Comparison of the effects of bimatoprost and a fixed combination of latanoprost and timolol on 24-hour blood and ocular perfusion pressures: the results of a randomized trial

Abstract

BackgroundTo compare the effect of bimatoprost and the fixed combination latanoprost-timolol (LTFC) on 24-hour systolic (SBP) and diastolic (DBP) blood pressure and on 24-hour ocular perfusion pressure (OPP).Methods200 patients with glaucoma or ocular hypertension, controlled on the unfixed combination of latanoprost and timolol or eligible for dual therapy being not being fully controlled on monotherapy were enrolled in a randomized, double-masked, placebo-controlled, multicentre clinical trial. They were randomized to LTFC (8 a.m.) or bimatoprost (8 p.m.) and received 24-hour IOP curve at baseline, 6 and 12 weeks (supine and sitting position IOPs were recorded at 8 p.m., midnight, 5 a.m., 8a.m., noon and 4 p.m.). Holter 24-hour blood pressure curve was obtained between weeks 2 and 12. SBP, DBP, OPP were calculated and compared with ANOVA. Rates of diastolic OPP (DPP) ≤50, ≤40, ≤30 mmHg in the 2 groups were calculated and compared using Fisher’s test.ResultsMean baseline SBP and DBP were 136.5 ± 18.3 vs 134.2 ± 20.1 mmHg (p = 0.1) and 79.1 ± 10.2 vs 78.2 ± 10.1 mmHg (p = 0.4) in the bimatoprost and LTFC groups respectively. Holter SBP was significantly higher for bimatoprost (135.1 mmHg vs 128.1 mmHg, p = 0.04), while no statistically significant difference in DBP was found. DPP was similar in the 2 groups, and proportions of patients with at least one value of the 24-hour curve ≤50, ≤40, ≤30 mmHg were 94%, 86%, 41% respectively.ConclusionsBimatoprost and LTFC had similar DBPs and OPPs; SBP was significantly lower with LTFC. In this study, the percentage of “dippers” was considerably higher than the one described in previous studies on the role of perfusion pressure in glaucoma.Trial registrationNCT02154217, May 21, 2014.

Genetic correlations between intraocular pressure, blood pressure and primary open-angle glaucoma: a multi-cohort analysis

“…[5][6][7] Since a lower BP in the context of higher IOP may result in poor optic nerve perfusion, glaucoma drugs are frequently scrutinized for their effects on both IOP and OPP. 8,9 Finally, post hoc analysis of two RCTs found that lower OPP was associated with glaucoma progression. 10,11 Several common gene variants have been identified for IOP 12 and BP.…”

Short-term reproducibility of intraocular pressure and ocular perfusion pressure measurements in Chinese volunteers and glaucoma patients

“…Different methods of calculation would lead to different results. Twenty-four-hour OPP fluctuations may be associated with nocturnal BP reductions [ 8 , 28 ]. We did not analyse the relationship between the reproducibility of OPP fluctuations and nocturnal BP reductions.…”