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Beta-blocker eyedrops and nocturnal arterial hypotension.

Abstract

PURPOSE

To investigate the effects of topical beta-blocker eyedrops on nocturnal arterial hypotension and heart rate and on visual field deterioration.

METHODS

We prospectively investigated 275 white patients, 161 with glaucomatous optic neuropathy and 114 with nonarteritic anterior ischemic optic neuropathy, by 24-hour ambulatory blood pressure monitoring and diurnal curve of intraocular pressure, in addition to detailed ophthalmic evaluation. Of the patients with glaucomatous optic neuropathy, 131 had normal-tension glaucoma and 30 had primary open-angle glaucoma. Of the 275 patients, 114 were using topical beta-blocker eyedrops twice daily (76 with normal-tension glaucoma, 26 with primary open-angle glaucoma, and 12 with anterior ischemic optic neuropathy).

RESULTS

Hourly average blood pressure data analyses showed overall a drop in blood pressure as well as heart rate during sleep, and a significantly greater drop in mean diastolic blood pressure (P = .009) at night in normal-tension glaucoma than in anterior ischemic optic neuropathy. Also, patients using beta-blocker eyedrops experienced a significantly greater percentage drop in diastolic blood pressure at night (P = .028), lower minimum nighttime diastolic blood pressure (P = .072), and lower minimum nighttime heart rate (P = .002) than did those not using them. In normal-tension glaucoma, eyes receiving beta-blocker eyedrops showed visual field progression significantly (P = .0003) more often than those not receiving beta-blockers.

CONCLUSIONS

The findings of our studies, as well as those of others, suggest that any factor that increases nocturnal arterial hypotension is a potential risk factor in vulnerable individuals with glaucomatous optic neuropathy or anterior ischemic optic neuropathy. The present study suggests that the use of beta-blocker eyedrops, by aggravating nocturnal arterial hypotension and reducing the heart rate, may be a potential risk factor in susceptible individuals.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Ophthalmology, College of Medicine, University of Iowa, Iowa City, USA.

    ,

    Source

    American journal of ophthalmology 128:3 1999 Sep pg 301-9

    MeSH

    Adrenergic beta-Antagonists
    Adult
    Aged
    Aged, 80 and over
    Betaxolol
    Blood Pressure
    Circadian Rhythm
    Female
    Glaucoma, Open-Angle
    Heart Rate
    Humans
    Hypotension
    Male
    Middle Aged
    Ophthalmic Solutions
    Optic Neuropathy, Ischemic
    Prospective Studies
    Timolol
    Visual Fields

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    10511024

    Citation

    Hayreh, S S., et al. "Beta-blocker Eyedrops and Nocturnal Arterial Hypotension." American Journal of Ophthalmology, vol. 128, no. 3, 1999, pp. 301-9.
    Hayreh SS, Podhajsky P, Zimmerman MB. Beta-blocker eyedrops and nocturnal arterial hypotension. Am J Ophthalmol. 1999;128(3):301-9.
    Hayreh, S. S., Podhajsky, P., & Zimmerman, M. B. (1999). Beta-blocker eyedrops and nocturnal arterial hypotension. American Journal of Ophthalmology, 128(3), pp. 301-9.
    Hayreh SS, Podhajsky P, Zimmerman MB. Beta-blocker Eyedrops and Nocturnal Arterial Hypotension. Am J Ophthalmol. 1999;128(3):301-9. PubMed PMID: 10511024.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Beta-blocker eyedrops and nocturnal arterial hypotension. AU - Hayreh,S S, AU - Podhajsky,P, AU - Zimmerman,M B, PY - 1999/10/8/pubmed PY - 1999/10/8/medline PY - 1999/10/8/entrez SP - 301 EP - 9 JF - American journal of ophthalmology JO - Am. J. Ophthalmol. VL - 128 IS - 3 N2 - PURPOSE: To investigate the effects of topical beta-blocker eyedrops on nocturnal arterial hypotension and heart rate and on visual field deterioration. METHODS: We prospectively investigated 275 white patients, 161 with glaucomatous optic neuropathy and 114 with nonarteritic anterior ischemic optic neuropathy, by 24-hour ambulatory blood pressure monitoring and diurnal curve of intraocular pressure, in addition to detailed ophthalmic evaluation. Of the patients with glaucomatous optic neuropathy, 131 had normal-tension glaucoma and 30 had primary open-angle glaucoma. Of the 275 patients, 114 were using topical beta-blocker eyedrops twice daily (76 with normal-tension glaucoma, 26 with primary open-angle glaucoma, and 12 with anterior ischemic optic neuropathy). RESULTS: Hourly average blood pressure data analyses showed overall a drop in blood pressure as well as heart rate during sleep, and a significantly greater drop in mean diastolic blood pressure (P = .009) at night in normal-tension glaucoma than in anterior ischemic optic neuropathy. Also, patients using beta-blocker eyedrops experienced a significantly greater percentage drop in diastolic blood pressure at night (P = .028), lower minimum nighttime diastolic blood pressure (P = .072), and lower minimum nighttime heart rate (P = .002) than did those not using them. In normal-tension glaucoma, eyes receiving beta-blocker eyedrops showed visual field progression significantly (P = .0003) more often than those not receiving beta-blockers. CONCLUSIONS: The findings of our studies, as well as those of others, suggest that any factor that increases nocturnal arterial hypotension is a potential risk factor in vulnerable individuals with glaucomatous optic neuropathy or anterior ischemic optic neuropathy. The present study suggests that the use of beta-blocker eyedrops, by aggravating nocturnal arterial hypotension and reducing the heart rate, may be a potential risk factor in susceptible individuals. SN - 0002-9394 UR - https://www.unboundmedicine.com/medline/citation/10511024/Beta_blocker_eyedrops_and_nocturnal_arterial_hypotension_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002939499001609 DB - PRIME DP - Unbound Medicine ER -