Although previous research has indicated that beta-blockers reduce cardiovascular mortality, a study published in the July issue of Ophthalmology counters these findings.

Specifically, patients with previously diagnosed glaucoma who reported taking topical timolol were found to have an increased risk of cardiovascular mortality compared with previously diagnosed patients who were not using the eye drops, the study says. Also, the latter patients had no significant increase in cardiovascular mortality when compared with non-glaucoma patients, and those newly diagnosed glaucoma patients had no increased cardiovascular mortality risk compared with non-glaucoma patients.

The study, which looked at 3,654 patients ages 49 to 97, sought to evaluate a link between open-angle glaucoma and an increased mortality rate over nine years as part of the Australian Blue Mountains Eye Study. A total of 108 subjects were diagnosed with glaucoma at baseline (1992 to 1994).

Out of 873 deaths prior to January 2002, 312 patients died from a cardiovascular incident, the study found. The cardiovascular mortality rate in glaucoma patients was 14.6% vs. 8.4% in non-glaucoma patients. Additional stratified analyses showed that cardiovascular mortality was higher among those previously diagnosed with glaucoma, specifically among those who reported timolol use.

However, when death from cardiovascular causes was considered in all users (with or without glaucoma) of ophthalmic timolol as compared with non-users, death rates were no longer statistically significant.

The researchers conclude that the link between timolol and cardiovascular mortality requires deeper investigation. Should further studies corroborate this finding, clinicians should be aware of the possible long-term side effects of beta-blockers, particularly in glaucoma patients who have an increased risk for cardiovascular disease, the researchers say. Clinicians should also consider low-dose timolol gel preparations, they say, which lessen the potential systemic risk.

Beta-Blockers Don"t Increase Depression

Despite previous research that has linked topical beta-blockers with depression, glaucoma patients who use these agents are not at a high risk of depression, says a study in the July issue of Ophthalmology.

Researchers in Israel divided 6,597 chronic glaucoma patients into two groups: those treated with topical beta-blockers either alone or in combination with other anti-glaucoma medications (5,846) and those treated with glaucoma medications other than beta-blockers (751). Among these patients, 810 filled at least four prescriptions for anti-depressantsmeeting the researchers criteria of clinical depression. A total of 715 of these patients used beta-blockers for their glaucoma (88.3%).

Overall, the percentage of glaucoma patients treated with topical beta-blockers who were depressed (12.2%) was about the same as those not treated with topical beta-blockers who were depressed (12.7%).

Because glaucoma and depression are more prevalent in the elderly, the researchers stratified all patients by age and calculated age-adjusted rates. The result? Topical beta-blocker treatment did not influence the preponderance of depression in any age group.

Kaiserman I, Kaiserman N, Elhayany A, Vinker S. Topical beta-blockers are not associated with an increased risk of treatment for depression. Ophthalmology 2006 Jul;113(7):1077-80

Lee AJ, Wang JJ, Kifley A, Mitchell P. Open-angle glaucoma and cardiovascular mortality: the Blue Mountains Eye Study. Ophthalmology 2006 Jul;113(7):1069-76.

Vol. No: 143:08Issue: 8/15/2006