Vascular effects of betaxolol, a cardioselective beta-adrenoceptor antagonist, in isolated rat arteries

Calcium channels and their blockers in intraocular pressure and glaucoma

Several factors besides high intraocular pressure assumed to be associated with the development and progression of glaucoma, and calcium channel blockers (CCBs) have been an anticipated option for glaucoma treatment by improving ocular perfusion and/or exerting neuroprotective effects on retinal ganglion cells with safety established in wide and long-term usage. Decrease in IOP has been reported after topical application of CCBs, however, the effect is much smaller and almost negligible after systemic application. Various CCBs have been reported to increase posterior ocular blood flow in vivo and to exert direct neuroprotection in neurons in vitro. Distribution of the drug at a pharmacologically active concentration in the posterior ocular tissues across the blood-brain barrier or blood-retina barrier, especially in the optic nerve head and retina where the ganglion cells mainly suffer from glaucomatous damage, is essential for clinical treatment of glaucoma. Improved visual functions such as sensitivity in the visual field test have been reported after administration of CCBs, but evidences from the randomized studies have been limited and effects of CCBs on blood flow and direct neuroprotection are hardly distinguished from each other.

Hypotensive effect and toxicology of the extract from Coscinium fenestratum (Gaertn.) Colebr

The water extract from Coscinium fenestratum (Gaertn.) Colebr. (CF extract) was tested for hypotensive and vasorelaxant effects. Acute and subchronic toxicity as well as motor activity of CF extract were also evaluated. The present study demonstrates that CF extract is effective in reducing blood pressure in anesthetized normotensive rats. This effect is shown to be dose-related and rapid in onset. The extract showed an endothelium-dependent and independent vasorelaxant activity in isolated aortic rings precontracted with phenylephrine (1 microM) and KCl (60 mM). The capacity of L-NAME (100 microM), an inhibitor of nitric oxide synthase, to reduce the vasorelaxant action of the extract indicates the involvement of nitric oxide. In the acute toxicity test, an oral dose of 5000 mg/kg of the CF extract did not produce mortality or significant changes of the general behavior of animals and gross appearance of internal organs of rats. Similarly, in the subchronic toxicity test, an oral dose of 2500 mg/kg/day of the CF extract given to rats for 90 days did not cause any significant change of any of the parameters observed when compared with those of the control animals. Moreover, the CF extract did not produce any effect on the central nervous system when spontaneous motor activity in rats was assessed. However, because some average hematological and blood chemistry values were found to be statistically different, further studies, including chronic toxicity test, should be done to confirm the safety of this plant when it is used over a long period of time.

Effect and Mechanism of Betaxolol and Timolol on Vascular Relaxation in Isolated Rabbit Ciliary Artery

PURPOSE

In order to clarify the vasodilatory mechanism of betaxolol and timolol, we studied the effects of these drugs in isolated rabbit ciliary arteries.

METHODS

Rabbit ciliary artery specimens were mounted in a double myograph system, and betaxolol, timolol, or another agent was introduced into the organ chamber. The mechanical response of the arteries was studied using an isometric tension recording method. The intracellular free calcium concentration [Ca2+]i was also measured using fluorescence photometry.

RESULTS

Betaxolol and timolol induced dose-dependent relaxation in the rabbit ciliary arteries precontracted by high-K+ Krebs solution. The minimum concentrations required to cause relaxation were 10 microM of betaxolol, and 30 microM of timolol. At the maximum concentration of 1 mM, betaxolol induced almost complete relaxation of the ciliary arteries, whereas timolol induced approximately 70% relaxation. These actions were not inhibited by pretreatment with 100 microM NG-nitro-l-arginine methylester (L-NAME), a nitric oxide synthase inhibitor, or by denudation of the vascular endothelium. However, 300 microM of betaxolol or timolol decreased the [Ca2+]i of the vascular smooth muscle, an action similar to that of diltiazem, a typical L-type voltage calcium-channel blocker.

CONCLUSIONS

Betaxolol, a selective beta1-adrenoceptor antagonist, and timolol, a nonselective beta-adrenoceptor antagonist, both frequently used in the medical management of glaucoma, decrease [Ca2+]i by acting as Ca2+ channel blockers, thus causing relaxation of isolated rabbit ciliary artery.

Sustained perimacular vascular and visual response to topical beta blockers in normal human eyes

PURPOSE

To assess visual and circulatory responses to treatment with topical beta adrenergic antagonists.

DESIGN

Institutional prospective randomized clinical trial in normal adults.

METHODS

Twenty adults (36 (mean) +/- 8 (S.D.) years) underwent repeated baseline perimetry (Humphrey 30-2), contrast sensitivity (Vector Vision), perimacular microcirculatory studies (Oculix blue-field entoptic simulator), intraocular pressure (IOP), heart rate (HR), and blood pressure (BP) testing. Subjects commenced either timolol 0.5% or betaxolol 0.5% twice daily on day 1, were retested on days 3 and 35, discontinued treatment for 21 days, whereupon repeated tests were performed. Treatment responses were compared by paired t-test.

RESULTS

Timolol-treated eyes showed improvement in contrast sensitivity (P=0.03) and pericentral perimetric thresholds (P=0.01), but corresponding increases among betaxolol-treated eyes were significantly higher (P=0.03 and 0.04, respectively, relative to timolol-treated eyes). Leukocyte velocity increased with both drugs, each with post-withdrawal carryover (P< or =0.03). Significant IOP reduction (approximately 2.5 mmHg) occurred in both groups, BP fell 2.8 mmHg among betaxolol-treated subjects (P=0.02), and HR was 2 bpm slower among timolol-treated subjects (P=0.03), but all reverted to baseline values after washout.

CONCLUSIONS

Both treatment groups demonstrated significant changes in visual function and perimacular hemodynamics, sustained after the terminal 3-week washout period.

Vasorelaxant effects of racemic betaxolol and its R- and S- isomers on bovine retinal vessels

PURPOSE

RS-Betaxolol (equimolar R- and S- isomers) lowers intraocular pressure and dilates precontracted retinal and posterior ciliary arteries in vitro. Betaxolol's vasorelaxant effect is thought to involve the inhibition of calcium influx into vascular smooth muscle and is unrelated to its stereoselective beta-adrenergic blocking action. The authors assessed the vasodilatory effect of RS-betaxolol on different diameters of bovine retinal arterioles and venules, and these responses were compared with the responses induced by R- and S-betaxolol isomers in vitro.

METHOD

In-vitro preparations of the bovine retinal microcirculatory system were perfused continuously with oxygenated, heparinized physiological salt solution at 37 degrees C. Diameters of retinal arterioles and venules were measured using video imaging. The retinal vessels were preconstricted with 40 mM KCl, and concentration-response curves for vasodilation were obtained for RS-betaxolol, R-betaxolol, and S-betaxolol.

RESULTS

Baseline diameters of first-order (A1) and second-order (A2) branches of retinal arterioles were 50 +/- 0.6 microm and 39 +/- 1 microm, respectively (n = 20), whereas diameters of first-order (V1) and second-order (V2) branches of venules were 75 +/- 0.8 microm and 50 +/- 0.4 mM, respectively (n = 20). The diameters of all sizes of retinal arterioles and venules were significantly reduced (i.e., vasoconstricted) in the presence of 40 mM KCl (n = 20). These preconstricted vessels were relaxed in a dose-dependent manner by cumulative additions of RS-betaxolol, R-betaxolol, and S-betaxolol. The dose-response curves of these compounds were not significantly different.

CONCLUSION

RS-Betaxolol, R-betaxolol, and S-betaxolol were equiactive and produced concentration-dependent vasodilatation of all sizes of retinal arterioles and venules studied.

Primary open-angle glaucoma patients characterized by ocular vasospasm demonstrate a different ocular vascular response to timolol versus betaxolol

We evaluated the retrobulbar response to a selective versus nonselective beta blocker in a subgroup of primary open-angle glaucoma patients (POAG) characterized by ocular vasospasm. Eleven patients who exhibited ocular vasospasm (i.e. a significant increase in ophthalmic artery blood flow velocity or a significant decrease in ophthalmic artery resistance index during hypercapnia) underwent medication washout for 4 weeks and were enrolled in a double-masked cross-over study (betaxolol versus timolol). Patients were evaluated for blood flow velocity of the retrobulbar vessels using color Doppler imaging, intraocular pressure, visual field sensitivity and contrast sensitivity at the beginning and end of each 4 week treatment period. Timolol treatment caused a significant reduction in IOP (p = .007), but no change in retrobulbar hemodynamics or visual function. After betaxolol treatment, resistance index fell significantly (p = .040) in the ophthalmic artery and increased significantly in both the central retinal (p = .003) and temporal posterior ciliary arteries (p = .030). Also following betaxolol treatment, contrast sensitivity improved significantly (p = .006), and a significant positive correlation was shown between change in contrast sensitivity and change in resistance index (r = .70; p = .015) of the ciliary arteries. POAG patients characterized by ocular vasospasm display a significant hemodynamic response to betaxolol, but not to timolol.

Betaxolol, a beta1-adrenoceptor antagonist, has an affinity for L-type Ca2+ channels

The effect of betaxolol on the specific binding of [3H]diltiazem and [3H]nitrendipine to rat cortical membranes was examined. Betaxolol inhibited specific [3H]diltiazem and [3H]nitrendipine binding with IC50 values of 19.7 and 46.3 microM, respectively. The effect of betaxolol on L-type Ca2+ channels showed little stereospecificity, since similar inhibitions of radioligand binding were observed with both racemic betaxolol and L-betaxolol. The dissociation kinetics of [3H]diltiazem were unaffected by 30 microM betaxolol, whereas it increased the [3H]nitrendipine dissociation rate, thus suggesting that betaxolol directly interacts with the benzothiazepine binding site and allosterically modulates the dihydropyridine binding site. Carteolol, propranolol and timolol were also found to inhibit both specific [3H]diltiazem and [3H]nitrendipine binding to rat cortical membranes, but with less potency than betaxolol. The ability of betaxolol to interact with L-type Ca2+ channels may have a role in its therapeutic effects in the management of systemic hypertension and in reducing neuronal death as occurring in glaucoma.

Effect of topical betaxolol on tissue circulation in the human optic nerve head

There have been no reports to date on long-term betaxolol instillation effects on the human optic nerve head (ONH) tissue circulation. The purpose of this study was to study the effect of topical 0.5% betaxolol on tissue blood velocity in the human ONH. Using a laser-speckle tissue blood flow analyzer, normalized blur (NB; a quantitative index of tissue blood velocity) was measured every 0.125 seconds at a temporal ONH site free of visible surface vessels. Measurements were averaged for 3 cardiac cycles (NB(ONH)). For baseline comparison (day 0), recordings of bilateral NB(ONH) and intraocular pressure (IOP), blood pressure (BP) and pulse rate (PR) were recorded in healthy volunteers before, and 2, 4.5, and 7 hr after, instillation of 30 microL of betaxolol vehicle, and again on day 21; IOP was also recorded on days 7 and 14. On day 1 (the day after baseline measurements), and twice daily for 3 weeks, 30 microL of 0.5% betaxolol into one eye and 30 microL vehicle was instilled into the other in a double-blind study. Measurements as on day 0 were again recorded on day 21; IOP was also recorded on days 7 and 14. During baseline recordings, no significant changes were noted in any parameters. After administration of topical betaxolol, IOP was significantly reduced, bilaterally, with greater reduction in the betaxolol-treated eyes on day 21. Also on day 21, the NB(ONH) of the betaxolol-treated eyes was significantly higher 4.5 hr after instillation than that of the comparable baseline recording (p = 0.035 with Bonferroni's correction); BP, PR, and NB(ONH) in the eye which received only the vehicle showed little change. Tissue blood velocity in the human ONH was increased at least temporarily by instillation of topical betaxolol twice daily for 3 weeks. Although the obtained increase is small and may be clinically insignificant, the potential of betaxolol that can affect the ONH tissue circulation in humans after 21 days of instillation is thought to deserve further investigation.

