBP decreased by 12mmHg afterthe first massage and 11mmHg after the fifth massage in thearoma massage group This shows the acute effect of aromamassage for immediate decreasing of BP The BP decreaseafter the firstmassage in the placebo groupwas approximately7mmHg However it did not show substantial reduction asmassage sessions progressed pointing to a temporary effectof massage with artificial fragrance

The home DBP decreased by approximately 4mmHg inthe experimental group 3mmHg in the placebo group and1mmHg in the control group showing no difference amongthe groups The office DBP before and after massage showed

Evidence-Based Complementary and Alternative Medicine 7

a reduction of approximately 5mmHg in the experimentalgroup as opposed to an elevation of 2mmHg in the placebogroup The effect of aroma massage in reducing DBP is lim-ited although there appears to be some immediate reducingeffect of aroma massage for office DBP

There was no difference in 24-hour ambulatory BPbetween groups A once-weekly intervention of aroma mas-sage and cream application does not appear to promotepositive 24-hour ambulatory BP Therefore further researchon the frequency of massage and the active ingredients andtypes of oils used is necessary

In terms of sleep quality the aroma massage groupshowed an improvement while the placebo and no-treatmentgroups failed to do so This result appears to be due to theeffect of the essential oil used in this study on the autonomicnervous system to increase the quality of sleep [7 9] Theseresults are in line with those of a study by Jung and Jeon[16] They used a mixture of lavender bergamot and clarysage in a 3 2 1 ratio applied to hemiplegic patients on thearm hand and the lower neck through aroma massage andshowed reduction of sleep disturbance score The results ofthis study are consistent with the other study of middle-agedwomen using a lavender essential oil necklace and one totwo drops of lavender essential oil on the pillow before sleep(instead of the necklace) [17] which showed improvement insleep quality

Our study did not take into account the preference ofparticipants for aroma fragrance Althoughmost participantsreported a good feeling toward the aroma some reportedpreference for another fragranceThus the psychological andphysical responses may vary depending on the fragrancepreference of the subject receiving the aromatherapy

In conclusion aroma massage was effective in reducinghome SBP and immediate office BP before and after theintervention as well as increasing sleep quality in middle-aged women with hypertension Further research comparingthe effects of various and convenient aromatherapy methodsincluding bathing topical application and foot washing isneeded

Conflict of Interests

The authors declare no conflict of interests

Acknowledgment

This work was supported by the National Research Founda-tion of Korea (NRF)Grant funded by the Korean governmentMEST (no 2008-0061658) M S Lee was supported by KoreaInstitute of Oriental Medicine (K12130)

References

[1] World Health Organization Chronic Diseases World HealthOrganization Geneva Switzerland 2012

[2] National Health Statistics ldquoNational health nutrition surveyquaternary period secondary sourcerdquo Approval Number Statis-tics 11702 The Ministry of Health and Welfare 2008

[3] B H LeeManual of Hypertension Deahanuihakseojeok SeoulKorea 2009

[4] P Bansil E V Kuklina R K Merritt and P W YoonldquoAssociations between sleep disorders sleep duration qualityof sleep and hypertension results from theNational Health andNutrition Examination Survey 2005 to 2008rdquo Journal of ClinicalHypertension vol 13 no 10 pp 739ndash743 2011

[5] D D Smeltzer B G Bare J L Hinkle and K H CheeverBrunner amp Suddarthrsquos Textbook of Medical-Surgical NursingWolsters KluwerLippincott Williams amp Wilkins PhiladelphiaPa USA 2010

[6] S Battaglia The Complete Guide to Aromatherapy The Inter-national Centre of Holistic Aromatherapy Brisbane Australia2003

[7] B J Ha Aromatherapy Soo Moon Sa Seoul Korea 2006[8] P Daniel P Shirley and P Len Aromatherphy for Healt

Professionals Churchill Livingstone London UK 2001[9] S H Han M H Hur J H Park E J Lee and M K Park

Womenrsquos Health and Aromatherapy Hyun Moon Sa SeoulKorea 2002

[10] J F Owens and K A Matthews ldquoSleep disturbance in healthymiddle-aged womenrdquoMaturitas vol 30 no 1 pp 41ndash50 1998

[11] P Vara ldquoThe climacterium from the gynaecologist1015840s point ofviewrdquo Acta Obstetricia et Gynecologica Scandinavica Supple-ment vol 49 supplement 1 pp 43ndash55 1970

[12] MH Hur H OhM S Lee C Kim A N Choi andG R ShinldquoEffects of aromatherapy massage on blood pressure and lipidprofile in Korean climacteric womenrdquo International Journal ofNeuroscience vol 117 no 9 pp 1281ndash1287 2007

[13] Y J Jung Effects of Aromatherapy on Blood Pressure Heart RateVariability and Serum Catecholamines in the Pre-HypertensionMiddle AgedWomen Department of Nursing Catholic Univer-sity Seoul Korea 2007

[14] J H Hwang ldquoThe effects of the inhalation method usingessential oils on blood pressure and stress responses of clientswith essential hypertensionrdquo Journal of Korean Academy ofNursing vol 36 no 7 pp 1123ndash1134 2006

[15] Y K Choi and S Lee ldquoThe effect of posterior neck massageusing maychang oil on the blood pressure and componentsin elderly women who have hypertensionrdquo Journal of KoreanBeauty Society vol 17 no 2 pp 211ndash217 2011

[16] H M Jung and Y S Jeon ldquoEffects of the aroma massage onshoulder pain depression sleep disturbance in hemiparesispatientsrdquo The Korean Journal of Rehabilitation Nursing vol 7no 2 pp 231ndash237 2004

[17] G H Lee K M Park and M K Ryu ldquoThe effect of aro-matherapy with lavender essential oil on sleep disturbanceand depression on middle-aged womenrdquo Journal of the KoreanSociety of Maternal and Child Health vol 6 no 1 pp 23ndash372002

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Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

4 Evidence-Based Complementary and Alternative Medicine

Table 1 Homogeneity between groups

Categories Aroma (119899 = 28) Placebo (119899 = 28) Control (119899 = 27) 1205942 or 119865 P

Mean plusmn SDAge (yr) 525 plusmn 46 541 plusmn 38 533 plusmn 46 101 37Height (cm) 1571 plusmn 69 1580 plusmn 49 1584 plusmn 38 044 68Weight (kg) 618 plusmn 74 636 plusmn 76 642 plusmn 70 081 45Age of menarche (yr) 156 plusmn 168 154 plusmn 19 156 plusmn 18 015 86Age of first birth (yr) 261 plusmn 43 258 plusmn 36 266 plusmn 45 022 80First SBP (mmHg) 1281 plusmn 122 1275 plusmn 144 1215 plusmn 131 206 13First DBP (mmHg) 797 plusmn 95 804 plusmn 113 801 plusmn 106 004 96First PR (bpm) 692 plusmn 87 710 plusmn 124 708 plusmn 86 026 77

