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B. Sala, P. Fogagnolo, E. Vallenzasca, A. Lembo, N. Orzalesi; The Influence of Posture on Short-Term Changes in Intraocular Pressure in Glaucomatous Patients Treated With Systemic Hypotensive Drugs. Invest. Ophthalmol. Vis. Sci. 2010;51(13):987.
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To evaluate the short-term changes in intraocular pressure (IOP) with posture change in patients with glaucoma treated with systemic hypotensive drugs.
We enrolled 29 patients (69± 13.4 year old) with untreated primary open-angle glaucoma (POAG) and arterial hypertension (3 treated with systemic beta-blockers (Bb), 3 with calcio-antagonists (Ca), 8 with Ace-inhibitors (Ac), 9 with diuretics (Du), 4 with Du+Ca, 2 with Ac+Du) and 61 healthy controls (68± 6.7 year old). At the end of a 30 minute period in supine position, baseline IOP values ware taken with Perkins tonometer. Patients then sat down and 5 IOP measurements at intervals of 1 minute were taken with I-care tonometer. After 30 minutes patients stood up and 5 measurements were taken at the same time intervals. Only one eye per patient chosen at random was considered. At each time point, the difference in IOP from baseline was calculated and analysed using t-test.
When changing from supine to sitting position, a trough occurred after 1 minute in POAG (-5.3% ± 9.5%; P=< 0.05 v baseline), and 3 minutes in controls (-3.1% ± 7.9%; P= <0.05 v baseline). When changing from sitting to standing-up position both groups had a peak after 1 minute (+10% ± 9.8% and +8.9% ± 8.4% respectively, P<0.01). No differences between POAG and controls were found at any postural change.No differences were found due to systemic hypotensive treatment, except for Ac-Du. IOP phasing in these patients was: from -8.57% ± 2.1% to -7.7% ± 10.9% (P< 0.05) from supine to sitting, and +3.1% ± 4.42% to +0.8% ± 15.4% (P>0.05) from sitting to standing-up
Untreated POAG patients under hypotensive systemic treatment and controls show similar changes in IOP at postural changes. Only Ac-Du treated patients behaved differently from all other groups. These results should be taken into account in clinical practice due to the frequent association of glaucoma and arterial hypertension.
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