Systemic and ocular vascular roles of the antiglaucoma agents beta-adrenergic antagonists and Ca2+ entry blockers

This review addresses whether the antiglaucoma agents beta-adrenergic antagonists and Ca2+ entry blockers cause vasoactive effects in the retinal and other ocular vasculatures, as they do in other tissues. The potent vasodilating effects of Ca2+ entry blockers on ocular vessels have recently been demonstrated in in vivo and in vitro studies, implying that the maintenance of ocular vascular tone relies almost exclusively on extracellular Ca2+. Ca2+ entry blockers may potentially play a role in relaxing the retinal, long posterior ciliary, and ophthalmociliary arteries to improve the ocular circulation in vascular diseases in which there is considerable vascular tone present. The beta-adrenergic antagonists are discussed with reference to their antihypertensive role, their effect on other vascular beds, and finally what is known of their effect in the ocular vasculature. The emerging evidence that particular selective beta-adrenergic antagonists, such as betaxolol, are also potent Ca2+ channel entry blockers in other vascular beds is presented. Betaxolol has been shown to induce vasodilatation in the retinal and other ocular vascular beds, although studies have shown that beta1-adrenergic receptors are sparse in these vascular beds. This implies that an alternative mechanism must be responsible for betaxolol-induced vasodilatation. Evidence is presented that betaxolol vasodilates via its potent Ca2+ channel entry blocking properties, and its potency and ability to vasodilate are compared with those of nimodipine and timolol, as well as with those of other Ca2+ channel entry blockers. Important areas for future research in this area are discussed.

In vitro studies of the effects of beta-adrenergic drugs on retinal and posterior ciliary microarteries

The small-vessel myograph allows for precise measurements of physiopharmacologic responses of the ocular microarteries under controlled conditions. Studies using the myograph have shown that beta-adrenergic agonists are unable to induce significant relaxation in retinal and posterior ciliary microarteries, indicating that these microarteries have very few or no functional beta-adrenoceptors. Thus, beta-blockers would not be expected to have important adverse vasoconstrictory effects in the posterior part of the eye that are caused by their beta-adrenoceptor binding capacities. On the contrary, some beta-blockers, such as propranolol (the standard beta-blocker in pharmacology) and betaxolol (a beta-blocker used in ophthalmology), have vasorelaxant effects, probably a result of their Ca2+ channel-blocking activity. This activity shows no stereospecificity. Betaxolol could thus act as a vasodilator in glaucoma patients, on the condition that it penetrates in the posterior part of the eye after topical application. If so, it could also induce vasodilatation in circumstances of vascular endothelium injury, because this effect is endothelium-independent.

Periocular accumulation of timolol and betaxolol in glaucoma patients under long-term therapy

PURPOSE

To determine if betaxolol or timolol is present in measurable concentration in the Tenon capsule in patients under long-term topical therapy.

METHODS

Small (1-cc) specimens of Tenon capsule were removed at the time of filtering surgery from 15 glaucoma patients under long-term preoperative topical therapy, nine of whom had been treated with timolol and six of whom had been receiving betaxolol. Methanol extracts of these tissue samples were analyzed quantitatively for the presence of either beta-adrenergic antagonist by high-performance liquid chromatography.

RESULTS

Drug was detected in every specimen. A mean total of 2.6 (range, 0.1-30.0) microg of betaxolol was detected per 1-cc specimen.