119873 ()Marital status

Married 26 (929) 26 (929) 22 (815) 344 30Single 2 (71) 2 (71) 5 (185)

EducationMiddle school 4 (133) 8 (286) 5 (185) 284 58High school 13 (464) 12 (429) 15 (556)University 11 (393) 8 (286) 7 (259)

Presence of menopausePostmenopausal 14 (500) 15 (536) 17 (654) 379 47Intramenopausal 8 (286) 10 (357) 4 (154)No menopausal 6 (214) 3 (107) 5 (192)

DrinkingNo 18 (643) 18 (643) 17 (630) 001 99Yes 10 (357) 10 (357) 10 (370)

SmokingNo 27 (964) 28 (100) 25 (926) 217 34Yes 1 (36) 0 (00) 2 (74)

ExerciseNo exercise 5 (179) 8 (286) 7 (259) 213 71Less than two times per week 10 (357) 12 (429) 10 (370)More than three times per week 13 (464) 8 (286) 10 (370)

DBP diastolic blood pressure PR pulse rate SBP systolic blood pressure

home situation one patient who refused to participate dueto inability to perform 24-hour ambulatory BP monitoringat work and one patient who could not participate due tooverseas travelling leading to a final total of 27 participantsTherefore there were 83 members in the study analyzed asfinal eligible study participants

32 Homogeneity between the Groups The general character-istics of the participants in the experimental placebo andcontrol groups are shown in Table 1 No statistical differenceswere found between the groups with regards tomarital statuslevel of education presence of menopause drinking smok-ing and exercise There were also no significant differencesin age height weight age of menarche age of first birthbaseline SBP baseline DBP and baseline pulse rate

33 Effect of AromaMassage on Home BP The SBP and DBPweremeasured twice weekly for a total of eightmeasurementsto evaluate the effect of aroma massage on participant home

BP (Table 2) The SBP measurements over four weeks didnot show significant differences with time and there wasno interaction between the groups and time on repeatedmeasures ANCOVAusing initial SBP as a covariate Howeverthere were significant differences in repeated measurementsof SBP depending on the group (119865 = 671 119875 = 0002) Thepost-hoc analysis with the Tukey method showed that theexperimental group showed significant differences comparedto the placebo group and the control group (119875 lt 005)

The eight DBP measurements over four weeks did notshow significant differenceswith time and therewas no inter-action between the groups and time on repeated measuresANCOVA using initial DBP as a covariate There was nodifference in DBP measurements within the 3 groups

34 Effect of Aroma Massage on Office BP To determinethe immediate effect of aroma massage BP measurementswere taken before the massage in the office followed by SBPmeasurement 10 minutes after the massage to compare with

Evidence-Based Complementary and Alternative Medicine 5

Table 2 Aroma massage on home BP

Time Aroma (119899 = 28) Placebo (119899 = 28) Control (119899 = 27) 119865 119875

SBPBaseline 1281 plusmn 122 1275 plusmn 144 1215 plusmn 131 206 0131st week

Tue 1207 plusmn 141 1212 plusmn 124 1257 plusmn 123 124 029Fri 1185 plusmn 138 1228 plusmn 137 1233 plusmn 110 112 033

2nd weekTue 1206 plusmn 110 1216 plusmn 123 1224 plusmn 119 016 085Fri 1179 plusmn 101 1176 plusmn 134 1217 plusmn 113 106 035

3rd weekTue 1160 plusmn 125 1186 plusmn 127 1223 plusmn 118 177 018Fri 1147 plusmn 126 1195 plusmn 111 1219 plusmn 120 265 008

4th weekTue 1156 plusmn 93 1216 plusmn 121 1222 plusmn 111 321 005Fri 1133 plusmn 110a 1218 plusmn 113b 1209 plusmn 121b 466 001

Group 119865 = 671 119875 = 0002 time 119865 = 046 119875 = 086 group times time 119865 = 168 119875 = 007DBP

Baseline 797 plusmn 95 804 plusmn 113 801 plusmn 106 004 0961st week

Tue 790 plusmn 84 778 plusmn 91 815 plusmn 110 106 096Fri 788 plusmn 99 794 plusmn 101 815 plusmn 110 026 067

2nd weekTue 809 plusmn 66 787 plusmn 66 792 plusmn 98 052 036Fri 799 plusmn 83 770 plusmn 102 796 plusmn 91 086 021

3rd weekTue 794 plusmn 87 764 plusmn 115 810 plusmn104 145 013Fri 779 plusmn 95 768 plusmn 110 801 plusmn 76 091 040

4th weekTue 775 plusmn 91 782 plusmn 101 794 plusmn 86 029 090Fri 759 plusmn 81 774 plusmn 105 794 plusmn 101 089 066

Group 119865 = 102 119875 = 037 time 119865 = 053 119875 = 081 group times time 119865 = 146 119875 = 013Values are expressed as mean plusmn standard deviationMeans for each group with different superscript (a or b) indicate a significant difference (Tukey test 119875 lt 005)BP blood pressure DBP diastolic blood pressure PR pulse rate SBP systolic blood pressure

the office BP The postintervention office SBP measured aftereach of the fivemassages did not show significant differencesbetween the two groups after the first massage The aromamassage group showed significantly reduced SBP after thesecond (119905 = minus3444 119875 = 0001) third (119905 = minus265 119875 = 001)fourth (119905 = minus333 119875 = 0002) and fifth sessions (119905 = minus487119875 lt 0001)There was statistical significance in groups times time(119865 = 363 119875 = 0007) and the groups (119865 = 1334 119875 = 0001)while there was not statistically significant in time

Postintervention office DBP after the first session didnot show significant differences between the two groupsHowever there were significant differences between groupsafter the second (119905 = minus309 119875 = 0003) third (119905 = minus208119875 = 004) fourth (119905 = minus238 119875 = 002) and fifth sessions(119905 = minus376 119875 lt 0001) in office DBP The results of repeatedmeasures ANOVA showed significant difference with time(119865 = 384 119875 = 0005) groups (119865 = 846 119875 = 0005) andgroup times time (119865 = 279 119875 = 003) (Table 3)

35 Effect of Aroma Massage on 24-Hour Ambulatory BPThe 24-hour ambulatory BP was measured before and afterthe intervention for the experimental placebo and controlgroupsThere were no significant differences between groupsin 24-hour ambulatory daytime BP and 24-hour ambulatorynocturnal BP (Table 4)

36 Effect of Aroma Massage on Sleep Quality There weresignificant differences between groups (119865 = 675 119875 = 0002)after intervention (Table 5)Therewere significant differencesin changes of sleep quality between groups (119865 = 932 119875 lt0001) In a post-hoc analysis the aroma massage groupshowed significant improvement in sleep quality comparedwith placebo and no-treatment groups (Tukey 119875 lt 005)

4 Discussion

This study investigated the effects of aroma massage onhome BP 24-hour ambulatory BP and sleep quality in

