The Influence of Spirituality on Psychological Resilience and Recurrence in Hypertension Patients

  • Faisal Amir Ngudia Husada Madura Institute of Health Sciences
  • Lantin Sulistyorini Faculty of Nursing, Universitas Jember, Indonesia
  • M Hasinuddin Department of Pediatric Nursing, Nursing Study Program, Ngudia Husada School of Health, Madura, Indonesia
Keywords: spirituality, resilience, hypertension, hypertensive recurrence


Hypertension is a chronic disease that is prone to recurrence and disrupts the balance of systemic hemodynamics to cause various serious multi-system complications. This study aimed to analyze the spiritual level in the regulation of resilience and relapse in hypertensive patients. We used a correlation analysis method with a cross-sectional approach. The population was 76 patients who were recorded as coming to the Puskesmas with a sample size of 62 respondents who were taken by simple random sampling. The independent variable was spirituality, as measured using the Daily Spiritual Experience Scale (DSES). The dependent variable was resilience as measured by the Nicholson–McBride Resilience Questionnaire (NMRQ) and hypertension recurrence. Statistical tests using Spearman’s rank with alpha (α) 0.05. The results of the statistical tests show a significant relationship between spirituality and resilience. The p-value obtained is 0.001 less than 0.05, with a level of closeness of 0.790 or solid. Spirituality is also significantly related to hypertension recurrence with a p-value of 0.011, smaller than alpha 0.05, and a level of closeness of -0.325, which means a moderate level of closeness. Deep spirituality will trigger the strengthening of resilience that regulates the balance of stress and homeostasis of the sympathetic and parasympathetic nervous systems. The physiological sympathetic and parasympathetic systems regulate vascular smooth muscle contractions to control blood pressure and reduce the rate of hypertensive recurrence.


Al Ghorani, H., Götzinger, F., Böhm, M., & Mahfoud, F. (2022). Arterial hypertension - Clinical trials update 2021. Nutrition, Metabolism, and Cardiovascular Diseases : NMCD, 32(1), 21–31.

Altschul, D. M., Wraw, C., Der, G., Gale, C. R., & Deary, I. J. (2019). Hypertension Development by Midlife and the Roles of Premorbid Cognitive Function, Sex, and Their Interaction. Hypertension (Dallas, Tex. : 1979), 73(4), 812–819.

Amir, F., Mastutik, G., Hasinuddin, M., & Putra, S. T. (2018). Dhikr (Recitation) and Relaxation Improve Stress Perception and Reduce Blood Cortisol Level in Type 2 Diabetes Mellitus Patients with OAD. Folia Medica Indonesiana, 54(4), 249.

Bhatnagar, S. (2021). Rethinking stress resilience. Trends in Neurosciences, 44(12), 936–945.

Boima, V., Yorke, E., Ganu, V., Gyaban-Mensah, A., Ekem-Ferguson, G., Kretchy, I. A., & Mate-Kole, C. C. (2022). Coping strategies and resilience among patients with hypertension in Ghana. Frontiers in Psychology, 13, 1038346.

Curcio, N., Turner, E. D., Leonard, K., Bennett, M. M., Warren, A. M., & Edgerton, J. R. (2022). The role of resilience and spirituality in recovery following cardiac surgery. In Proceedings (Baylor University. Medical Center), 35(4), 420–427.

Dantzer, R., Cohen, S., Russo, S. J., & Dinan, T. G. (2018). Resilience and immunity. Brain, Behavior, and Immunity, 74, 28–42.

de Hartog-Keyzer, J. M. L., Pedersen, S. S., El Messaoudi, S., Nijveldt, R., & Pop, V. J. M. (2022). Psychological distress is independently related to new coronary events at 8 years’ follow-up in elderly primary care patients with hypertension. Journal of Psychosomatic Research, 160, 110980.

Ellison, C. W. (1983). Spiritual Well-Being: Conceptualization and Measurement. Journal of Psychology and Theology, 11, 330–338.

Elsaafien, K., Kirchner, M. K., Mohammed, M., Eikenberry, S. A., West, C., Scott, K. A., de Kloet, A. D., Stern, J. E., & Krause, E. G. (2021). Identification of Novel Cross-Talk between the Neuroendocrine and Autonomic Stress Axes Controlling Blood Pressure. The Journal of Neuroscience : The Official Journal of the Society for Neuroscience, 41(21), 4641–4657.

Flack, J. M., & Adekola, B. (2020). Blood pressure and the new ACC/AHA hypertension guidelines. Trends in Cardiovascular Medicine, 30(3), 160–164.

Fonkoue, I. T., Norrholm, S. D., Marvar, P. J., Li, Y., Kankam, M. L., Rothbaum, B. O., & Park, J. (2018). Elevated resting blood pressure augments autonomic imbalance in posttraumatic stress disorder. American Journal of Physiology. Regulatory, Integrative and Comparative Physiology, 315(6), R1272–R1280.

Fuchs, F. D., & Whelton, P. K. (2020). High Blood Pressure and Cardiovascular Disease. Hypertension (Dallas, Tex. : 1979), 75(2), 285–292.

Giovannetti, A. M., Solari, A., & Pakenham, K. I. (2022). Effectiveness of a group resilience intervention for people with multiple sclerosis delivered via frontline services. Disability and Rehabilitation, 44(22), 6582–6592.

Hall, J. E., Omoto, A. C. M., Wang, Z., Mouton, A., Li, X., & Hall, M. E. (2024). 5 - Pathophysiology of Hypertension. In G. L. Bakris, M. J. Sorrentino, & L. J. B. T.-H. (Fourth E. Laffin (Eds.), A Companion to Braunwald’s Heart Disease (pp. 71–86). Elsevier.

Hamka, Suen, M.-W., Ramadhan, Y. A., Yusuf, M., & Wang, J.-H. (2022). Spiritual Well-Being, Depression, Anxiety, and Stress in Indonesian Muslim Communities During COVID-19. Psychology Research and Behavior Management, 15, 3013–3025.

Hayden, K. M., Gaussoin, S. A., Hunter, J. C., Manson, J. E., Sachs, B. C., Shadyab, A. H., Tindle, H. A., Mossavar-Rahmani, Y., Mozhui, K., Snively, B. M., Rapp, S. R., & Resnick, S. M. (2019). Cognitive resilience among APOE ε4 carriers in the oldest old. International Journal of Geriatric Psychiatry, 34(12), 1833–1844.

Heintzman, P. (2019). Empirical research on leisure and spiritual well-being: conceptualisation, measurement and findings. Leisure Studies, 39, 1–10.

Herrera Moro Chao, D., Kirchner, M. K., Pham, C., Foppen, E., Denis, R. G. P., Castel, J., Morel, C., Montalban, E., Hassouna, R., Bui, L.-C., Renault, J., Mouffle, C., García-Cáceres, C., Tschöp, M. H., Li, D., Martin, C., Stern, J. E., & Luquet, S. H. (2022). Hypothalamic astrocytes control systemic glucose metabolism and energy balance. Cell Metabolism, 34(10), 1532-1547.e6.

Hou, T., Guo, Z., & Gong, M. C. (2021). Circadian variations of vasoconstriction and blood pressure in physiology and diabetes. Current Opinion in Pharmacology, 57, 125–131.

Houle, S. A., Vincent, C., Jetly, R., & Ashbaugh, A. R. (2021). Patterns of distress associated with exposure to potentially morally injurious events among Canadian Armed Forces service members and Veterans: A multi-method analysis. Journal of Clinical Psychology, 77(11), 2668–2693.

Imani, A., Parsa, H., Chookalaei, L. G., Rakhshan, K., Golnazari, M., & Faghihi, M. (2019). Acute Physical Stress Preconditions the Heart Against Ischemia/Reperfusion Injury Through Activation of Sympathetic Nervous System. Arquivos Brasileiros de Cardiologia, 113(3), 401–408.

Jiang, G., He, Y., Li, T., Qin, Q., Wang, D., Huang, F., Sun, Y., & Li, J. (2024). Association of psychological resilience and cognitive function in older adults: Based on the Ma’ anshan Healthy Aging Cohort Study. Archives of Gerontology and Geriatrics, 116, 105166.

Killgore, W. D. S., Taylor, E. C., Cloonan, S. A., & Dailey, N. S. (2020). Psychological resilience during the COVID-19 lockdown. Psychiatry research, 291, 113216.

