Introduction
My nursing practice problem is to determine the most effective remedy against hypertension in pregnant patients. Currently, there are two most common medications for the treatment of this disease: labetalol and methyldopa. The investigated question is to evaluate the advantages of labetalol over methyldopa during the gestational period. My PICOT question is the following: in gestational patients suffering from hypertension (P), does labetalol medication therapy (I), compared with methyldopa medication therapy (C), improve hypertension control and patient pregnancy outcomes (O), during the gestational period (T)?
Background of Studies
Problem
Arterial hypertension during pregnancy is an increase in blood pressure recorded two or more times within four hours. The numbers ≥ 140 mm for upper systolic and ≥ 90 mm for lower diastolic blood pressure are considered elevated (Easterling et al., 2019). In this paper, gestational arterial hypertension is investigated, which is detected after the 20th week of pregnancy by the time of detection (Bellos et al., 2020). It is a problem due to the threat to the health of both the mother and the fetus. The risks for mother and child are placental insufficiency, fetal growth retardation syndrome intrauterine fetal death, as well as the death of a child in the early postpartum period.
Significance to Nursing
The significance of treating the problem of arterial hypertension in pregnant women to nursing is to reduce the death of mothers and fetuses. This problem is quite common: it affects from 5 to 8% of expectant mothers (Easterling et al., 2019). For this reason, special attention should be paid to the study of drugs used to treat this pathology.
Purpose
The purpose of this paper is a comparative studying of the characteristics of two drugs used for the treatment of gestational hypertension in pregnant women: labetalol and methyldopa, and to identify the most effective of them.
Objective
The objective of the study is to compare the drugs used to treat the diagnosis of arterial hypertension in pregnant women, finding distinctive signs taking into account individual statistics of the effectiveness of therapy at the gestational stage.
Research Questions
This study aims to get answers to the following research questions: What are the advantages of labetalol medicine therapy over methyldopa medicine therapy? How much do each of the drugs improve hypertension control and patient pregnancy outcome? What are the features of prescribing these drugs during the gestational period?
Support of the Nursing Practice Problem
These two articles will be used to answer my PICOT question because they provide evidence-based research regarding the effectiveness of labetalol and methyldopa medicine therapy. The first article is a network meta-analysis evaluating the effect of drugs on the etiological, pathogenetic and symptomatic components of the disease in terms of the composition of these drugs and their complex component effects (Easterling et al., 2019). The second article is a description of the open-label, randomized controlled trial, which appeals to the evidence base of the use of labetalol and methyldopa in arterial hypertension of pregnant women (Bellos et al., 2006).
The interventions in both of the articles consist in the treatment of pregnant patients suffering from hypertension with drugs identified in my PICOT question. Comparison groups in the articles are almost identical to those identified in my PICOT question. In both articles, pregnant women are treated with labetalol and methyldopa both before and after the 20th week (Easterling et al., 2019). However, in the following case, a narrower sample is needed, since in this research, patients are examined during the gestational period.
Method of Studies
The first article uses the theoretical method of classification of the following drugs labetalol and methyldopa. The classification method involves the division of drugs into groups according to the active substance and effectiveness in countering symptoms and their causes (Easterling et al., 2019). The second article uses a practical comparison method: the effectiveness of several drugs for hypertension in pregnant women, including labetalol and methyldopa, is compared (Bellos et al., 2006). The methods used in the articles differ, since the first article uses the theoretical one, and the second one uses the practical one. The first method involved the processing of existing scientific material through logic (Rezk et al., 2019). The second method is used to obtain new data empirically, in practice.
The advantages of the comparison method are that in this way it becomes possible to simultaneously cover changes in the condition and reactions of pregnant patients to treatment with labetalol and methyldopa. The advantages of the classification method are large information capacity, conventionality and familiarity of use, good adaptability for information processing, and the ability to create mnemonic codes that carry a semantic load (Rezk et al., 2019). The limitations of the classification method are its rigid structure, which is due to the fixity of the features laid in its foundation. Due to the pre-established order of drugs, it is not allowed to include new medicines in the classification and exclude medicines that have disappeared from the market.
Results of Studies
The key findings of the first study are the appointment of labetalol as a first-line drug as the most studied antihypertensive drug for the treatment of hypertension during pregnancy (Easterling et al., 2019). However, according to the results of the analysis of theoretical literature, methyldopa in most countries is a first-line drug for the treatment of hypertension in pregnant women, which has been studied in numerous prospective studies in comparison with other antihypertensive drugs. The second study confirms the effectiveness of labetalol in comparison with methyldopa, but notes its cost, which is a complicating factor in the wider use of this drug (Bellos et al., 2006). The implications of the two studies in nursing practice include the need to change the accepted standards for the treatment of hypertension in pregnant women. According to the existing practice, methyldopa drugs are prescribed first of all. However, as both practical and theoretical studies have shown, labetalol is better at improving hypertension control and patient pregnancy outcomes during the gestational period.
Ethical Considerations
The first ethical consideration is conducting research is to test drugs on pregnant women. The ethical dilemma in this case is to decide what poses a greater risk – side effects for the mother and fetus when testing the test drug or the mother’s disease. The second ethical consideration is to prescribe, first of all, a more effective drug: labetalol, which has proven to be more effective than methyldopa. However, it is also more expensive, and not all pregnant women can afford to buy this medicine. When conducting these studies, scientists exclude pregnant women and women with childbearing potential from clinical trials of phase I and phase II medicines, in which new drugs are tested for safety and efficacy (Rezk et al., 2019). Moreover, the appointment of labetalol should be carried out taking into account the financial situation of the pregnant woman, and the priority of this drug does not exclude the possibility of prescribing methyldopa treatment.
Conclusion
As a result of the study, it was revealed that drug therapy with labetalol, compared with drug therapy with methyldopa, really improves the control of hypertension and pregnancy outcomes of patients during the gestational period in patients suffering from hypertension.
References
Bellos, I., Pergialiotis, V., Papapanagiotou, A., Loutradis, D., & Daskalakis, D. (2020). Comparative efficacy and safety of oral antihypertensive agents in pregnant women with chronic hypertension: A network metaanalysis. American Journal of Obstetrics and Gynecology, 223(4), 525-537.
Easterling, T., Mundle, S., Bracken, H., Parvekar, S., Mool, S., Magee, A. L., … Phil, P. D. (2019). Oral antihypertensive regimens (nifedipine retard, labetalol, and methyldopa) for management of severe hypertension in pregnancy: An open-label, randomised controlled trial. The Lancet, 394(10203), 1011-1021.
Rezk, M., Emarh, M., Masood, A., Dawood, R., El-Shamy, E., Gamal, A., & Badr, H. (2019). Methyldopa versus labetalol or no medication for treatment of mild and moderate chronic hypertension during pregnancy: A randomized clinical trial. Hypertension in Pregnancy, 39(4), 393-398.