6 Evidence-Based Complementary and Alternative Medicine

Table 3 Aroma massage on office BP

Time Aroma (119899 = 28) Placebo (119899 = 28) 119905 119875

SBP1st session

Pre 1240 plusmn 111 1258 plusmn 157 minus049 063Post 1128 plusmn 124 1189 plusmn 152 minus163 011

2nd sessionPre 1190 plusmn 117 1214 plusmn 115 minus078 044Post 1085 plusmn 108 1197 plusmn 133 minus344 0001

3rd sessionPre 1182 plusmn 107 1223 plusmn 131 minus128 021Post 1097 plusmn 111 1186 plusmn 139 minus265 001

4th sessionPre 1190 plusmn 103 1251 plusmn 155 minus175 009Post 1111 plusmn 99 1229 plusmn 159 minus333 0002

5th sessionPre 1194 plusmn 121 1266 plusmn 157 minus193 006Post 1089 plusmn 97 1250 plusmn 146 minus487 lt0001

Group 119865 = 1334 119875 = 0001 time 119865 = 215 119875 = 008group times time 119865 = 363 119875 = 0007

DBP1st session

Pre 743 plusmn 77 760 plusmn 109 minus067 051Post 718 plusmn 84 747 plusmn 97 minus119 024

2nd sessionPre 721 plusmn 84 743 plusmn 80 minus101 032Post 678 plusmn 78 748 plusmn 93 minus309 0003

3rd sessionPre 727 plusmn 77 737 plusmn 80 minus050 062Post 702 plusmn 78 746 plusmn 83 minus208 004

4th sessionPre 731 plusmn 68 760 plusmn 98 minus127 021Post 720 plusmn 67 774 plusmn 101 minus238 002

5th sessionPre 726 plusmn 83 760 plusmn 99 minus138 018Post 695 plusmn 64 781 plusmn 103 minus376 lt0001

Group 119865 = 846 119875 = 0005 time 119865 = 384 119875 = 0005group times time 119865 = 279 119875 = 003

Values are expressed as mean plusmn standard deviationBP blood pressure DBP diastolic blood pressure SBP systolic blood pres-sure

middle-agedwomenwith hypertensionTheresults show thataroma massage significantly reduced home SBP comparedwith the placebo and no-treatment groups

The aromamassage group showed an approximate reduc-tion of 15mmHg for home SBP while the placebo groupshowed an approximate reduction of 6mmHg One previousstudy showed a reduction of 4mmHg in SBP using posteriorneck massage three times a week for six weeks with lavenderoil [15] Comparing with these results the effect observedwith once-weekly overall body massage in this study showsthat it is very effective in lowering BP The oils used inthis study (a blend of lavender ylang-ylang marjoram and

Table 4 Aroma massage on 24-hour ambulatory BP

Time Aroma Placebo Control119865 119875

(119899 = 28) (119899 = 28) (119899 = 27)SBP

DaytimePre 1348 plusmn 120 1362 plusmn 135 1285 plusmn 125 288 06Post 1303 plusmn 117 1284 plusmn 122 1339 plusmn 129 137 26

Night timePre 1222 plusmn 158 1249 plusmn 139 1191 plusmn 164 098 38Post 1175 plusmn 156 1190 plusmn 99 1229 plusmn 181 093 40

DBPDaytime

Pre 827 plusmn 86 836 plusmn 81 816 plusmn 94 037 69Post 814 plusmn 83 800 plusmn 81 834 plusmn 89 107 35

Night timePre 748 plusmn 99 764 plusmn 89 744 plusmn 111 030 74Post 736 plusmn 105 717 plusmn 68 746 plusmn 110 059 55

Values are expressed as mean plusmn standard deviationBP blood pressure DBP diastolic blood pressure SBP systolic blood pres-sure

Table 5 Aroma massage on sleep quality

Time Aroma Placebo Control119865 119875

(119899 = 28) (119899 = 28) (119899 = 27)Pre 510 plusmn 126 481 plusmn 158 556 plusmn 105 224 011Post 581 plusmn 113

a465 plusmn 138

b503 plusmn 109

b 675 0002Difference 71 plusmn 126

aminus16 plusmn 96

bminus53 plusmn 106

b 932 lt0001Values are expressed as mean plusmn standard deviationMeans for each group with different superscript (a b or c) indicate asignificant difference (Tukey test 119875 lt 005)

Neroli) are thought to have produced synergistic effects inlowering BP compared with a simple lavender oil [13] Inaddition previous research using inhalation therapy usinglavender ylang-ylang and bergamot showed a decrease of1910mmHg in BP and showed synergistic effects in loweringBP compared to this study [14]

The aroma massage may reduce BP by inducing thephysical relaxation and decreasing activation of sympatheticnervous system In this study the placebo groupwith artificialfragrance also showed decreased BP with massage This isthought to be due to the effect of massage rather than theartificial fragrance

In particular the office SBP decreased by 12mmHg afterthe first massage and 11mmHg after the fifth massage in thearoma massage group This shows the acute effect of aromamassage for immediate decreasing of BP The BP decreaseafter the firstmassage in the placebo groupwas approximately7mmHg However it did not show substantial reduction asmassage sessions progressed pointing to a temporary effectof massage with artificial fragrance

The home DBP decreased by approximately 4mmHg inthe experimental group 3mmHg in the placebo group and1mmHg in the control group showing no difference amongthe groups The office DBP before and after massage showed

Evidence-Based Complementary and Alternative Medicine 7

a reduction of approximately 5mmHg in the experimentalgroup as opposed to an elevation of 2mmHg in the placebogroup The effect of aroma massage in reducing DBP is lim-ited although there appears to be some immediate reducingeffect of aroma massage for office DBP

There was no difference in 24-hour ambulatory BPbetween groups A once-weekly intervention of aroma mas-sage and cream application does not appear to promotepositive 24-hour ambulatory BP Therefore further researchon the frequency of massage and the active ingredients andtypes of oils used is necessary

In terms of sleep quality the aroma massage groupshowed an improvement while the placebo and no-treatmentgroups failed to do so This result appears to be due to theeffect of the essential oil used in this study on the autonomicnervous system to increase the quality of sleep [7 9] Theseresults are in line with those of a study by Jung and Jeon[16] They used a mixture of lavender bergamot and clarysage in a 3 2 1 ratio applied to hemiplegic patients on thearm hand and the lower neck through aroma massage andshowed reduction of sleep disturbance score The results ofthis study are consistent with the other study of middle-agedwomen using a lavender essential oil necklace and one totwo drops of lavender essential oil on the pillow before sleep(instead of the necklace) [17] which showed improvement insleep quality

Our study did not take into account the preference ofparticipants for aroma fragrance Althoughmost participantsreported a good feeling toward the aroma some reportedpreference for another fragranceThus the psychological andphysical responses may vary depending on the fragrancepreference of the subject receiving the aromatherapy

In conclusion aroma massage was effective in reducinghome SBP and immediate office BP before and after theintervention as well as increasing sleep quality in middle-aged women with hypertension Further research comparingthe effects of various and convenient aromatherapy methodsincluding bathing topical application and foot washing isneeded

