Clinical and pharmacological aspects of combined pathology: cardiovascular diseases and glaucoma

The review presents clinical and pharmacological aspects of treating glaucoma patients with cardiovascular diseases and current epidemiology of cardiovascular diseases in Russian Federation. It discusses the most widespread cardiovascular diseases and medications for their treatment (organic nitrates, systemic beta-blockers etc.). The article describes the effects of anti-glaucoma medications (beta-blockers, alpha2-adrenoceptor agonists, prostaglandins, carbonic anhydrase inhibitors) on cardiovascular system (heart rate, blood pressure) and the course of treatment of cardiovascular diseases, including cardiovascular mortality. Authors enumerate the main absolute and relative contraindications to different groups of anti-glaucoma medications: prominent forms of cardiovascular pathology (atrioventricular block II-III degree, decompensation of chronic heart failure, marked bradycardia). The impact of the medications for cardiovascular diseases (antihypertensive drugs, organic nitrates, antiplatelet medications) on intraocular pressure and the course of glaucoma is also described in the review. It emphasizes the necessity of developing a rational systemic antihypertensive regimen to avoid the episodes of nocturnal arterial hypotension that promote the progression of glaucoma. The article also presents examples of possible clinically significant drug-drug interactions in patients with combined pathology. The authors provide recommendations on improving treatment efficiency and pharmacotherapeutic safety in patients with glaucoma in combination with cardiovascular diseases.

клиническая фармакология, глаукома, сердечно-сосудистые заболевания, неблагоприятные реакции, межлекарственные взаимодействия, clinical pharmacology, glaucoma, cardiovascular diseases, adverse drug reactions, drug-drug interaction

1. Шальнова С.А., Конради А.О., Карпов Ю.А., Концевая А.В., Деев А.Д., Капустина А.В., Худяков М.Б., Шляхто Е.В., Бойцов С.А. Анализ смертности от сердечно-сосудистых заболеваний в 12 регионах Российской федерации, участвующих в исследовании «Эпидемиология сердечно-сосудистых заболеваний в различных регионах России». Российский кардиологический журнал 2012; 5(97): 6-11

2. Беленков Ю.Н., Оганов Р.Г. Кардиология. Национальное руководство. Москва: Гэотар-Медиа; 2012. 848 с

3. Егоров Е.А., Астахов Ю.С., Щуко А.Г. Национальное руководство (путеводитель) по глаукоме для поликлинических врачей. Москва, Столичный бизнес, 2008; 136 c

4. Saxena R., Prakash J., Gupta S. Pharmacotherapy of glaucoma. Indian Journal of Pharmacology 2002; 34: 71-85.

5. Nieminen T., Lehtimki T., Mäenpää J., Ropo A., Uusitalo H., Kähönen M. Ophthalmic timolol: plasma concentration and systemic cardiopulmonary effects. Scand J Clin Lab Invest 2007; 67(2): 237-245.

6. Goldberg I., Moloney G., McCluskey P. Topical ophthalmic medications: what potential for systemic side effects and interactions with other medications. Med J Aust 2008; 189(7): 406-407.

7. Клиническая фармакология по Гудману и Гилману / Под ред. А.Г. Гилмана. М.: Практика; 2006. 2850 с.

8. Zimmerman F.H., Cameron A., Fisher L.D., Ng G. Myocardial infarction in young adults: angiographic characterization, risk factors and prognosis (Coronary Artery Surgery Study Registry). J Am Coll Cardiol 1995; 26(3): 654-661.

9. Müskens R.P., Wolfs R.C., Witteman J.C., Hofman A., de Jong P.T., Stricker B.H., Jansonius N.M. Topical beta-blockers and mortality. Ophthalmology 2008; 115(11): 2037-2043.

10. Ergin A., Ornek K., Giillii R., Bulcun E., Ekici M., Ekici A. Effects of timolol and latanoprost on respiratory and cardiovascular status in elderly patients with glaucoma. J Ocul Pharmacol Ther 2009; 25(5): 463-466.

11. Waldock A., Snape J., Graham C.M. Effects of glaucoma medications on the cardiorespiratory and intraocular pressure status of newly diagnosed glaucoma patients. Br J Ophthalmol 2000; 84(7): 710-713.

12. Stewart W.C., Stewart J.A., Jackson A.L. Cardiovascular effects of timolol maleate, brimonidine or brimonidine/timolol male-ate in concomitant therapy. Acta Ophthalmol Scand 2002; 80(3): 277-281.

13. Krasińska B., Karolczak-Kulesza M., Krasiński Z., Pawlaczyk-Gabriel K., Lopatka P., Głuszek J., Tykarski A. Effects of the time of antihypertensive drugs administration on the stage of primary open-angle glaucoma in patients with arterial hypertension. Blood Press 2012; 21(4): 240-248.

14. Grunwald J.E., DuPont J., Dreyer E.B. Effect of chronic nitrate treatment on retinal vessel caliber in open-angle glaucoma. Am J Ophthalmol 1997; 123(6): 753-758.

15. Wizemann A.J., Wizemann V. Organic nitrate therapy in glaucoma. Am J Ophthalmol 1980; 90(1): 106-109.

16. Marcus M.W., Müskens R.P., Ramdas W.D., Wolfs R.C., de Jong P.T., Vingerling J.R., Hofman A., Stricker B.H., Jansonius N.M. Antithrombotic medication and incident open-angle glaucoma. Invest Ophthalmol Vis Sci 2012; 53(7): 3801-3805.

17. Кукес В.Г., Грачев С.В., Сычев Д.А., Раменская Г.В. Метаболизм лекарственных средств: научные основы персонализированной медицины. М.: ГЭОТАР-Медиа; 2008; 304 с.

18. Курышева Н.И., Брежнев А.Ю., Капкова С.Г. Распространенность псевдоэксфолиативной глаукомы в Центральном и Центрально-Черноземном регионах России. Глаукома 2008; 3: 11-15

19. Авдеев Р.В., Александров А.С., Басинский А.С., Блюм Е.А., Брежнев А.Ю., Волков Е.Н. и др. Клинико-эпидемиологическое исследование факторов риска развития и прогрессирования глаукомы. Российский офтальмологический журнал 2013; 6(3): 4-11

20. Egorov E., Ropo A., Erichev V., Astakhov Y., Alekseev V., Takhchidi K., et al. Adjunctive use of tafluprost with timolol provides additive effects for reduction of intraocular pressure in patients with glaucoma. Eur J Ophthalmol 2009; 19(2): 214-222