Comparion of aqueou and gellan ophthalmic timolol with placebo on the 24-hour heart rate repone in patient on treatment for glaucoma

PURPOE: Topical beta-blocker treatment i routine therapy in the management of patient with glaucoma. Therapy reult in ytemic aborption, however, the degree of reduction of reting and peak heart rate ha not been quantified. DEIGN: Thi trial evaluated the effect of placebo, 0.5% aqueou timolol (timolol olution) and a 0.5% timolol upenion that form a gel on application to the conjunctiva (timolol gellan) on the 24-hour heart rate in patient currently being treated for glaucoma to quantify the reduction in mean heart rate. METHOD: Forty-three Caucaian patient with primary open-angle glaucoma or ocular hypertenion with a mean (±D) age of 63 (±8) year were randomized and croed over in a double-maked manner to 14 day of treatment with placebo (morning and evening in both eye), timolol olution (morning and evening in both eye), or timolol gellan (morning in both eye with placebo in the evening). On the 13th day of each period, heart rate wa recorded continuouly during a typical, ambulant 24-hour period. REULT: Both timolol olution and timolol gellan reduced the mean 24-hour heart rate compared with placebo (P ≤ .001), and thi reduction wa mot pronounced during the daytime (−7.5% change in mean heart rate, −5.7 beat/min). Timolol gellan howed a numerically but not ignificantly maller reduction in 24-hour heart rate, compared with timolol olution. During the night, the mean 12-hour heart rate on placebo and timolol gellan were both ignificantly le than on timolol olution; the difference between olution and gellan treatment wa tatitically ignificant (P = .01). CONCLUION: Both timolol olution and timolol gellan decreae the mean 24-hour heart rate compared with placebo. Thi repone wa mot pronounced during the active daytime period. Thee data quantify the modet bradycardia aociated with ophthalmic β-blocker therapy in a typical patient population on therapy for glaucoma. Although exercie performance wa not aeed in thi trial, reduction of thi magnitude hould not have ubtantial clinical conequence.