New Evidence Links Calcium Channel Blockers to Increased Risk of Glaucoma

— Meta-diagnosis reveals very best glaucoma likelihood with CCB monotherapy, reduced IOP with beta-blockers

by
Charles Bankhead, Senior Editor, MedPage On the brand new time
June 13, 2023

Notify of calcium channel blockers (CCBs), particularly cardioselective agents, had a modest nonetheless statistically fundamental association with glaucoma, a desirable meta-diagnosis confirmed.

Total, sufferers with a history of CCB treatment had a 23% higher likelihood of rising glaucoma in contrast with individuals who by no potential extinct the antihypertensives. The likelihood virtually doubled amongst sufferers who bought single-agent cardioselective CCBs. In distinction, beta-blocker therapy changed into once connected with modestly reduced intraocular stress (IOP), which is connected with a reduced likelihood of glaucoma.

Pretty quite a lot of reasonably quite a lot of recurrently extinct medications had no definite associations with glaucoma or IOP, including lipid-lowering medication, antidepressants, and diabetes medications, reported Anthony Khawaja, MD, PhD, of University College London, and colleagues within the European Stare Epidemiology (E3) Consortium.

“While our recent findings require additional reports to uncover whether or no longer the associations are causal, these findings will most likely be of ardour to physicians caring for glaucoma sufferers with systemic comorbidities,” the authors acknowledged in Ophthalmology.

“A doubtlessly awful association of CCBs for glaucoma is very mighty, as right here is a recurrently prescribed class of medication,” they added. “If additional reports ascertain an informal nature for this association, this would possibly occasionally repeat different treatment methods for hypertensive sufferers with, or inclined to, glaucoma.”

Adds to Existing Proof

The findings add to proof from old reports showing that systemic beta-blockers lower IOP, and on the least one prior watch has proven an association between CCBs and glaucoma, said Roma Patel, MD, MBA, of Baylor College of Treatment and Ben Taub Sanatorium in Houston, and a clinical spokesperson for the American Academy of Ophthalmology.

“The watch’s contribution is believed to be one of vitality,” Patel instructed MedPage On the brand new time by the exhaust of email. “The dataset extinct for this diagnosis represented over 143,000 individuals with glaucoma. Attributable to the measurement of population studied, this watch changed into once in a articulate to collect that an supreme stronger association between CCBs with relate cardiac effects and glaucoma versus diagnosis of all CCBs and glaucoma. Presumably this would possibly occasionally back researchers decide out if there is a causal link. We all know that glaucoma is one way or the opposite connected to dysfunction and death of the retinal ganglion cells. We do now not concretely know the effects of calcium blockade at that level so it poses a factual research demand.”

With respect to implications for clinical observe, Patel added, “I agree with it is stunning to repeat sufferers there is a identified association for calcium channel blockers and glaucoma nonetheless we do now not fully realize why and there is no proof of a causal relationship. If the patient chooses to consult with their PCP [primary care physician] or cardiologist about a pretty quite a lot of treatment regimen for his or her cardiac grunt, that’s as a lot as the patient. But I’m no longer encouraging that dialog with my sufferers.”

“I attain abet my sufferers to consult with their PCP or cardiologist about avoiding evening anti-hypertensive medications because we attain know that low blood stress overnight can consequence in glaucoma progression,” she said. “It’s a must always-want to bear in tips that the watch lives contained within the human body and all of our methods are connected. But when the cardiologist feels that a distinct medication is warranted, I like to recommend we observe that recommendation because all of us know that the watch cannot are residing with out the coronary heart.”

Glaucoma is the main reason of irreversible imaginative and prescient impairment worldwide, and IOP for the time being is the fully modifiable likelihood part for glaucoma onset and progression, Khawaja and co-authors effectively-known. Loads of forms of medication are identified or suspected of modulating glaucoma likelihood by affecting optic nerve head perfusion, retinal ganglion cell survival, and aqueous humor outflow facility.

A watch in accordance to U.S. effectively being claims urged that selective serotonin reuptake inhibitors were connected with a reduced likelihood of main delivery-attitude glaucoma and CCBs with an elevated likelihood. Other medications that will impression glaucoma likelihood comprise beta-blockers, metformin, statins, and bupropion. Additionally, some medications had been connected with higher IOP, including angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), statins, and sulfonylureas.

“For quite a lot of of the cited associations, there had been inconsistent findings between reports, and few reports bear accounted for polypharmacy or essential confounders,” Khawaja and colleagues effectively-known.

Clarifying Gaze

To proceed the line of research, investigators within the E3 Consortium performed a meta-diagnosis of 11 European cohort reports appealing a entire of 143,240 contributors, all of whom were included in analyses of glaucoma associations. Analyses of IOP included 47,177 contributors. Treatment exhaust encompassed more than one forms of antihypertensives, lipid-lower medications, antidepressants, and antidiabetic medications (restricted fully to contributors with identified diabetes). For antihypertensives, the investigators famed monotherapy from combination therapy.

Multivariable analyses confirmed that any CCB exhaust changed into once connected with a glaucoma OR of 1.23 (95% CI 1.08-1.39) versus no exhaust. Sufferers who bought CCB monotherapy had a glaucoma OR of 1.96 (95% CI 1.23-3.12). No reasonably quite a lot of medications were clearly connected with glaucoma, the authors reported. Systemic beta-blockers were connected with marginally lower IOP (-0.33 mmHg, 95% CI -0.57 to -0.08). Monotherapy with selective beta-blockers changed into once connected with a 0.forty five mmHg good aquire in IOP (95% CI -0.74 to -0.16) and non-selective agents with a 0.54 mmHg good aquire in IOP (95% CI -0.94 to -0.15).

High-ceiling diuretics (such as furosemide and torasemide/torsemide) had a “suggestive” association with lower IOP (-0.30 mmHg, 95% CI -0.47 to -0.14), nonetheless no longer when extinct as monotherapy.

None of the completely different medications included within the diagnosis had associations with IOP.