TOPICAL GLAUCOMA MEDICATIONS AND CARDIOVASCULAR RISK IN THE ELDERLY

Objective: To determine the frequency of congestive heart failure and cardiac conduction disturbances in elderly patients treated with topic al glaucoma medications. Methods: These case-control studies were cond ucted among participants in the New Jersey Medicaid and Medicare progr am from 1986 to 1990. A total of 35,445 subjects (ages 65 to 99 years) were included in the congestive heart failure analysis, and 4278 subj ects were included in the conduction disorder analysis. Results: The f requency of initiation of congestive heart failure therapy, defined as the new use of digoxin or furosemide, was not increased for users of topical glaucoma medications. The frequency of pacemaker placement was also not increased for topical glaucoma medication users. Analyses we re adjusted for age, race, gender, nursing home or hospital status, nu mber of prescription medications, and selected medication exposures. A dvanced age and heavy use of other prescription medications were assoc iated with an increased likelihood of both cardiovascular outcomes. Co nclusion: Major cardiovascular side effects did not occur at an increa sed rate among patients using topical beta-blockers or other glaucoma medications compared with control subjects. This population-based stud y places findings from case reports and small clinical trials in a bro ader context to help with clinical assessment of the risks and benefit s of glaucoma therapy in the elderly.