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Glaucoma with hypertension: a comparison of treatment modality

Navin Patel, Rakesh Ranjan Pathak.

Abstract
Background: As the intraocular pressure (IOP) increases, the risk of open-angle glaucoma (OAG) substantially increases. However, individuals with systemic hypertension at baseline exhibit one-half of the relative risk. The range of IOP fluctuation is larger in patients with untreated glaucoma; but, as some other studies deny it as independent risk factor, further studies are warranted. It is also established that drug effect varies with the timing of application. Thus, effect of amlodipine and atenolol should also vary.

Objective: To compare the efficacy/safety of amlodipine versus atenolol in the glaucomatous hypertensive people using IOP control as the primary endpoint.

Materials and Methods: IOP maxima, minima, and fluctuation were chosen as three separate outcome variables while minima, maxima, and fluctuations of systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean ocular perfusion pressure (MOPP) as predictor variables. The criteria and methods were decided as in the study by Choi et al. (Invest Ophthalmol Vis Sci 2006;47(3):831–6), with some modifications. We included freshly diagnosed patients of coexistent “hypertension + glaucoma” and used amlodipine (5 mg OD)/atenolol (50 mg OD) + timolol (1 drop; 0.25% solution twice daily).

Result: Baseline parameters showed no significant difference among the two groups. Amlodipine significantly changed all the three IOP and SBP parameters. SBP and DBP fluctuations increased but circadian MOPP fluctuation (CMF) decreased. Atenolol significantly changed all the three IOP parameters. Although peak SBP did not vary significantly, least SBP decreased and SBP fluctuation increased. DBP fluctuation and CMF decreased. Amlodipine and atenolol differed significantly in fluctuation effects—while amlodipine bettered on DBP fluctuation, atenolol bettered on IOP, SBP, and CMF fluctuations.

Conclusion: Instead of SBP or DBP, their fluctuations show more effects. Atenolol is better than amlodipine in glaucomatous hypertensive people.

Key words: glaucoma, POAG, hypertension, amlodipine, atenolol


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