Conflict of Interests

The authors declare no conflict of interests

Acknowledgment

This work was supported by the National Research Founda-tion of Korea (NRF)Grant funded by the Korean governmentMEST (no 2008-0061658) M S Lee was supported by KoreaInstitute of Oriental Medicine (K12130)

References

[1] World Health Organization Chronic Diseases World HealthOrganization Geneva Switzerland 2012

[2] National Health Statistics ldquoNational health nutrition surveyquaternary period secondary sourcerdquo Approval Number Statis-tics 11702 The Ministry of Health and Welfare 2008

[3] B H LeeManual of Hypertension Deahanuihakseojeok SeoulKorea 2009

[4] P Bansil E V Kuklina R K Merritt and P W YoonldquoAssociations between sleep disorders sleep duration qualityof sleep and hypertension results from theNational Health andNutrition Examination Survey 2005 to 2008rdquo Journal of ClinicalHypertension vol 13 no 10 pp 739ndash743 2011

[5] D D Smeltzer B G Bare J L Hinkle and K H CheeverBrunner amp Suddarthrsquos Textbook of Medical-Surgical NursingWolsters KluwerLippincott Williams amp Wilkins PhiladelphiaPa USA 2010

[6] S Battaglia The Complete Guide to Aromatherapy The Inter-national Centre of Holistic Aromatherapy Brisbane Australia2003

[7] B J Ha Aromatherapy Soo Moon Sa Seoul Korea 2006[8] P Daniel P Shirley and P Len Aromatherphy for Healt

Professionals Churchill Livingstone London UK 2001[9] S H Han M H Hur J H Park E J Lee and M K Park

Womenrsquos Health and Aromatherapy Hyun Moon Sa SeoulKorea 2002

[10] J F Owens and K A Matthews ldquoSleep disturbance in healthymiddle-aged womenrdquoMaturitas vol 30 no 1 pp 41ndash50 1998

[11] P Vara ldquoThe climacterium from the gynaecologist1015840s point ofviewrdquo Acta Obstetricia et Gynecologica Scandinavica Supple-ment vol 49 supplement 1 pp 43ndash55 1970

[12] MH Hur H OhM S Lee C Kim A N Choi andG R ShinldquoEffects of aromatherapy massage on blood pressure and lipidprofile in Korean climacteric womenrdquo International Journal ofNeuroscience vol 117 no 9 pp 1281ndash1287 2007

[13] Y J Jung Effects of Aromatherapy on Blood Pressure Heart RateVariability and Serum Catecholamines in the Pre-HypertensionMiddle AgedWomen Department of Nursing Catholic Univer-sity Seoul Korea 2007

[14] J H Hwang ldquoThe effects of the inhalation method usingessential oils on blood pressure and stress responses of clientswith essential hypertensionrdquo Journal of Korean Academy ofNursing vol 36 no 7 pp 1123ndash1134 2006

[15] Y K Choi and S Lee ldquoThe effect of posterior neck massageusing maychang oil on the blood pressure and componentsin elderly women who have hypertensionrdquo Journal of KoreanBeauty Society vol 17 no 2 pp 211ndash217 2011

[16] H M Jung and Y S Jeon ldquoEffects of the aroma massage onshoulder pain depression sleep disturbance in hemiparesispatientsrdquo The Korean Journal of Rehabilitation Nursing vol 7no 2 pp 231ndash237 2004

[17] G H Lee K M Park and M K Ryu ldquoThe effect of aro-matherapy with lavender essential oil on sleep disturbanceand depression on middle-aged womenrdquo Journal of the KoreanSociety of Maternal and Child Health vol 6 no 1 pp 23ndash372002

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

Evidence-Based Complementary and Alternative Medicine 5

Table 2 Aroma massage on home BP

Time Aroma (119899 = 28) Placebo (119899 = 28) Control (119899 = 27) 119865 119875

SBPBaseline 1281 plusmn 122 1275 plusmn 144 1215 plusmn 131 206 0131st week

Tue 1207 plusmn 141 1212 plusmn 124 1257 plusmn 123 124 029Fri 1185 plusmn 138 1228 plusmn 137 1233 plusmn 110 112 033

2nd weekTue 1206 plusmn 110 1216 plusmn 123 1224 plusmn 119 016 085Fri 1179 plusmn 101 1176 plusmn 134 1217 plusmn 113 106 035

3rd weekTue 1160 plusmn 125 1186 plusmn 127 1223 plusmn 118 177 018Fri 1147 plusmn 126 1195 plusmn 111 1219 plusmn 120 265 008

4th weekTue 1156 plusmn 93 1216 plusmn 121 1222 plusmn 111 321 005Fri 1133 plusmn 110a 1218 plusmn 113b 1209 plusmn 121b 466 001

Group 119865 = 671 119875 = 0002 time 119865 = 046 119875 = 086 group times time 119865 = 168 119875 = 007DBP

Baseline 797 plusmn 95 804 plusmn 113 801 plusmn 106 004 0961st week

Tue 790 plusmn 84 778 plusmn 91 815 plusmn 110 106 096Fri 788 plusmn 99 794 plusmn 101 815 plusmn 110 026 067

2nd weekTue 809 plusmn 66 787 plusmn 66 792 plusmn 98 052 036Fri 799 plusmn 83 770 plusmn 102 796 plusmn 91 086 021

3rd weekTue 794 plusmn 87 764 plusmn 115 810 plusmn104 145 013Fri 779 plusmn 95 768 plusmn 110 801 plusmn 76 091 040

4th weekTue 775 plusmn 91 782 plusmn 101 794 plusmn 86 029 090Fri 759 plusmn 81 774 plusmn 105 794 plusmn 101 089 066

Group 119865 = 102 119875 = 037 time 119865 = 053 119875 = 081 group times time 119865 = 146 119875 = 013Values are expressed as mean plusmn standard deviationMeans for each group with different superscript (a or b) indicate a significant difference (Tukey test 119875 lt 005)BP blood pressure DBP diastolic blood pressure PR pulse rate SBP systolic blood pressure

the office BP The postintervention office SBP measured aftereach of the fivemassages did not show significant differencesbetween the two groups after the first massage The aromamassage group showed significantly reduced SBP after thesecond (119905 = minus3444 119875 = 0001) third (119905 = minus265 119875 = 001)fourth (119905 = minus333 119875 = 0002) and fifth sessions (119905 = minus487119875 lt 0001)There was statistical significance in groups times time(119865 = 363 119875 = 0007) and the groups (119865 = 1334 119875 = 0001)while there was not statistically significant in time

Postintervention office DBP after the first session didnot show significant differences between the two groupsHowever there were significant differences between groupsafter the second (119905 = minus309 119875 = 0003) third (119905 = minus208119875 = 004) fourth (119905 = minus238 119875 = 002) and fifth sessions(119905 = minus376 119875 lt 0001) in office DBP The results of repeatedmeasures ANOVA showed significant difference with time(119865 = 384 119875 = 0005) groups (119865 = 846 119875 = 0005) andgroup times time (119865 = 279 119875 = 003) (Table 3)

