Balancing treatments for patients with systemic hypertension and glaucoma

ABSTRACT

Introduction

Treatment of glaucoma and systemic hypertension requires careful balancing of ophthalmic and systemic medications. This report offers background on various common therapies and considerations to minimize undesirable systemic and ophthalmic outcomes.

Areas covered

Key considerations relating to medical treatments for systemic hypertension and glaucoma chosen from a review of the literature are included. The historic safety of ophthalmic beta blockers and sub-types as well as combination agents are described. The potential role of ocular perfusion pressure in the pathogenesis of glaucoma is reviewed with a discussion of landmark studies, including the Barbados Eye Study and the Early Manifest Glaucoma Trial, with implications for medication choices for hypertension and glaucoma. Systemic antihypertensives are considered with regards to their potential association with glaucoma and its progression, especially in patients with low blood pressure and normal tension glaucoma. Opinions are offered with regard to therapeutic choices and considerations.

Expert opinion

The medical treatment of systemic hypertension and glaucoma carries the potential for drug interactions and significant adverse effects requiring customization for each patient’s particular issues. The evolution of new therapies and treatment paradigms, including laser as a first-line treatment, has expanded safe options and minimized potential dangers for high-risk patients.

KEYWORDS:

• Glaucoma
• hypertension
• beta blockers
• topical
• systemic

Highlights

1. Glaucoma and hypertension are frequent comorbidities and optimal care requires balancing treatments.

2. Topical ophthalmic medications that must be carefully considered in this setting include beta-adrenergic blockers as well as alpha-2 agonists, both of which have demonstrated unwanted cardiovascular effects in some individuals.

3. Topical beta blockers may lower heart rate and blood pressure, and may be less effective in patients on systemic beta blockers.

4. Low blood pressure, including nocturnal dipping related to systemic antihypertensive agents, may be a risk factor for glaucoma progression.

5. Glaucoma may be more common in patients with treated systemic hypertension.

Declaration of interest

JS Myers declares that they have served as a consultant for Aerie and Allergan and have received research grants via their institution from Aerie Alcon, Allergan and Bausch & Lomb. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

One referee declares serving as a consultant for Aerie, Allergan and Bausch and Lomb, while another declares serving as a consultant for Bausch and Lomb and Ivantis. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This manuscript has not been funded.