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Systemic β-blockers have little effect on IOP reduction
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Nonselective systemic β-blocker intake showed a clinically relevant association and a borderline significant trend with IOP decrease, while the use of cardioselective β-blockers and all other cardiovascular medication did not, according to researchers.
In contrast to published literature, the researchers found no association between systemic β-blocker intake and lower IOP in non-glaucoma subjects, according to research in British Journal of Ophthalmology.
Researchers examined 13,527 adults taking cardiovascular medication from 35 years to 74 years from the Gutenberg Health Study.
The medication classes examined were peripheral vasodilators, diuretics, β-blockers, calcium channel blockers, renin-angiotensin blockers, nitrates, other antihypertensive medications, aspirin and statins.
IOP was measured using a noncontact tonometer (Nidek NT-2000, Nidek Co.).
Researchers found that both selective and nonselective systemic β-blocker intake were not associated with statistically significant lower IOP.
IOP was not associated with the use of ACE inhibitors after adjustment for body mass index, systolic blood pressure and central corneal thickness, according to researchers.
The highest mean IOP was observed in subjects taking other systemic antihypertensives. In addition, men on diuretics, nitrates or peripheral vasodilators had a lower mean IOP than men not taking these medications.
Only nonselective β-blockers, selective β-blockers and β-blockers in general showed a trend to be associated with lower IOPs, according to researchers.
β-blocker is used to treat IOP in a patient who is concomitantly given systemic β-blockers,” researchers wrote.
Researchers said that only a prospective randomized controlled study will determine a causal relationship between systemic β-blocker and IOP effect. – by Abigail Sutton
Disclosures: The researchers report no relevant financial disclosures.
Perspective
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Derek MacDonald, OD, FAAO
Cardiovascular disease and glaucoma are common comorbidities, and beta-blockers have long been first- or second-line treatments for both conditions. Originally developed in the mid-1960s for the treatment of angina, beta-blockers arrived on the ophthalmic scene 15 years later with the introduction of topical timolol.
Despite a history spanning nearly 4 decades, two important questions remain unanswered: Do systemic beta-blockers lower IOP, and are topical agents effective with concurrent systemic administration?
While some studies suggest that systemic beta-blockers temporarily lower IOP, Hohn and colleagues propose that tachyphylaxis is responsible for the relatively minor impact seen in most population-based surveys. Further, a weak local effect but robust blood pressure reduction may compromise ocular perfusion pressure (OPP), which increased glaucoma prevalence in a number of epidemiologic surveys. The Rotterdam and Thessaloniki studies specifically implicated (over-) treated high blood pressure as compromising OPP, while other investigators (including Krasinska et al. and Charlson et al.) have noted that nocturnal blood pressure dips increase glaucoma progression.
In caring for patients with glaucoma, clinicians may be wise to consider systemic blood pressure treatment (particularly evening dosing) more of an exacerbating than mitigating factor and individually trial any topical beta-blocker to ensure its efficacy with concomitant systemic treatment.
References:
Charlson ME, et al. Ophthalmology. 2014;121(10): 2004-2012.
Krasinska B, et al. J Clin Hyperten. 2012;14(10):701-710.
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