Systemic beta-blocker and nitrates result in a lowering of IOP which has implications for the management of ocular hypertension and glaucoma

The science behind the tip

Systemic beta-blockers and nitrates are frequently used in the elderly. It has been known for many years that systemic beta-blockers lower the IOP (1). This was recently confirmed in a large population based, cross-sectional study (2). Oral beta-blockers reduced the IOP by 1mmHg and systemic nitrates by 0.7mmHg on average, compared to those not using the medication, independently of age, gender or BMI. A difference of 1mmHg is relatively large at a population level and translates into a 14% reduced risk of incident glaucoma at 5 years for individuals on oral beta-blockers and a 10% reduced risk for those on nitrates (3).

Although the concurrent prescription of oral and topical beta-blockers is not optimal practice it does occur very often in real life (4). Therefore, the commencement or stopping of these systemic medications may have implications for the management of a known glaucoma patient as it may require an adjustment in the topical medication regimen.

Contributors: Gordana Sunaric-Mégevand, Geneva CH

References:

1. Philips Cl, Howitt G, Rowlands DJ. Propanalol as ocular hypotensive agent. Br J Ophthalmol 1967; 51: 222-226.2014; 121: 1501-1507

2. Khawaja AP, Chan MPY, Broadway DC et al Systemic medication and intraocular pressure in a British population. The EPIC ? Norfolk Eye Study. Ophthalmology 2014; 121: 1501-1507

3. De Voogd S, Ikram MK, Wolfs RC. Incidence of open-angle glaucoma in a general elderly population: the Rotterdam Study. Ophthalmology 2005; 112: 1487-1493.

4. Goldberg I, Adena MA. Co-prescribing of topical and systemic beta-blockers in patients with glaucoma: a quality use of medicine issue in Australian practice. Clin Experiment Ophthalmol 2007; 35: 700-705.

Tip Reviewer: Roger Hitchings
Tip Editors: John Salmon and Gordana Sunaric Mégevand