CONCLUSION

Timolol and betaxolol penetrate the conjunctiva and accumulate in the Tenon capsule. In patients under long-term therapy, the periocular tissue can accumulate a greater quantity of beta-antagonist than is present in a daily dosage of applied eyedrops, manyfold higher than the maximal intraocular concentration.

Comparison of short- and long-term effects of betaxolol and timolol on human retinal circulation

PURPOSE

To determine the short- and long-term effects of betaxolol and timolol on human retinal circulation.

METHODS

In a double-masked, randomised, placebo-controlled study we evaluated the effects of both a one-drop application and a twice-daily 2-week application of either topical 0.5% betaxolol hydrochloride or topical 0.5% timolol maleate on the retinal circulation in 12 healthy volunteers. Laser Doppler velocimetry was used to detect changes in the retinal venous blood flow.

RESULTS

In both betaxolol- and timolol-treated eyes, intraocular pressure decreased significantly compared with baseline values after both 90 min and 2 weeks. In betaxolol-treated eyes, retinal blood flow did not change significantly after 90 min, but increased significantly (14 +/- 9%; p = 0.02) compared with baseline after 2 weeks. In timolol-treated eyes, retinal blood flow decreased significantly (18 +/- 5%: p = 0.04) compared with baseline after 90 min, and also decreased significantly (14 +/- 6%; p = 0.04) compared with baseline after 2 weeks.

CONCLUSIONS

Retinal blood flow increases as a long-term effect of betaxolol and decreases as both a short- and long-term effects of timolol.

Ca2+ channel-blocking activity of propranolol and betaxolol in isolated bovine retinal microartery

The relaxant action of the standard beta-blocker propranolol was compared with betaxolol, a beta-blocker with established vasorelaxant properties. Ring segments of bovine retinal microartery (n=36, theta=237 microm), which lacks adrenergic nerves and beta-adrenoceptors, were mounted in an organ bath for isometric force recording. l-, d-, dl-Propranolol and betaxolol were equally effective in relaxing tonic K+-induced contractions. The median effective dose (ED50) value was approximately 10(-5) M for both beta-blockers. The relaxation by both beta-blockers was unaffected by endothelium removal. Like verapamil, both beta-blockers induced smaller relaxation of tonic prostaglandin F2alpha (PGF2alpha)-induced force, which depended less on Ca2+ influx than did K+-induced force: K+-, but not PGF2alpha-induced contractions were abolished in Ca2+-free medium. The minor betaxolol-induced relaxation of tonic PGF2alpha-induced force was blocked in Ca2+-free medium. With repeated exposures to PGF2alpha in Ca2+-free medium, initial phasic PGF2alpha-induced force declined less with every exposure than did subsequent tonic force. When the preparations were briefly equilibrated with K+- and Ca2+-rich solution before every exposure to PGF2alpha phasic force did not decline, indicating that phasic force primarily depended on Ca2+ released from intracellular stores. Both beta-blockers failed to relax phasic PGF2alpha-induced force. Thus propranolol and betaxolol are equipotent vasorelaxant drugs in retinal microartery, both probably acting via Ca2+ channel blockade. This activity (that shows no stereospecificity) thus appears to be a more general property of beta-blockers. Microarteries might be more sensitive to this activity than are conductance arteries.

Effect of topical betablockers on human retinal vessels diameters

PURPOSE

To measure the effect of topical betaxolol 0.5% and timolol 0.5% on retinal vessels diameters by means of photographic enlargement.

METHODS

Thirteen glaucomatous patients (primary open angle glaucoma (POAG) and ocular hypertensive (OH)) were treated twice daily with betaxolol 0.5% for one year. These same patients were subsequently treated with timolol 0.5% during the following year. Fundus photographs were taken with Canon camera 30 degree angle at baseline and two hours after instillation at 3, 6 and 12 months of treatment for each drug. The diameters of the superior and inferior temporal vessels (arteries and veins) were measured at one and two disc radii from the margin of the disc using photographic enlargement (x 66.7) of the right eye and were analysed under double masked fashion during the same session.

RESULTS

A significant increase of the mean arterial diameter (+ 7.4% p = 0.000 paired t) was found after 12 months of betaxolol treatment, while no persistent further difference (+ 1.3% NS) was found after 12 months of timolol treatment. No modification was found in venous diameter.

CONCLUSION

Betaxolol treatment is associated with a beneficial effect on retinal arteries width whereas Timolol does not yield the same amplitude of benefit.

Association of retinal capillary perfusion with visual status during chronic glaucoma therapy

PURPOSE

The purpose of the study is to determine whether retinal microcirculation is associated with the degree of visual function in glaucomatous eyes receiving chronic bilateral medical therapy with topical beta-blockers.

METHODS

A nonrandomized, 3-year prospective clinical study was undertaken on 37 patients with glaucoma and normal visual acuity receiving symmetric topical medication in both eyes. Humphrey 30-2, Henson CFA 2000, and Vistech 3 and 6 cycles/degree contrast sensitivity were obtained bilaterally at multiple visits, along with Oculix 1000 blue-field estimates of perimacular leukocyte velocity. The mean asymmetry of measurements obtained throughout the treatment period for each pair of eyes was determined, and correlations were obtained to assess visual function asymmetry circulatory asymmetry.

RESULTS

Significant associations were observed between blue-field entoptic capillary leukocyte velocity measurements and those for all three visual function testing methods, the eye with the superior vision typically having the higher mean leukocyte velocity (P < 0.001 for both Humphrey mean deviation and Henson perimetry, P < 0.002 for Humphrey corrected pattern standard deviation, and P < 0.02 for contrast sensitivity at both 3 and 6 cycles/degree).

CONCLUSIONS

Central retinal microcirculation is associated with various measures of central and peripheral visual function in glaucomatous eyes receiving beta-adrenergic blocker therapy.

Contrasting effects of betaxolol and propranolol on Ca(2+)-activated contractions in skinned fibers from canine coronary arteries and ventricular muscles

The effects of some beta-adrenoceptor antagonists (atenolol, betaxolol, bunitrolol, labetalol, pindolol, and propranolol) on Ca2+ (pCa 5.8)-activated tension development in chemically skinned fibers from canine coronary artery and right ventricular trabeculae were studied. In skinned coronary arteries, Ca(2+)-activated tension development was decreased by betaxolol and propranolol at concentration of more than 10(-5) and 10(-4) M, respectively. The pCa-tension relationships were shifted to the right and down by betaxolol. In contrast, in skinned cardiac muscle Ca(2+)-activated tension development was increased by betaxolol and propranolol at the same range of concentrations as in coronary arteries, with no change in maximum tension. The pCa-tension relation was shifted to the left by betaxolol. Other beta-adrenoceptor antagonists (atenolol, bunitrolol, labetalol, and pindolol) had no effect on Ca(2+)-induced contraction in either muscle type. These results indicate that among beta-adrenoceptor antagonists, only betaxolol and propranolol can directly modulate the Ca2+ sensitivity of myofilaments and have opposite effects on the contractile system in canine cardiac and vascular smooth muscle.

Betaxolol, a beta 1-adrenoceptor antagonist, inhibits Ca(2+)-induced contraction in skinned renal artery of the dog

The effects of betaxolol on Ca(2+)-induced contractions in saponin-treated skinned canine renal arteries were examined. Betaxolol decreased the pCa (-log[Ca2+] M) 5.8-induced contraction at the same concentrations at which the drug relaxed the high K(+)-induced contraction in intact smooth muscles. The pCa-tension relation was shifted to the right and downward by betaxolol. Betaxolol inhibited the increase in Ca(2+)-induced contraction by calmodulin, and this effect of betaxolol was observed even at the concentration that had no effect when given alone. These results suggest that betaxolol decreases the Ca2+ sensitivity of the contractile system in skinned canine renal arteries, presumably by inhibiting calmodulin-mediated contractions.

Retrobulbar arterial hemodynamic effects of betaxolol and timolol in normal-tension glaucoma

PURPOSE

beta-Adrenergic blocking drugs lower intraocular pressure. The question of whether these drugs also alter, either directly or indirectly, orbital hemodynamics is potentially of great importance for patients with normal-tension glaucoma who may have some degree of reversible vasospasm.

METHODS

We compared the effect of selective (betaxolol) and nonselective (timolol) beta-adrenergic blocking drugs on flow velocities (as determined by color Doppler imaging) in orbital vessels in 13 patients with normal-tension glaucoma (mean age, 62 +/- 3 years; mean intraocular pressure, 15 +/- 2 mm Hg). A one-month drug treatment double-masked crossover design, with a three-week washout before each drug, was used.

RESULTS

Neither drug changed peak systolic velocity in any of the four vessels studied (ophthalmic, nasal and temporal posterior ciliary, and central retinal arteries). Additionally, timolol did not alter end-diastolic velocity or resistance index (defined as [peak systolic velocity minus end-diastolic velocity] divided by peak systolic velocity) in any of the vessels measured. In contrast, betaxolol tended to increase end-diastolic velocity and to decrease resistance index: the four-vessel average end-diastolic velocity increased 30% (P = .08), and the four-vessel average resistance index decreased significantly (P = .04). These reductions in resistance index occurred despite that betaxolol, in contrast to timolol, did not significantly decrease intraocular pressure.

CONCLUSIONS

These results suggest that, in patients with normal-tension glaucoma, selective beta-adrenergic blockade (betaxolol) may have ocular vasorelaxant effects independent of any influence on intraocular pressure, whereas nonselective blockade (timolol) lowers intraocular pressure without apparently altering orbital hemodynamics.

Inhibitory action of betaxolol, a beta 1-selective adrenoceptor antagonist, on voltage-dependent calcium channels in guinea-pig artery and vein

1. The effects of betaxolol, (+/-)-1-[4-[2-(cyclopropylmethoxy) ethyl] phenoxy]-3-(isopropylamino)-2-propanol hydrochloride, a beta 1-selective adrenoceptor antagonist, on voltage-dependent Ca2+ channels were investigated in single smooth muscle cells from guinea-pig mesenteric artery and portal vein using a whole-cell variant of the patch-clamp technique. Ca2+ channel currents were recorded with bath solutions contained 10 mM Ba2+ for arterial cells and 2 mM Ca2+ for venous cells. 2. Betaxolol inhibited Ca2+ channel currents dose-dependently in both mesenteric artery cells and portal vein cells. The two isomers, (+)-betaxolol and (-)-betaxolol (relative beta-antagonistic efficacies of 0.1 and 1, respectively), had similar potencies for inhibiting Ca2+ channel currents in portal vein cells. Propranolol did not inhibit the currents. Thus the inhibitory action of betaxolol on Ca2+ channel currents was independent of the beta-adrenoceptor. 3. The inhibitory action of betaxolol on Ca2+ channel currents was compared with that of diltiazem and of nifedipine in mesenteric artery cells. The current inhibition depended on the stimulation frequency with all drugs (use-dependent block). All drugs also accelerated the current decay and shifted the voltage-dependent inactivation curve in a negative direction. 4. In conclusion, betaxolol inhibited Ca2+ channel currents in vascular smooth muscle cells. The mode of inhibitory action was similar to that of diltiazem and nifedipine. Our results suggest that betaxolol is a unique beta-adrenoceptor antagonist that has a direct inhibitory action on voltage-dependent Ca2+ channels in vascular smooth muscle cells.

