Fludrocortisone in the treatment of systemic hypotension in primary open-angle glaucoma patients.
BACKGROUND
Fludrocortisone is a potent mineralocorticoid, which has no known direct vasoactive properties, and is the first-line drug for treatment of orthostatic hypotension. The present study evaluated the systemic hemodynamic effects of fludrocortisone treatment in glaucoma patients.


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 with fludrocortisone were selected. The selected patients had one 24-h blood pressure recording immediately prior to treatment with fludrocortisone and 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 blood pressure 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 significantly under fludrocortisone therapy.


CONCLUSIONS
Hemodynamic parameters show a tendency towards improvement in a magnitude which might be of clinical relevance.
Gugleta
K
K
University Eye Clinic Basel, Switzerland.
Orgül
S
S
Stümpfig
D
D
Dubler
B
B
Flammer
J
J
D001783:Blood Flow Velocity / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000502:physiology; D005260:Female; D005438:Fludrocortisone / Q000627:therapeutic use*; D005902:Glaucoma, Open-Angle / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007022:Hypotension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D007429:Intraocular Pressure / Q000187:drug effects / Q000502:physiology; D008297:Male; D020678:Microscopic Angioscopy; D008875:Middle Aged; D008901:Mineralocorticoids / Q000627:therapeutic use*; D012189:Retrospective Studies; D014741:Video Recording
D008901:Mineralocorticoids; D005438:Fludrocortisone