Topical Beta-Blockers and Mortality: Long-Term and Short-Term Effects

Abstract

Purpose: : Recently, an association between the use of topical timolol and cardiovascular mortality was reported by the Blue Mountains Eye Study (Lee et al. Ophthalmology 2006). The purpose of the present study was to confirm or falsify this clinically very important finding. Using data from the population based Rotterdam Study, we investigated both long-term (i.e. repeating the analysis of Lee et al.) and short-term (death shortly after the first prescription) effects of topical beta-blockers on mortality.

Methods: : Long-term effects: 3842 participants of the Rotterdam Study were followed from 1997 onwards. Cause of death was registered up to January 1, 2005. Use of topical beta-blockers was recorded at and before baseline (following Lee et al.), between 1990 and 1997. Data were analysed using Cox regression - Hazard ratios were adjusted for age, sex, smoking, cardiovascular disease and use of systemic cardiovascular medication.Short-term effects: 484 incident beta-blocker users (participants who started using a topical beta-blocker between the onset of the Rotterdam study in 1990 and October 1, 2004) were compared to an age-matched group of 4700 controls. Short term effects (death within three months after the first prescription of topical beta-blockers) were examined using a chi-squared test. Possible confounding by the presence of cardiovascular disease and smoking was evaluated as well.

Results: : Long-term effects: Mean age at baseline was 72 years (SD 7 years). 228 participants were using topical beta-blockers. 709 participants died during follow-up (18%), 135 (3.5%) had a cardiovascular cause of death. Hazard ratio of topical beta-blocker use was 0.94 (95% CI 0.71-1.25; P=0.69) for all cause mortality and 1.02 (0.56-1.86; P=0.95) for cardiovascular mortality.Short-term effects: 4 (0.8%) of 484 incident topical beta-blocker users died within 3 months after their first prescription. 65 (1.4%; P=0.31) of 4700 aged-matched controls died within a similar period.

Conclusions: : Use of topical beta-blockers appears not to be associated with mortality.

Keywords: clinical (human) or epidemiologic studies: risk factor assessment • drug toxicity/drug effects • intraocular pressure