Kurnianto, A., Kurniadi Sunjaya, D., Ruluwedrata Rinawan, F., & Hilmanto, D. (2020). Prevalence of Hypertension and Its Associated Factors among Indonesian Adolescents. International Journal of Hypertension, 2020, 4262034.

Kurniyawan, E. H., Cahyani, P. S. R., Khoiriyah, A. A., Purnomo, F. K. A., Afandi, A. T., Kurniawan, D. E., & Nur, K. R. M. (2023). Coping Mechanisms Used by Farmers to Encounter Psychosocial Problems: Literature Review. Health and Technology Journal (HTechJ), 1(4), 445–454.

Kurniyawan, E. H., Ikhtiarini Dewi, E., Wuri Wuryaningsih, E., Deviantony, F., & Fitria, Y. (2023). Improving Farmers’ Adaptive Coping in the Post-Covid 19 Period: Meningkatkan Koping Adaptif Petani di Masa Pasca COVID-19. Journal of Community Empowerment for Multidisciplinary (JCEMTY), 1(1), 15–22.

Lentz, L. M., Smith-MacDonald, L., Malloy, D., Carleton, R. N., & Brémault-Phillips, S. (2021). Compromised Conscience: A Scoping Review of Moral Injury Among Firefighters, Paramedics, and Police Officers. Frontiers in Psychology, 12, 639781.

Lestari, Y., Ni Luh Putu Thrisna Dewi, & Ni Made Era Mahayani. (2023). The Effect of Feet Reflection Massage on Blood Pressure in Hypertension Patients at Community Health Centers II Petang. Nursing and Health Sciences Journal (NHSJ), 3(1), 56-60.

Li, R. J. W., Zhang, S.-Y., & Lam, T. K. T. (2020). Interaction of glucose sensing and leptin action in the brain. Molecular Metabolism, 39, 101011.

Manning, L., Ferris, M., Rosario, C. N., Prues, M., & Bouchard, L. (2019). Spiritual resilience: Understanding the protection and promotion of well-being in the later life. Journal of Religion, Spirituality & Aging, 31(2), 168–186.

Manosroi, W., & Williams, G. H. (2019). Genetics of Human Primary Hypertension: Focus on Hormonal Mechanisms. Endocrine Reviews, 40(3), 825–856.

Mills, K. T., Stefanescu, A., & He, J. (2020). The global epidemiology of hypertension. Nature Reviews. Nephrology, 16(4), 223–237.

Min, S., Chang, R. B., Prescott, S. L., Beeler, B., Joshi, N. R., Strochlic, D. E., & Liberles, S. D. (2019). Arterial Baroreceptors Sense Blood Pressure through Decorated Aortic Claws. Cell Reports, 29(8), 2192-2201.e3.

Nakazato, L., Mendes, F., Paschoal, I. A., Oliveira, D. C., Moreira, M. M., & Pereira, M. C. (2021). Association of daily physical activity with psychosocial aspects and functional capacity in patients with pulmonary arterial hypertension: a cross-sectional study. Pulmonary Circulation, 11(2), 2045894021999955.

Oktamianti, P., Kusuma, D., Amir, V., Tjandrarini, D. H., & Paramita, A. (2022). District-Level Inequalities in Hypertension among Adults in Indonesia: A Cross-Sectional Analysis by Sex and Age Group. International Journal of Environmental Research and Public Health, 19(20).

Ong, H. L., Vaingankar, J. A., Abdin, E., Sambasivam, R., Fauziana, R., Tan, M.-E., Chong, S. A., Goveas, R. R., Chiam, P. C., & Subramaniam, M. (2018). Resilience and burden in caregivers of older adults: moderating and mediating effects of perceived social support. BMC Psychiatry, 18(1), 27.

Pomerleau, J., Pargament, K., Krause, N., Ironson, G., & Hill, P. (2019). Religious and spiritual struggles as a mediator of the link between stressful life events and psychological adjustment in a nationwide sample. Psychology of Religion and Spirituality, 12.

Rias, Y. A., Rosyad, Y. S., Chipojola, R., Wiratama, B. S., Safitri, C. I., Weng, S. F., Yang, C. Y., & Tsai, H. T. (2020). Effects of Spirituality, Knowledge, Attitudes, and Practices toward Anxiety Regarding COVID-19 among the General Population in INDONESIA: A Cross-Sectional Study. Journal of Clinical Medicine, 9(12).

Salari, N., Hosseinian-Far, A., Jalali, R., Vaisi-Raygani, A., Rasoulpoor, S., Mohammadi, M., Rasoulpoor, S., & Khaledi-Paveh, B. (2020). Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis. Globalization and Health, 16(1), 57.

Salman, A., & Lee, Y.-H. (2019). Spiritual practices and effects of spiritual well-being and depression on elders’ self-perceived health. Applied Nursing Research, 48, 68–74.

Sánchez-Manso, J. C., Gujarathi, R., & Varacallo, M. (2023). Autonomic Dysfunction.

Schober, P., Boer, C., & Schwarte, L. (2018). Correlation Coefficients: Appropriate Use and Interpretation. Anesthesia & Analgesia, 126, 1.

Senthilnathan, S. (2019). Usefulness of Correlation Analysis. SSRN Electronic Journal, July.

Shechter, A., Diaz, F., Moise, N., Anstey, D. E., Ye, S., Agarwal, S., Birk, J. L., Brodie, D., Cannone, D. E., Chang, B., Claassen, J., Cornelius, T., Derby, L., Dong, M., Givens, R. C., Hochman, B., Homma, S., Kronish, I. M., Lee, S. A. J., … Abdalla, M. (2020). Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. General Hospital Psychiatry, 66, 1–8.

Solomon, M., Shiferaw, B. Z., Tarekegn, T. T., GebreEyesus, F. A., Mengist, S. T., Mammo, M., Mewahegn, A. A., Mengiste, B. T., & Terefe, T. F. (2023). Prevalence and Associated Factors of Hypertension Among Adults in Gurage Zone, Southwest Ethiopia, 2022. SAGE Open Nursing, 9, 23779608231153470.

Song, L., Cao, Y., Li, J., Lu, M., & Tang, L. (2022). Psychological distress and resilience in patients with gastroenteropancreatic neuroendocrine tumor. Frontiers in Endocrinology, 13, 947998.

Suvila, K., Langén, V., Cheng, S., & Niiranen, T. J. (2020). Age of Hypertension Onset: Overview of Research and How to Apply in Practice. Current Hypertension Reports, 22(9), 68.

Valle-Tenney, R., Melis, S., & Maes, C. (2023). Hypoxia signaling in bone physiology and energy metabolism. Current Opinion in Endocrine and Metabolic Research, 32, 100473.

Wang, X., & Cheng, Z. (2020). Cross-Sectional Studies: Strengths, Weaknesses, and Recommendations. Chest, 158(1), S65–S71.

Wenger, N. K., Arnold, A., Bairey Merz, C. N., Cooper-DeHoff, R. M., Ferdinand, K. C., Fleg, J. L., Gulati, M., Isiadinso, I., Itchhaporia, D., Light-McGroary, K., Lindley, K. J., Mieres, J. H., Rosser, M. L., Saade, G. R., Walsh, M. N., & Pepine, C. J. (2018). Hypertension Across a Woman’s Life Cycle. Journal of the American College of Cardiology, 71(16), 1797–1813.

Whitehead, B. R., & Bergeman, C. S. (2020). Daily Religious Coping Buffers the Stress-Affect Relationship and Benefits Overall Metabolic Health in Older Adults. Psychology of Religion and Spirituality, 12(4), 393–399.

WHO. (2021). Hypertension (May 17, 2021)

Zekewos, A., Egeno, T., & Loha, E. (2019). The magnitude of hypertension and its risk factors in southern Ethiopia: A community based study. PloS One, 14(8), e0221726.

Zhou, B., Perel, P., Mensah, G. A., & Ezzati, M. (2021). Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nature Reviews. Cardiology, 18(11), 785–802.

How to Cite
Amir F, Sulistyorini L, Hasinuddin M. The Influence of Spirituality on Psychological Resilience and Recurrence in Hypertension Patients. NHSJ [Internet]. 2023Dec.1 [cited 2024Feb.21];3(4):443-9. Available from:

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