35 Effect of Aroma Massage on 24-Hour Ambulatory BPThe 24-hour ambulatory BP was measured before and afterthe intervention for the experimental placebo and controlgroupsThere were no significant differences between groupsin 24-hour ambulatory daytime BP and 24-hour ambulatorynocturnal BP (Table 4)

36 Effect of Aroma Massage on Sleep Quality There weresignificant differences between groups (119865 = 675 119875 = 0002)after intervention (Table 5)Therewere significant differencesin changes of sleep quality between groups (119865 = 932 119875 lt0001) In a post-hoc analysis the aroma massage groupshowed significant improvement in sleep quality comparedwith placebo and no-treatment groups (Tukey 119875 lt 005)

4 Discussion

This study investigated the effects of aroma massage onhome BP 24-hour ambulatory BP and sleep quality in

6 Evidence-Based Complementary and Alternative Medicine

Table 3 Aroma massage on office BP

Time Aroma (119899 = 28) Placebo (119899 = 28) 119905 119875

SBP1st session

Pre 1240 plusmn 111 1258 plusmn 157 minus049 063Post 1128 plusmn 124 1189 plusmn 152 minus163 011

2nd sessionPre 1190 plusmn 117 1214 plusmn 115 minus078 044Post 1085 plusmn 108 1197 plusmn 133 minus344 0001

3rd sessionPre 1182 plusmn 107 1223 plusmn 131 minus128 021Post 1097 plusmn 111 1186 plusmn 139 minus265 001

4th sessionPre 1190 plusmn 103 1251 plusmn 155 minus175 009Post 1111 plusmn 99 1229 plusmn 159 minus333 0002

5th sessionPre 1194 plusmn 121 1266 plusmn 157 minus193 006Post 1089 plusmn 97 1250 plusmn 146 minus487 lt0001

Group 119865 = 1334 119875 = 0001 time 119865 = 215 119875 = 008group times time 119865 = 363 119875 = 0007

DBP1st session

Pre 743 plusmn 77 760 plusmn 109 minus067 051Post 718 plusmn 84 747 plusmn 97 minus119 024

2nd sessionPre 721 plusmn 84 743 plusmn 80 minus101 032Post 678 plusmn 78 748 plusmn 93 minus309 0003

3rd sessionPre 727 plusmn 77 737 plusmn 80 minus050 062Post 702 plusmn 78 746 plusmn 83 minus208 004

4th sessionPre 731 plusmn 68 760 plusmn 98 minus127 021Post 720 plusmn 67 774 plusmn 101 minus238 002

5th sessionPre 726 plusmn 83 760 plusmn 99 minus138 018Post 695 plusmn 64 781 plusmn 103 minus376 lt0001

Group 119865 = 846 119875 = 0005 time 119865 = 384 119875 = 0005group times time 119865 = 279 119875 = 003

Values are expressed as mean plusmn standard deviationBP blood pressure DBP diastolic blood pressure SBP systolic blood pres-sure

middle-agedwomenwith hypertensionTheresults show thataroma massage significantly reduced home SBP comparedwith the placebo and no-treatment groups

The aromamassage group showed an approximate reduc-tion of 15mmHg for home SBP while the placebo groupshowed an approximate reduction of 6mmHg One previousstudy showed a reduction of 4mmHg in SBP using posteriorneck massage three times a week for six weeks with lavenderoil [15] Comparing with these results the effect observedwith once-weekly overall body massage in this study showsthat it is very effective in lowering BP The oils used inthis study (a blend of lavender ylang-ylang marjoram and

Table 4 Aroma massage on 24-hour ambulatory BP

Time Aroma Placebo Control119865 119875

(119899 = 28) (119899 = 28) (119899 = 27)SBP

DaytimePre 1348 plusmn 120 1362 plusmn 135 1285 plusmn 125 288 06Post 1303 plusmn 117 1284 plusmn 122 1339 plusmn 129 137 26

Night timePre 1222 plusmn 158 1249 plusmn 139 1191 plusmn 164 098 38Post 1175 plusmn 156 1190 plusmn 99 1229 plusmn 181 093 40

DBPDaytime

Pre 827 plusmn 86 836 plusmn 81 816 plusmn 94 037 69Post 814 plusmn 83 800 plusmn 81 834 plusmn 89 107 35

Night timePre 748 plusmn 99 764 plusmn 89 744 plusmn 111 030 74Post 736 plusmn 105 717 plusmn 68 746 plusmn 110 059 55

Values are expressed as mean plusmn standard deviationBP blood pressure DBP diastolic blood pressure SBP systolic blood pres-sure

Table 5 Aroma massage on sleep quality

Time Aroma Placebo Control119865 119875

(119899 = 28) (119899 = 28) (119899 = 27)Pre 510 plusmn 126 481 plusmn 158 556 plusmn 105 224 011Post 581 plusmn 113

a465 plusmn 138

b503 plusmn 109

b 675 0002Difference 71 plusmn 126

aminus16 plusmn 96

bminus53 plusmn 106

b 932 lt0001Values are expressed as mean plusmn standard deviationMeans for each group with different superscript (a b or c) indicate asignificant difference (Tukey test 119875 lt 005)

Neroli) are thought to have produced synergistic effects inlowering BP compared with a simple lavender oil [13] Inaddition previous research using inhalation therapy usinglavender ylang-ylang and bergamot showed a decrease of1910mmHg in BP and showed synergistic effects in loweringBP compared to this study [14]

The aroma massage may reduce BP by inducing thephysical relaxation and decreasing activation of sympatheticnervous system In this study the placebo groupwith artificialfragrance also showed decreased BP with massage This isthought to be due to the effect of massage rather than theartificial fragrance

In particular the office SBP decreased by 12mmHg afterthe first massage and 11mmHg after the fifth massage in thearoma massage group This shows the acute effect of aromamassage for immediate decreasing of BP The BP decreaseafter the firstmassage in the placebo groupwas approximately7mmHg However it did not show substantial reduction asmassage sessions progressed pointing to a temporary effectof massage with artificial fragrance

The home DBP decreased by approximately 4mmHg inthe experimental group 3mmHg in the placebo group and1mmHg in the control group showing no difference amongthe groups The office DBP before and after massage showed

Evidence-Based Complementary and Alternative Medicine 7

a reduction of approximately 5mmHg in the experimentalgroup as opposed to an elevation of 2mmHg in the placebogroup The effect of aroma massage in reducing DBP is lim-ited although there appears to be some immediate reducingeffect of aroma massage for office DBP

There was no difference in 24-hour ambulatory BPbetween groups A once-weekly intervention of aroma mas-sage and cream application does not appear to promotepositive 24-hour ambulatory BP Therefore further researchon the frequency of massage and the active ingredients andtypes of oils used is necessary

