Fludrocortisone in the treatment of systemic hypotension in primary open-angle glaucoma patients

Background: Fludrocortisone is a potent mineralocorticoid, which has no kno wn direct vasoactive properties, and is the first-line drug for treatment o f orthostatic hypotension. The present study evaluated the systemic hemodyn amic effects of fludrocortisone treatment in glaucoma patients. Patients an d methods: A retrospective analysis of the charts of glaucoma patients of t he University Eye-Clinic Basel was performed. Twenty-two patients with open -angle glaucoma under treatment with fludrocortisone were selected. The sel ected patients had one 24-h blood pressure recording immediately prior to t reatment with fludrocortisone and one recording at least 2 months after sta rting the treatment. Parallel to blood pressure recordings, diurnal intraoc ular tension curve recordings and visual field testings were carried out. I n addition, twelve patients also had nail-fold video-capillaroscopy. Result s: IOP and visual fields remained stable. The average values for all system ic 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). Baselin e capillary blood-flow velocity increased and capillary blood-flow standsti ll time after cold provocation decreased significantly under fludrocortison e therapy. Conclusion: Hemodynamic parameters show a tendency towards impro vement in a magnitude which might be of clinical relevance.