Introduction
Cardiovascular diseases are one of the significant causes of mortality, disability, and low quality of life [1]. It has been highly attempted in the field of medicine and pharmacy that significantly reduced the mortality rate of cardiovascular diseases in the last three decades [3 ,4]. In the meantime, cardiac catheterization is the most common intervention in cardiac patients and is an invasive method associated with increased stress and anxiety in patients like other invasive measures [5].
In this regard, benzodiazepines are often used to control post-surgery anxiety; however, patients use herbal and non-pharmacological treatments due to the complications of these medicines [8]. The results of studies indicate that the antioxidant effects of geranium can reduce the level of anxiety, anger, restlessness, and depression [11, 12 ,13]. Additionally, the anti-anxiety effect of lemon on patients has been examined. In the Kamrani et al. study (2016), the anxiety score of the intervention group with lemon was significantly reduced compared to the control group [14]. 
Methods
In this randomized controlled clinical trial study, 150 patients undergoing coronary angioplasty hospitalized in Isfahan were studied. Sampling was performed by convenience sampling method and according to the inclusion criteria. Demographic information form, Spielberger state-trait anxiety inventory, and a checklist of the physiological index were used to collect data. The lemon and geranium essential oil applied in this research was prepared from Tabib Daroo Company. 
Questionnaires were completed by participants before random allocation. In addition, the patient’s physiological indices were measured and recorded. To randomly allocate, a nursing expert outside the research team covered the bottles of essential oils and almond oil with a black bar and used three red, orange, and yellow labels for each bottle. Each of the bottles was then set inside a box, and each box was specified with the same color label according to the color of the bottle. Therefore, the participants chose one of the colors and were placed in the relevant group. Hence, the sampling continued until the number of samples reached the required volume (30 people in each group).
To perform the intervention, the researcher poured three drops of geranium essential oil, lemon essential oil, and sweet almond oil onto a cloth and attached them to their shirts at a distance of 20 cm from the participants’ noses so that the patients inhaled the perfume for 20 minutes. After 20 minutes, the state anxiety inventory was re-completed by the samples, and physiological indices were measured and recorded. 
The paired t test and analysis of covariance were used to analyze the research hypotheses. Analysis was performed at a 5% error level.
Results
Table 1 presents that by controlling the effect of primary anxiety, the mean anxiety score of patients after aromatherapy with geranium essential oil was significantly lower compared to the patients in the aromatherapy group with lemon essential oil and the control group.


Table 2 presents that the increase in arterial blood oxygen saturation of patients in the control group was significantly lower than the two groups of geranium essential oil and lemon essential oil. 


Discussion
Moreover, the rate of decrease in pulse rate and systolic blood pressure of patients in the group of geranium essential oil was significantly higher than in the group of lemon essential oil and the control group. 

Ethical Considerations
Compliance with ethical guidelines
This article with ethical code No. IR.IAU.KHUISF.REC.1399.132 was approved by the Ethics Committee in the research of Isfahan Branch (Khorasgan), Islamic Azad University.

Funding
This study did not receive any funding from various organizations. 

Authors' contributions
All authors have contributed to the preparation of this article. 

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors appreciate the sincere cooperation of patients and staff of Dr Chamran Hospital in Isfahan City, Iran.
 


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