In terms of sleep quality the aroma massage groupshowed an improvement while the placebo and no-treatmentgroups failed to do so This result appears to be due to theeffect of the essential oil used in this study on the autonomicnervous system to increase the quality of sleep [7 9] Theseresults are in line with those of a study by Jung and Jeon[16] They used a mixture of lavender bergamot and clarysage in a 3 2 1 ratio applied to hemiplegic patients on thearm hand and the lower neck through aroma massage andshowed reduction of sleep disturbance score The results ofthis study are consistent with the other study of middle-agedwomen using a lavender essential oil necklace and one totwo drops of lavender essential oil on the pillow before sleep(instead of the necklace) [17] which showed improvement insleep quality

Our study did not take into account the preference ofparticipants for aroma fragrance Althoughmost participantsreported a good feeling toward the aroma some reportedpreference for another fragranceThus the psychological andphysical responses may vary depending on the fragrancepreference of the subject receiving the aromatherapy

In conclusion aroma massage was effective in reducinghome SBP and immediate office BP before and after theintervention as well as increasing sleep quality in middle-aged women with hypertension Further research comparingthe effects of various and convenient aromatherapy methodsincluding bathing topical application and foot washing isneeded

Conflict of Interests

The authors declare no conflict of interests

Acknowledgment

This work was supported by the National Research Founda-tion of Korea (NRF)Grant funded by the Korean governmentMEST (no 2008-0061658) M S Lee was supported by KoreaInstitute of Oriental Medicine (K12130)

References

[1] World Health Organization Chronic Diseases World HealthOrganization Geneva Switzerland 2012

[2] National Health Statistics ldquoNational health nutrition surveyquaternary period secondary sourcerdquo Approval Number Statis-tics 11702 The Ministry of Health and Welfare 2008

[3] B H LeeManual of Hypertension Deahanuihakseojeok SeoulKorea 2009

[4] P Bansil E V Kuklina R K Merritt and P W YoonldquoAssociations between sleep disorders sleep duration qualityof sleep and hypertension results from theNational Health andNutrition Examination Survey 2005 to 2008rdquo Journal of ClinicalHypertension vol 13 no 10 pp 739ndash743 2011

[5] D D Smeltzer B G Bare J L Hinkle and K H CheeverBrunner amp Suddarthrsquos Textbook of Medical-Surgical NursingWolsters KluwerLippincott Williams amp Wilkins PhiladelphiaPa USA 2010

[6] S Battaglia The Complete Guide to Aromatherapy The Inter-national Centre of Holistic Aromatherapy Brisbane Australia2003

[7] B J Ha Aromatherapy Soo Moon Sa Seoul Korea 2006[8] P Daniel P Shirley and P Len Aromatherphy for Healt

Professionals Churchill Livingstone London UK 2001[9] S H Han M H Hur J H Park E J Lee and M K Park

Womenrsquos Health and Aromatherapy Hyun Moon Sa SeoulKorea 2002

[10] J F Owens and K A Matthews ldquoSleep disturbance in healthymiddle-aged womenrdquoMaturitas vol 30 no 1 pp 41ndash50 1998

[11] P Vara ldquoThe climacterium from the gynaecologist1015840s point ofviewrdquo Acta Obstetricia et Gynecologica Scandinavica Supple-ment vol 49 supplement 1 pp 43ndash55 1970

[12] MH Hur H OhM S Lee C Kim A N Choi andG R ShinldquoEffects of aromatherapy massage on blood pressure and lipidprofile in Korean climacteric womenrdquo International Journal ofNeuroscience vol 117 no 9 pp 1281ndash1287 2007

[13] Y J Jung Effects of Aromatherapy on Blood Pressure Heart RateVariability and Serum Catecholamines in the Pre-HypertensionMiddle AgedWomen Department of Nursing Catholic Univer-sity Seoul Korea 2007

[14] J H Hwang ldquoThe effects of the inhalation method usingessential oils on blood pressure and stress responses of clientswith essential hypertensionrdquo Journal of Korean Academy ofNursing vol 36 no 7 pp 1123ndash1134 2006

[15] Y K Choi and S Lee ldquoThe effect of posterior neck massageusing maychang oil on the blood pressure and componentsin elderly women who have hypertensionrdquo Journal of KoreanBeauty Society vol 17 no 2 pp 211ndash217 2011

[16] H M Jung and Y S Jeon ldquoEffects of the aroma massage onshoulder pain depression sleep disturbance in hemiparesispatientsrdquo The Korean Journal of Rehabilitation Nursing vol 7no 2 pp 231ndash237 2004

[17] G H Lee K M Park and M K Ryu ldquoThe effect of aro-matherapy with lavender essential oil on sleep disturbanceand depression on middle-aged womenrdquo Journal of the KoreanSociety of Maternal and Child Health vol 6 no 1 pp 23ndash372002

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

6 Evidence-Based Complementary and Alternative Medicine

Table 3 Aroma massage on office BP

Time Aroma (119899 = 28) Placebo (119899 = 28) 119905 119875

SBP1st session

Pre 1240 plusmn 111 1258 plusmn 157 minus049 063Post 1128 plusmn 124 1189 plusmn 152 minus163 011

2nd sessionPre 1190 plusmn 117 1214 plusmn 115 minus078 044Post 1085 plusmn 108 1197 plusmn 133 minus344 0001

3rd sessionPre 1182 plusmn 107 1223 plusmn 131 minus128 021Post 1097 plusmn 111 1186 plusmn 139 minus265 001

4th sessionPre 1190 plusmn 103 1251 plusmn 155 minus175 009Post 1111 plusmn 99 1229 plusmn 159 minus333 0002

5th sessionPre 1194 plusmn 121 1266 plusmn 157 minus193 006Post 1089 plusmn 97 1250 plusmn 146 minus487 lt0001

Group 119865 = 1334 119875 = 0001 time 119865 = 215 119875 = 008group times time 119865 = 363 119875 = 0007

DBP1st session

Pre 743 plusmn 77 760 plusmn 109 minus067 051Post 718 plusmn 84 747 plusmn 97 minus119 024

2nd sessionPre 721 plusmn 84 743 plusmn 80 minus101 032Post 678 plusmn 78 748 plusmn 93 minus309 0003

3rd sessionPre 727 plusmn 77 737 plusmn 80 minus050 062Post 702 plusmn 78 746 plusmn 83 minus208 004

4th sessionPre 731 plusmn 68 760 plusmn 98 minus127 021Post 720 plusmn 67 774 plusmn 101 minus238 002

5th sessionPre 726 plusmn 83 760 plusmn 99 minus138 018Post 695 plusmn 64 781 plusmn 103 minus376 lt0001

Group 119865 = 846 119875 = 0005 time 119865 = 384 119875 = 0005group times time 119865 = 279 119875 = 003

Values are expressed as mean plusmn standard deviationBP blood pressure DBP diastolic blood pressure SBP systolic blood pres-sure

middle-agedwomenwith hypertensionTheresults show thataroma massage significantly reduced home SBP comparedwith the placebo and no-treatment groups

The aromamassage group showed an approximate reduc-tion of 15mmHg for home SBP while the placebo groupshowed an approximate reduction of 6mmHg One previousstudy showed a reduction of 4mmHg in SBP using posteriorneck massage three times a week for six weeks with lavenderoil [15] Comparing with these results the effect observedwith once-weekly overall body massage in this study showsthat it is very effective in lowering BP The oils used inthis study (a blend of lavender ylang-ylang marjoram and

Table 4 Aroma massage on 24-hour ambulatory BP

Time Aroma Placebo Control119865 119875

(119899 = 28) (119899 = 28) (119899 = 27)SBP

DaytimePre 1348 plusmn 120 1362 plusmn 135 1285 plusmn 125 288 06Post 1303 plusmn 117 1284 plusmn 122 1339 plusmn 129 137 26

Night timePre 1222 plusmn 158 1249 plusmn 139 1191 plusmn 164 098 38Post 1175 plusmn 156 1190 plusmn 99 1229 plusmn 181 093 40

DBPDaytime

Pre 827 plusmn 86 836 plusmn 81 816 plusmn 94 037 69Post 814 plusmn 83 800 plusmn 81 834 plusmn 89 107 35

Night timePre 748 plusmn 99 764 plusmn 89 744 plusmn 111 030 74Post 736 plusmn 105 717 plusmn 68 746 plusmn 110 059 55

Values are expressed as mean plusmn standard deviationBP blood pressure DBP diastolic blood pressure SBP systolic blood pres-sure

Table 5 Aroma massage on sleep quality

Time Aroma Placebo Control119865 119875

(119899 = 28) (119899 = 28) (119899 = 27)Pre 510 plusmn 126 481 plusmn 158 556 plusmn 105 224 011Post 581 plusmn 113

a465 plusmn 138

b503 plusmn 109

b 675 0002Difference 71 plusmn 126

aminus16 plusmn 96

bminus53 plusmn 106

b 932 lt0001Values are expressed as mean plusmn standard deviationMeans for each group with different superscript (a b or c) indicate asignificant difference (Tukey test 119875 lt 005)

Neroli) are thought to have produced synergistic effects inlowering BP compared with a simple lavender oil [13] Inaddition previous research using inhalation therapy usinglavender ylang-ylang and bergamot showed a decrease of1910mmHg in BP and showed synergistic effects in loweringBP compared to this study [14]

The aroma massage may reduce BP by inducing thephysical relaxation and decreasing activation of sympatheticnervous system In this study the placebo groupwith artificialfragrance also showed decreased BP with massage This isthought to be due to the effect of massage rather than theartificial fragrance

In particular the office SBP decreased by 12mmHg afterthe first massage and 11mmHg after the fifth massage in thearoma massage group This shows the acute effect of aromamassage for immediate decreasing of BP The BP decreaseafter the firstmassage in the placebo groupwas approximately7mmHg However it did not show substantial reduction asmassage sessions progressed pointing to a temporary effectof massage with artificial fragrance

The home DBP decreased by approximately 4mmHg inthe experimental group 3mmHg in the placebo group and1mmHg in the control group showing no difference amongthe groups The office DBP before and after massage showed

Evidence-Based Complementary and Alternative Medicine 7

a reduction of approximately 5mmHg in the experimentalgroup as opposed to an elevation of 2mmHg in the placebogroup The effect of aroma massage in reducing DBP is lim-ited although there appears to be some immediate reducingeffect of aroma massage for office DBP

There was no difference in 24-hour ambulatory BPbetween groups A once-weekly intervention of aroma mas-sage and cream application does not appear to promotepositive 24-hour ambulatory BP Therefore further researchon the frequency of massage and the active ingredients andtypes of oils used is necessary

In terms of sleep quality the aroma massage groupshowed an improvement while the placebo and no-treatmentgroups failed to do so This result appears to be due to theeffect of the essential oil used in this study on the autonomicnervous system to increase the quality of sleep [7 9] Theseresults are in line with those of a study by Jung and Jeon[16] They used a mixture of lavender bergamot and clarysage in a 3 2 1 ratio applied to hemiplegic patients on thearm hand and the lower neck through aroma massage andshowed reduction of sleep disturbance score The results ofthis study are consistent with the other study of middle-agedwomen using a lavender essential oil necklace and one totwo drops of lavender essential oil on the pillow before sleep(instead of the necklace) [17] which showed improvement insleep quality

Our study did not take into account the preference ofparticipants for aroma fragrance Althoughmost participantsreported a good feeling toward the aroma some reportedpreference for another fragranceThus the psychological andphysical responses may vary depending on the fragrancepreference of the subject receiving the aromatherapy

In conclusion aroma massage was effective in reducinghome SBP and immediate office BP before and after theintervention as well as increasing sleep quality in middle-aged women with hypertension Further research comparingthe effects of various and convenient aromatherapy methodsincluding bathing topical application and foot washing isneeded

Conflict of Interests

The authors declare no conflict of interests

Acknowledgment

This work was supported by the National Research Founda-tion of Korea (NRF)Grant funded by the Korean governmentMEST (no 2008-0061658) M S Lee was supported by KoreaInstitute of Oriental Medicine (K12130)

References

[1] World Health Organization Chronic Diseases World HealthOrganization Geneva Switzerland 2012

[2] National Health Statistics ldquoNational health nutrition surveyquaternary period secondary sourcerdquo Approval Number Statis-tics 11702 The Ministry of Health and Welfare 2008

[3] B H LeeManual of Hypertension Deahanuihakseojeok SeoulKorea 2009

[4] P Bansil E V Kuklina R K Merritt and P W YoonldquoAssociations between sleep disorders sleep duration qualityof sleep and hypertension results from theNational Health andNutrition Examination Survey 2005 to 2008rdquo Journal of ClinicalHypertension vol 13 no 10 pp 739ndash743 2011

[5] D D Smeltzer B G Bare J L Hinkle and K H CheeverBrunner amp Suddarthrsquos Textbook of Medical-Surgical NursingWolsters KluwerLippincott Williams amp Wilkins PhiladelphiaPa USA 2010

[6] S Battaglia The Complete Guide to Aromatherapy The Inter-national Centre of Holistic Aromatherapy Brisbane Australia2003

[7] B J Ha Aromatherapy Soo Moon Sa Seoul Korea 2006[8] P Daniel P Shirley and P Len Aromatherphy for Healt

Professionals Churchill Livingstone London UK 2001[9] S H Han M H Hur J H Park E J Lee and M K Park

Womenrsquos Health and Aromatherapy Hyun Moon Sa SeoulKorea 2002

[10] J F Owens and K A Matthews ldquoSleep disturbance in healthymiddle-aged womenrdquoMaturitas vol 30 no 1 pp 41ndash50 1998

[11] P Vara ldquoThe climacterium from the gynaecologist1015840s point ofviewrdquo Acta Obstetricia et Gynecologica Scandinavica Supple-ment vol 49 supplement 1 pp 43ndash55 1970

