Second, because patients on systemic beta-blockers will have plasma levels of the drug far greater than those achieved by topical administration, concomitant topical administration will not appreciably affect their total plasma levels. How does this information affect ophthalmologists? First, we now know that certain heart conditions not only do not preclude beta-blocker therapy but actually necessitate it. In fact, even patients with the most advanced degrees of heart failure, including some awaiting heart transplantation, may benefit from beta-blocker therapy.2 The American College of Cardiology currently recommends that all patients with depressed left ventricular function, when clinically stable, begin beta-blocker therapy, regardless of whether or not they had a myocardial infarction.2-8 Studies conducted more than 20 years ago showed that all patients who have suffered myocardial infarction should undergo beta-blocker therapy for at least 3 years. 2-8 The evidence demonstrating a reduction in mortality and improved functional status is incontrovertible. Recent data from randomized placebo-controlled trials, however, prove that beta-blockers actually benefit patients with compensated heart failure. It is therefore incumbent upon the clinician to know beta-blockers' potential systemic interactions as evident from scientifically available data rather than unproven dogma or non–peer-reviewed sources, especially those peddled by competing pharmaceutical companies.īeta-blockers have long played an integral role in the management of cardiovascular disease, but, traditionally, medical education has held that these agents should be avoided in patients with congestive heart failure (CHF) and symptomatic bradycardia as well as more advanced degrees of heart block. The complete and indiscriminate avoidance of beta-blocker therapy, however, ignores a substantial proportion of patients who may benefit from these agents. The use of beta-blockers, whether first-line or adjunctive, will therefore likely be inescapable.ĭespite beta-blockers' efficacy and local tolerability, practitioners have become increasingly concerned that these agents' chronic use could result in potentially serious systemic side effects. In addition, investigations such as the Ocular Hypertension Treatment Study 1 have shown that more than half of patients on medical glaucoma therapy will need multi-agent treatment. These agents are second to prostaglandin analogues in efficacy, and they have unsurpassed ocular tolerability. Ophthalmic beta-adrenergic blockers have been important in the management of glaucoma and ocular hypertension.
0 Comments
Leave a Reply. |