Skip to main content
SpringerLink
Log in

Fludrocortisone in the treatment of systemic hypotension in primary open-angle glaucoma patients

  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Background: Fludrocortisone is a potent mineralocorticoid, whichhas no known direct vasoactive properties, and is the first-line drug fortreatment of orthostatic hypotension. The present study evaluated thesystemic hemodynamic effects of fludrocortisone treatment in glaucomapatients. Patients and methods: A retrospective analysis of the charts of glaucoma patients of the University Eye-Clinic Basel was performed. Twenty-two patients with open-angle glaucoma under treatment withfludrocortisone were selected. The selected patients had one 24-hblood pressure recording immediately prior to treatment with fludrocortisoneand one recording at least 2 months after starting the treatment. Parallel to blood pressure recordings, diurnal intraocular tension curve recordings and visual field testings were carried out. In addition, twelve patients also had nail-fold video-capillaroscopy. Results: IOP and visual fields remained stable. The average values for all systemic blood-pressure readings showed an improvement in the follow-up compared to primary examination. Mean (±SD) night-to-day ratio (`nocturnal dips')of systolic, diastolic and mean arterial bloodpressure decreased from 13.6 ± 4.3%, 16.9 ± 5.2% and 15.9 ± 3.5%, respectively, to 9.9 ± 5.9% (p=0.01), 13.2 ± 4.3% (p = 0.044) and 11.7 ± 3.9% (p = 0.0004). Baseline capillary blood-flow velocity increased and capillary blood-flow standstill time after cold provocation decreased significantlyunder fludrocortisone therapy. Conclusion: Hemodynamic parameters show a tendency towards improvement in a magnitude which might be of clinical relevance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Flammer J, Orgul S. Optic nerve blood- flow abnormalities in glaucoma. Prog Ret Eye Res 1999; 17: 267–289.

    Google Scholar 

  2. Armaly MF, Krueger DE, Maunder L et al. Biostatistical analysis of the collaborative glaucoma study. I. Summary report of the risk factors for glaucomatous visual- field defects. Arch Ophthalmol 1980; 98: 2163–2171.

    Google Scholar 

  3. Cartwright MJ, Anderson DR. Correlation of asymmetric damage with asymmetric intraocular pressure in normaltension glaucoma (low- tension glaucoma). Arch Ophthalmol 1988;106: 898–900.

    Google Scholar 

  4. Crichton A, Drance SM, Douglas GR, Schulzer M. Unequal intraocular pressure and its relation to asymmetric visual field defects in low- tension glaucoma. Ophthalmology 1989; 96: 1312–1314.

    Google Scholar 

  5. Haefliger IO, Hitchings RA. Relationship between asymmetry of visual field defects and intraocular pressure difference in an untreated normal (low) tension glaucoma population. Acta Ophthalmol 1990; 68: 564–567.

    Google Scholar 

  6. Orgül S, Flammer J. Interocular visual- field and intraocular pressure asymmetries in normal- tension glaucoma. Eur J Ophthalmol 1994; 4: 199–201.

    Google Scholar 

  7. Gasser P, Flammer J. Blood- cell velocity in the nailfold capillaries of patients with normal- tension and high- tension glaucoma. Am J Ophthalmol 1991; 111: 585–588.

    Google Scholar 

  8. Kaiser HJ, Flammer J. Systemic hypotension: a risk factor for glaucomatous damage? Ophthalmologica 1991; 203: 105–108.

    Google Scholar 

  9. Kaiser HJ, Flammer J, GrafT, Stümpfig D. Systemic blood pressure in glaucoma patients. Graefe's Arch Clin Exp Ophthalmol 1993; 231: 677–680.

    Google Scholar 

  10. Hayreh SS, Zimmerman MB, Podhajsky P, Alward WL. Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders. Am J Ophthalmol 1994; 117: 603–624.

    Google Scholar 

  11. Gaspar AZ, Gasser P, Flammer J. The influence of magnesium on visual field and peripheral vasospasm in glaucoma. Ophthalmologica 1995; 209: 11–13.

    Google Scholar 

  12. Kanellopoulos AJ, Erickson KA, Netland PA. Systemic calcium channel blockers and glaucoma. J Glaucoma 1996; 5: 357–362.

    Google Scholar 

  13. Kitazawa J, Shirai H, Go FJ. The effect of calcium antagonists on visual field in low- tension glaucoma. Graefe's Arch Clin Exp Ophthalmol 1989; 227: 408–412.

    Google Scholar 

  14. Liu S, Araujo SV, Spaeth GL, Katz U, Smith M. Lack of effect of calcium channel blockers on open- angle glaucoma. J Glaucoma 1996; 5: 187–190.

    Google Scholar 

  15. Netland PA, Chaturvedi N, Dreyer EB. Calcium channel blockers in the management of low- tension and open- angle glaucoma. Am J Ophthalmol 1993; 115: 608–613.