[12] MH Hur H OhM S Lee C Kim A N Choi andG R ShinldquoEffects of aromatherapy massage on blood pressure and lipidprofile in Korean climacteric womenrdquo International Journal ofNeuroscience vol 117 no 9 pp 1281ndash1287 2007

[13] Y J Jung Effects of Aromatherapy on Blood Pressure Heart RateVariability and Serum Catecholamines in the Pre-HypertensionMiddle AgedWomen Department of Nursing Catholic Univer-sity Seoul Korea 2007

[14] J H Hwang ldquoThe effects of the inhalation method usingessential oils on blood pressure and stress responses of clientswith essential hypertensionrdquo Journal of Korean Academy ofNursing vol 36 no 7 pp 1123ndash1134 2006

[15] Y K Choi and S Lee ldquoThe effect of posterior neck massageusing maychang oil on the blood pressure and componentsin elderly women who have hypertensionrdquo Journal of KoreanBeauty Society vol 17 no 2 pp 211ndash217 2011

[16] H M Jung and Y S Jeon ldquoEffects of the aroma massage onshoulder pain depression sleep disturbance in hemiparesispatientsrdquo The Korean Journal of Rehabilitation Nursing vol 7no 2 pp 231ndash237 2004

[17] G H Lee K M Park and M K Ryu ldquoThe effect of aro-matherapy with lavender essential oil on sleep disturbanceand depression on middle-aged womenrdquo Journal of the KoreanSociety of Maternal and Child Health vol 6 no 1 pp 23ndash372002

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

Evidence-Based Complementary and Alternative Medicine 7

a reduction of approximately 5mmHg in the experimentalgroup as opposed to an elevation of 2mmHg in the placebogroup The effect of aroma massage in reducing DBP is lim-ited although there appears to be some immediate reducingeffect of aroma massage for office DBP

There was no difference in 24-hour ambulatory BPbetween groups A once-weekly intervention of aroma mas-sage and cream application does not appear to promotepositive 24-hour ambulatory BP Therefore further researchon the frequency of massage and the active ingredients andtypes of oils used is necessary

In terms of sleep quality the aroma massage groupshowed an improvement while the placebo and no-treatmentgroups failed to do so This result appears to be due to theeffect of the essential oil used in this study on the autonomicnervous system to increase the quality of sleep [7 9] Theseresults are in line with those of a study by Jung and Jeon[16] They used a mixture of lavender bergamot and clarysage in a 3 2 1 ratio applied to hemiplegic patients on thearm hand and the lower neck through aroma massage andshowed reduction of sleep disturbance score The results ofthis study are consistent with the other study of middle-agedwomen using a lavender essential oil necklace and one totwo drops of lavender essential oil on the pillow before sleep(instead of the necklace) [17] which showed improvement insleep quality

Our study did not take into account the preference ofparticipants for aroma fragrance Althoughmost participantsreported a good feeling toward the aroma some reportedpreference for another fragranceThus the psychological andphysical responses may vary depending on the fragrancepreference of the subject receiving the aromatherapy

In conclusion aroma massage was effective in reducinghome SBP and immediate office BP before and after theintervention as well as increasing sleep quality in middle-aged women with hypertension Further research comparingthe effects of various and convenient aromatherapy methodsincluding bathing topical application and foot washing isneeded

Conflict of Interests

The authors declare no conflict of interests

Acknowledgment

This work was supported by the National Research Founda-tion of Korea (NRF)Grant funded by the Korean governmentMEST (no 2008-0061658) M S Lee was supported by KoreaInstitute of Oriental Medicine (K12130)

References

[1] World Health Organization Chronic Diseases World HealthOrganization Geneva Switzerland 2012

[2] National Health Statistics ldquoNational health nutrition surveyquaternary period secondary sourcerdquo Approval Number Statis-tics 11702 The Ministry of Health and Welfare 2008

[3] B H LeeManual of Hypertension Deahanuihakseojeok SeoulKorea 2009

[4] P Bansil E V Kuklina R K Merritt and P W YoonldquoAssociations between sleep disorders sleep duration qualityof sleep and hypertension results from theNational Health andNutrition Examination Survey 2005 to 2008rdquo Journal of ClinicalHypertension vol 13 no 10 pp 739ndash743 2011

[5] D D Smeltzer B G Bare J L Hinkle and K H CheeverBrunner amp Suddarthrsquos Textbook of Medical-Surgical NursingWolsters KluwerLippincott Williams amp Wilkins PhiladelphiaPa USA 2010

[6] S Battaglia The Complete Guide to Aromatherapy The Inter-national Centre of Holistic Aromatherapy Brisbane Australia2003

[7] B J Ha Aromatherapy Soo Moon Sa Seoul Korea 2006[8] P Daniel P Shirley and P Len Aromatherphy for Healt

Professionals Churchill Livingstone London UK 2001[9] S H Han M H Hur J H Park E J Lee and M K Park

Womenrsquos Health and Aromatherapy Hyun Moon Sa SeoulKorea 2002

[10] J F Owens and K A Matthews ldquoSleep disturbance in healthymiddle-aged womenrdquoMaturitas vol 30 no 1 pp 41ndash50 1998

[11] P Vara ldquoThe climacterium from the gynaecologist1015840s point ofviewrdquo Acta Obstetricia et Gynecologica Scandinavica Supple-ment vol 49 supplement 1 pp 43ndash55 1970

[12] MH Hur H OhM S Lee C Kim A N Choi andG R ShinldquoEffects of aromatherapy massage on blood pressure and lipidprofile in Korean climacteric womenrdquo International Journal ofNeuroscience vol 117 no 9 pp 1281ndash1287 2007

[13] Y J Jung Effects of Aromatherapy on Blood Pressure Heart RateVariability and Serum Catecholamines in the Pre-HypertensionMiddle AgedWomen Department of Nursing Catholic Univer-sity Seoul Korea 2007

[14] J H Hwang ldquoThe effects of the inhalation method usingessential oils on blood pressure and stress responses of clientswith essential hypertensionrdquo Journal of Korean Academy ofNursing vol 36 no 7 pp 1123ndash1134 2006

[15] Y K Choi and S Lee ldquoThe effect of posterior neck massageusing maychang oil on the blood pressure and componentsin elderly women who have hypertensionrdquo Journal of KoreanBeauty Society vol 17 no 2 pp 211ndash217 2011

[16] H M Jung and Y S Jeon ldquoEffects of the aroma massage onshoulder pain depression sleep disturbance in hemiparesispatientsrdquo The Korean Journal of Rehabilitation Nursing vol 7no 2 pp 231ndash237 2004

[17] G H Lee K M Park and M K Ryu ldquoThe effect of aro-matherapy with lavender essential oil on sleep disturbanceand depression on middle-aged womenrdquo Journal of the KoreanSociety of Maternal and Child Health vol 6 no 1 pp 23ndash372002

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom