Beta-blocker eyedrops and nocturnal arterial hypotension

Am J Ophthalmol. 1999 Sep;128(3):301-9. doi: 10.1016/s0002-9394(99)00160-9.


Purpose: To investigate the effects of topical beta-blocker eyedrops on nocturnal arterial hypotension and heart rate and on visual field deterioration.

Methods: We prospectively investigated 275 white patients, 161 with glaucomatous optic neuropathy and 114 with nonarteritic anterior ischemic optic neuropathy, by 24-hour ambulatory blood pressure monitoring and diurnal curve of intraocular pressure, in addition to detailed ophthalmic evaluation. Of the patients with glaucomatous optic neuropathy, 131 had normal-tension glaucoma and 30 had primary open-angle glaucoma. Of the 275 patients, 114 were using topical beta-blocker eyedrops twice daily (76 with normal-tension glaucoma, 26 with primary open-angle glaucoma, and 12 with anterior ischemic optic neuropathy).

Results: Hourly average blood pressure data analyses showed overall a drop in blood pressure as well as heart rate during sleep, and a significantly greater drop in mean diastolic blood pressure (P = .009) at night in normal-tension glaucoma than in anterior ischemic optic neuropathy. Also, patients using beta-blocker eyedrops experienced a significantly greater percentage drop in diastolic blood pressure at night (P = .028), lower minimum nighttime diastolic blood pressure (P = .072), and lower minimum nighttime heart rate (P = .002) than did those not using them. In normal-tension glaucoma, eyes receiving beta-blocker eyedrops showed visual field progression significantly (P = .0003) more often than those not receiving beta-blockers.

Conclusions: The findings of our studies, as well as those of others, suggest that any factor that increases nocturnal arterial hypotension is a potential risk factor in vulnerable individuals with glaucomatous optic neuropathy or anterior ischemic optic neuropathy. The present study suggests that the use of beta-blocker eyedrops, by aggravating nocturnal arterial hypotension and reducing the heart rate, may be a potential risk factor in susceptible individuals.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adrenergic beta-Antagonists / adverse effects*
  • Adrenergic beta-Antagonists / therapeutic use
  • Adult
  • Aged
  • Aged, 80 and over
  • Betaxolol / adverse effects
  • Betaxolol / therapeutic use
  • Blood Pressure / drug effects*
  • Blood Pressure / physiology
  • Circadian Rhythm
  • Female
  • Glaucoma, Open-Angle / drug therapy
  • Glaucoma, Open-Angle / physiopathology
  • Heart Rate / drug effects*
  • Heart Rate / physiology
  • Humans
  • Hypotension / chemically induced*
  • Hypotension / physiopathology
  • Male
  • Middle Aged
  • Ophthalmic Solutions / adverse effects
  • Ophthalmic Solutions / therapeutic use
  • Optic Neuropathy, Ischemic / drug therapy
  • Optic Neuropathy, Ischemic / physiopathology
  • Prospective Studies
  • Timolol / adverse effects
  • Timolol / therapeutic use
  • Visual Fields / drug effects*
  • Visual Fields / physiology


  • Adrenergic beta-Antagonists
  • Ophthalmic Solutions
  • Timolol
  • Betaxolol