    Google Scholar 

  16. Netland PA, Grosskreutz CL, Feke GT, Hart U. Color Doppler ultrasound analysis of ocular circulation after topical calcium channel blocker. Am J Ophthalmol 1995; 119: 694–700.

    Google Scholar 

  17. Schumer RA, Podos SM. The nerve of glaucoma! Arch Ophthalmol 1994; 112: 37–44.

    Google Scholar 

  18. Sawada A, Kitazawa Y, Yamamoto T, Okabe I, Ichien K. Prevention of visual field defect progression with brovincamine in eyes with normal- tension glaucoma. Ophthalmology 1996; 103: 283–288/

    Google Scholar 

  19. Harris A, Evans DW, Cantor L, Martin B. Hemodynamic and visual function effects of oral nifedipine in patients with primary open- angle glaucoma. Am J Ophthalmol 1997; 124: 296–302.

    Google Scholar 

  20. Ishida K, Yamamoto I, Kitazawa Y. Clinical factors associated with progression of normal- tension glaucoma. J Glaucoma 1998; 7: 372–377.

    Google Scholar 

  21. Tielsch JM, Katz J, Sommer A, Quigley HA, Javitt JC. Hypertension, perfusion pressure, and primary open- angle glaucoma. A population- based assessment. Arch Ophthalmol 1995; 113: 216–221.

    Google Scholar 

  22. Flammer J, Gasser P, Prünte C, Yao K. The probable involvement of factors other than ocular pressure in the pathogenesis of glaucoma. In: Drance SM, Van Buskirk EM, Neufeld AH eds. Pharmacology of Glaucoma. Baltimore: Williams & Wilkins, 1992: 273–283.

    Google Scholar 

  23. Gasser P. Clinical syndromes with vasoconstrictor response. Wien Klin Wochenschr 1991; 103: 217–221.

    Google Scholar 

  24. Flammer J. Therapeutical aspects of normal- tension glaucoma. Curr Opin Ophthalmol 1993; 4: 58–64.

    Google Scholar 

  25. Sossi N, Anderson DR. Blockage of axonal transport in optic nerve induced by elevation of intraocular pressure. Effect of arterial hypertension induced by angiotensin I. Arch Ophthalmol 1983; 101:94–97.

    Google Scholar 

  26. Hussain RM, McIntosh SJ, Lawson J, Kenny RA. Fludrocortisone in the treatment of hypotensive disorders in the elderly. Heart 1996; 76: 507–509.

    Google Scholar 

  27. Robertson D, Davis TL. Recent advances in the treatment of orthostatic hypotension. Neurology 1995; 45: 526–532.

    Google Scholar 

  28. Stumpf JL, Mitrzyk B. Management of orthostatic hypotension. Am J Hosp Pharm 1994; 51: 648–660.

    Google Scholar 

  29. Kaiser HJ, Flammer J, Burckhardt D. Silent myocardial ischemia in glaucoma patients. Ophthalmologica 1993; 207: 6–8.

    Google Scholar 

  30. Gass A, Flammer J, Linder L, Romeno SC, Gasser P, Haefeli WE. Inverse correlation between endothelin- 1- induced peripheral microvascular vasoconstriction and blood pressure in glaucoma patients. Graefe's Arch Clin Exp Ophthalmol 1997; 235: 634–638.

    Google Scholar 

  31. Orgül S, Kaiser HJ, Flammer J, Gasser P. Systemic blood pressure and capillary blood- cell velocity in glaucoma patients. A preliminary study. Eur J Ophthalmol 1995; 5: 88–91.

    Google Scholar 

  32. Orgül S, Prünte C, Flammer J. Endothelium derived vasoactive substances relevant for normal- tension glaucoma. Curr Opin Ophthalmol 1999: in press.

  33. Schirger A, Hines EA, Molnar GD et al. Idiopathic orthostatic hypotension. J Am Med Assoc 1962; 181: 822–826.

    Google Scholar 

  34. Hickeler RB, Thompson GR, Fox LM et al. Successful treatment of orthostatic hypotension with 9- alpha fluorohydrocortisone. N EngI J Med 1959; 261: 788–791.

    Google Scholar 

  35. Peterson PK, Pheley A, Schroeppel J et al. A preliminary placebo- controlled crossover trial of fludrocortisone for chronic fatigue syndrome. Arch Intern Med 1998; Apr 27; 158(8): 908–914.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University Eye Clinic Basel, Switzerland

    Konstantin Gugleta, Selim Orgül, Daniela Stümpfig & Josef Flammer

Authors
  1. Konstantin Gugleta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Selim Orgül
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniela Stümpfig
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Josef Flammer
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gugleta, K., Orgül, S., Stümpfig, D. et al. Fludrocortisone in the treatment of systemic hypotension in primary open-angle glaucoma patients. Int Ophthalmol 23, 25–30 (1999). https://doi.org/10.1023/A:1006434231844

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1006434231844

Search

Navigation