SUMMARY The cardiovascular effects of topical ophthalmological preparations of 2% epinephrine (EPI), 0-1% dipivalyl epinephrine (DPE), and placebo were studied in double-blind fashion in 20 patients with glaucoma. Both drugs and placebo produced a decrease in heart rate (2±3 beats/min) which, although small, was highly significant (p<0001). Neither drug nor placebo produced a significant effect on mean or systolic blood pressure (BP) over the group as a whole (p>0O1). However, 5 of 20 patients responded to EPI with a significant rise in mean or systolic BP (defined as a change greater than mean change +2 SD), whereas there were no such responses to DPE or placebo. One patient developed marked ventricular ectopy after EPI. We conclude that EPI may cause cardiovascular side effects in a high percentage of patients (25% in this study) through individual susceptibility rather than a predictable effect. DPE, a new epinephrine analogue, appears to be devoid of these effects.Topical ophthalmic preparations are commonly employed in the treatment of patients with glaucoma. By the nature of this condition a large number of such patients fall into an older age group, a group also with a high prevalence of heart disease.Little has been reported on the cardiovascular effects of topical eye drops. Such reports have been largely case studies, and as yet no prospective trial has been undertaken to analyse the effects of these preparations. The purpose of this study was to evaluate in a prospective, randomised, double-blind fashion the cardiovascular response to topically applied epinephrine (EPI), dipivalyl epinephrine (DPE, a new epinephrine analogue), and placebo (P) in patients with chronic open-angle glaucoma.
Patients and methodsTwenty consecutive patients with chronic open-angle glaucoma were selected as they returned for followup care to the
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