Cardiovascular and Respiratory Considerations With Pharmacotherapy of Glaucoma and Ocular Hypertension

Abstract

Glaucoma and ocular hypertension are highly prevalent conditions in individuals over the age of 40 and are commonly seen together in patients with cardiovascular disease. Many of the antiglaucoma medications, when systemically absorbed, affect the sympathetic and parasympathetic nervous systems of patients and can cause cardiovascular toxicity. Such adverse effects are frequently associated with the long-term use of potentially toxic agents in elderly people, who are most prone to chronic eye disease. Moreover, patients may not associate their symptoms with the topical eye medications, and consequently may not report adverse drug effects. Drug-drug interactions can also occur when patients are taking medications for both cardiovascular disease and glaucoma. In this review, the systemic toxicity of these agents is reviewed, along with possible drug-drug interactions. Mention is made of other antiglaucoma medications used alone and in combination with topical beta-blockers. Identification of genetic loci-a bold new step toward glaucoma treatment-is mentioned briefly at the end of the article.

Pulmonary safety of ophthalmic beta‐blockers: a nationwide registry‐based cohort study

“…Generally, most of the research in this field comprise of small-scale trials, most of which emphasize the potentially detrimental effects of ophthalmic beta-blockers on pulmonary safety (Schoene et al 1981;Weinreb et al 1988;Diggory et al 1993Diggory et al , 1995Diggory et al , 1998Waldock et al 2000), both in patients with concomitant obstructive pulmonary disease and in patients without known susceptibility (Han et al 2008). However, the absolute risk was very small.…”

“…Increased intraocular pressure has been identified as the most important risk factor for the development of glaucomatous optic neuropathy (Braunger et al 2015), making intraocular pressure-lowering drugs an essential part of the treatment. They are all applied locally but are partially absorbed directly into the bloodstream, as approximately 80% is drained through the nasolacrimal duct and enter the systemic circulation through the highly vascularized nasal mucosa, thus preventing first-pass metabolism in the liver (Han et al 2008). They are all applied locally but are partially absorbed directly into the bloodstream, as approximately 80% is drained through the nasolacrimal duct and enter the systemic circulation through the highly vascularized nasal mucosa, thus preventing first-pass metabolism in the liver (Han et al 2008).…”

“…These include beta-blockers, alfa-2-agonists, carbonic anhydrase inhibitors, prostaglandin analogues and parasympathomimetics. The nonselective beta-blocker timolol is one of the most effective first-line drugs in the treatment of increased intraocular pressure (Li et al 2016), however, activation of beta-adrenoceptors in the bronchial tree might cause systemic adverse effects (Vander Zanden et al 2001;Lama 2002;Han et al 2008) and consequently, many practitioners are reluctant to prescribe it. The nonselective beta-blocker timolol is one of the most effective first-line drugs in the treatment of increased intraocular pressure (Li et al 2016), however, activation of beta-adrenoceptors in the bronchial tree might cause systemic adverse effects (Vander Zanden et al 2001;Lama 2002;Han et al 2008) and consequently, many practitioners are reluctant to prescribe it.…”

Correlation between tea consumption and prevalence of hypertension among Singaporean Chinese residents aged ⩾40 years

“…8 Glaucoma and ocular hypertension were also more commonly found in individuals aged 440 years. 9 From the Statistics of the Ministry of Health, Singapore, the prevalence of hypertension in adults aged 18-69 years was 23.5% (2010), 10 but the prevalence increased markedly from age 40 years onwards. More than half of the elderly (53.4%) in Singapore aged 60-69 years were found to have hypertension.…”

Recent Advances in Ocular Nucleic Acid-Based Therapies: The Silent Era

“…Beta blockers and prostaglandins are the standard first line treatment for POAG (29). Both groups of drugs are very efficient in lowering IOP but beta blockers are not recommended in patients with cardiovascular and respiratory problems and prostaglandin-analogs have local tolerability issues (30,31). Second-line drugs of choice include alpha-2-adrenergic agonists and carbonic anhydrase inhibitors.…”