High blood pressure. Causes, symptoms, treatments

Donepezil in the treatment of Alzheimer's disease: long-term efficacy and safety.


This study illustrates the great variety of glaucoma diagnostic subgroups and the use of surgery and drug therapies.

In six patients (4 women aged 80, 62, 43 and 52 years and 2 men aged 58 and 51 years), who used eyedrops containing beta-blockers for the treatment of glaucoma, allergic contact dermatitis of the eyelids was diagnosed. Three were allergic to metipranolol, 2 to levobunolol and 1 to timolol. In literature, less than 50 cases of hypersensitivity to beta-blockers in eye medication have been reported. There are, however, reasons to assume that sensitization is more frequent: (a) not all patients are referred by the ophthalmologist to the dermatologist; (b) false-negative reactions to patch tests with the commercial preparations and with beta-blockers are not infrequent; (c) they are not routinely tested because beta-blockers are difficult to obtain in pure form; (d) cross-reactions with other beta-blockers are infrequent, and changing to another preparation therefore usually solves the clinical problem. Nevertheless it is advisable to test a battery of beta-blockers (befunolol, levobunolol, metipranolol, timolol) in allergic patients. A test preparation of 2% in water or 3%-10% in petrolatum may be suitable. Control testing in non-exposed individuals is necessary to exclude irritation reactions.

We compared the efficacy of timolol maleate ophthalmic gel-forming solution 0.5% QD with that of levobunolol hydrochloride 0.5% BID, as measured by change in intraocular pressure (IOP), effect on heart rate, and ocular tolerability. The study had a positive-controlled, double-masked, randomized, multicenter, 12-week, two-period (6 weeks each), crossover design. One hundred fifty-two patients with open-angle glaucoma or ocular hypertension were randomized to receive either timolol maleate gel-forming solution QD or levobunolol BID for 6 weeks, followed by a crossover to the alternate treatment. IOP and heart rate were measured at morning trough and peak during weeks 3, 6, 9, and 12. Timolol maleate gel-forming solution QD was comparable to levobunolol BID in reducing IOP at peak and trough. Although the effects on peak heart rate were similar between the two medications, the effect on trough heart rate of timolol maleate gel-forming solution QD was significantly less than that of levobunolol BID (P = 0.001). The incidence of ocular burning and stinging was comparable between the two treatments. Patients experienced significantly more blurred vision when using timolol maleate gel-forming solution than when using levobunolol (P = 0.013). Overall, more patients experienced at least one adverse event when using timolol maleate gel-forming solution. Timolol maleate gel-forming solution QD is as efficacious in reducing IOP as levobunolol BID.

In a 3-month, double-masked, randomized clinical trial, the ocular hypotensive efficacy and systemic safety of 0.5% levobunolol and 2% carteolol were compared in 59 patients with open-angle glaucoma or ocular hypertension. The overall mean decrease in intraocular pressure was 7.3 mm Hg (27.4%) in the 0.5% levobunolol group and 4.1 mm Hg (14.8%) in the carteolol group. This difference was statistically significant (p = 0.0004). Changes in visual field and cup-disk ratios were few and similar between the groups. Effects on mean heart rate were noted in both treatment groups. The mean decrease in heart rate in the carteolol group was greater (-8.4 beats/min) than in the levobunolol group (-3.1 beats/min). This difference had marginal statistical significance (p = 0.059). We conclude that 0.5% levobunolol and 2% carteolol administered twice daily differ in lowering intraocular pressure as well as in their effects on heart rate.

Fifteen healthy volunteers with no history of ocular disease were included in this study. In a double-masked, randomized, cross-over design, one eye of each subject was treated, for one week, with one drop of either levobunolol or placebo, administered twice daily. Following a washout period of at least three weeks, the same eye received the alternate treatment for one week. Before the beginning of therapy and then two hours after the last drop, vessel diameter (D), maximum erythrocyte velocity (Vmax), and volumetric blood flow rate (Q) were determined in one major retinal vein of the treated eye, using bidirectional laser Doppler velocimetry and monochromatic fundus photography. Statistical analysis was performed using two-tailed, paired Student's t-test, linear regression, and correlation analysis.

A randomized, masked study measuring postoperative intraocular pressure at 4, 8, and 24 hours, two to seven days, and one month after planned extracapsular cataract extraction with posterior chamber lens implantation was conducted. Seven commonly used ocular hypotensive agents and a control, given at the completion of surgery, were compared: timolol maleate (Timoptic), levobunolol hydrochloride (Betagan), betaxolol hydrochloride (Betoptic), pilocarpine hydrochloride (Pilopine Gel), carbachol (Miostat), apraclonidine hydrochloride (Iopidine), acetazolamide (Diamox). There were significant differences between agents. Miostat was the most effective in controlling postoperative IOP, followed by Timoptic. Diamox, Pilopine Gel, and Betagan were equally effective. Betoptic was somewhat less effective and Iopidine was not significantly better than the control.