title: Resting pulse rates in a glaucoma clinic: the effect of topical and systemic beta-blocker usage.
abstract: BACKGROUND
  Beta-blockers have, for 25 years, been a commonly used agent in the treatment of raised intraocular pressure (IOP). Beta-blockers can also reduce the pulse rate. With no available literature examining a cohort of patients, this study aims to investigate the resting pulse rates in patients attending a specialist glaucoma clinic in order to identify if routine review of ophthalmic medication use is indicated.
  
  
  METHODS
  The resting pulse rates of patients attending a glaucoma clinic were measured using pulseoximetry, with a medical and drug history established for each patient.
  
  
  RESULTS
  In all, 205 patients were included in the study. A total of 101 (49%) of patients were using beta-blockers in some form. The mean pulse rate for patients not using beta-blockers (104 patients) was 76 beats per minute (bpm), for topical use only (68 patients) it was 70.3 bpm, for oral use (18 patients) it was 64.7 bpm, and 58 bpm for patients using both topical and oral beta-blockers (15 patients). Groups using beta-blockers (oral, topical, oral and topical) were considered in relation to patients not using beta-blockers. All groups using beta-blockers showed a significant association with causing a bradycardia of less than 60 bpm. Patients with a pulse rate of less than 50 bpm were significantly more likely to be using topical and oral beta-blockers than oral beta-blockers alone (P=0.01).
  
  
  CONCLUSIONS
  Topical beta-blockers should be used with caution, even in the presence of established systemic beta-blocker use. Routine pulse rate monitoring and review of ophthalmic medication are indicated in patients using beta-blocker therapy.
authors.affiliation: Department of Ophthalmology, Queens Medical Centre, NHS trust, Nottingham, UK. chris.tattersall@mail.qmcuh-tr.trent.nhs.uk
authors.forename: C
authors.initials: C
authors.lastname: Tattersall
authors.forename: S
authors.initials: S
authors.lastname: Vernon
authors.forename: R
authors.initials: R
authors.lastname: Singh
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001919:Bradycardia / Q000139:chemically induced; D016903:Drug Monitoring / Q000379:methods; D004359:Drug Therapy, Combination; D005901:Glaucoma / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods
chemical_list: D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents