Meta-analysis of Timolol on Diurnal and Nighttime Intraocular Pressure and Blood Pressure

Purpose To evaluate the nighttime intraocular pressure (IOP) and blood pressure (BP) response to timolol treatment in patients with ocular hypertension or primary open-angle glaucoma. Methods This was a meta-analysis of previously published studies that must have been randomized, prospective, crossover or parallel, single or double-masked trials. The treatment period must have been ≥2 weeks with ≥19 patients per treatment arm for a crossover, and ≥50 patients for a parallel designed trial. Studies must have included both baseline and treated 24-hour curves. Results For the IOP analysis, we included 8 articles with 340 patients. A reduction from baseline was observed for timolol at each time point and for the 24-hour curve (p≤0.009). When 2 studies, in which timolol was used adjunctively were removed, a similar difference was observed as above at each time point and for the 24-hour curve (p≤0.003). In 2 studies, there were small reductions from baseline for the mean diastolic and systolic BPs at most time points and for the 24-hour curve (3.9 and 4.2 mmHg, respectively) with timolol treatment. The ocular perfusion pressure did not show any difference between baseline and timolol treatment at any time point or for the 24-hour curve (p>0.05). Conclusions This meta-analysis suggests that topical timolol therapy provides an ocular hypotensive effect over the 24-hour curve, including the nighttime hours, and while small reductions in the systolic and diastolic pressures occur, the ocular perfusion pressure is not altered over 24 hours.