The relaxant action of betaxolol on isolated bovine retinal microarteries

We investigated the possible effects on retinal blood flow of betaxolol, a beta blocker which is used as antiglaucomatous medication. Ring segments of retinal microarteries were isolated from bovine eyes and mounted in an organ bath for measurement of contractile force. The effects of betaxolol were studied during K(+)-, stretch-, and serotonin-induced contractions, to enable comparison to the effects of the standard beta blocker propranolol and the Ca2+ channel blocker verapamil. Betaxolol relaxed K(+)-induced contractions in a dose-dependent manner. The drug relaxed the phasic part of the K(+)-induced contractions more than the tonic part. Betaxolol had no effect on stretch-induced contractions. The tonic part of the serotonin-induced contractions showed a trend to decrease in response to betaxolol. These highly specific effects of betaxolol resembled the effects of propranolol. Since betaxolol has significantly less membrane stabilizing activity than has propranolol, this activity is not responsible for the relaxant action of beta blockers on retinal microarteries. The action of both beta blockers resembled the action of the Ca2+ channel blocker verapamil.

Longterm effect of topical beta-blockers on intraocular pressure and visual field sensitivity in ocular hypertension and chronic open-angle glaucoma

In a prospective, randomized study, nineteen patients with ocular hypertension (n = 14) or chronic open-angle glaucoma (n = 5) were treated with either betaxolol 0.5% or timolol 0.5% in both eyes twice daily. Visual field sensitivity and intraocular pressure were assessed with the Octopus perimeter (program G1) and applanation tonometry, respectively, at 3, 6, 12, 24, 36, and 48 months during treatment. Four of the nineteen patients (two timolol-treated and two betaxolol-treated) were lost to follow-up after the 36-month examination. Whereas both drugs reduced the intraocular pressure, the decrease in the timolol-treated group was statistically more pronounced than in the betaxolol-treated group at month 3, 6, and 48 (p < 0.03). In both treatment groups, the visual field mean sensitivity (MS) index decreased slightly during the first six months of treatment, but remained so only in the timolol-treated group at all subsequent examinations. In the betaxolol-treated group, there was a statistically significant increase in MS at the 12, 24, 36, and 48 month visits (p < 0.01). These findings suggest that factors other than IOP alone may determine visual field outcome.

Differences in the longterm effect of timolol and betaxolol on the pulsatile ocular blood flow

In the past several years the effect of longterm glaucoma therapy on ocular hemodynamics has taken on increased interest. This interest has been sparked by studies demonstrating differential effects of various beta-blockers on visual function, and the possible contributory role of ocular blood flow. In the present study, the pulsatile ocular blood flow (POBF), as derived by the Langham OBF system, was measured prior to treatment and then tracked throughout a one-year period of beta-blocker therapy (betaxolol 0.5% or timolol 0.5%) in 25 glaucoma patients. Results of the two treatments were compared, and indicated that, whereas both betaxolol- and timolol-treated patients had similar significant reductions in the IOP, the effect of the two treatments on the POBF differed. In timolol-treated patients, the POBF decreased significantly over the 12-month observation period, whereas in betaxolol-treated patients it remained stable.

The direct vascular relaxing action of betaxolol, carteolol and timolol in porcine long posterior ciliary artery

The vascular relaxing properties of three beta adrenoceptor antagonists, betaxolol, carteolol and timolol, currently used in the treatment of glaucoma, were characterized, compared and contrasted in the porcine long posterior ciliary artery. Isolated arterial ring segments precontracted with increased extracellular KCl (plus 40 mM) or the thromboxane analog, U-46619 (3 x 10(-7) M), were relaxed in a concentration-dependent fashion by betaxolol, carteolol, timolol or nitroprusside. In vessel segments depolarized with increased extracellular KCl, EC50 values indicated that the intrinsic relaxant sensitivity to betaxolol was equal to that of nitroprusside, six-fold greater than that of carteolol, and ten-fold greater than that of timolol. Similarly, the maximum relaxation occurring at equimolar concentrations (10(-4) M) for the beta adrenoceptor antagonists was betaxolol > carteolol = timolol. Qualitatively similar results were noted in ring segments of the rabbit external iliac artery precontracted with increased extracellular KCl (plus 30 mM). Under conditions in which specific receptor-linked events are absent and voltage-gated Ca++ entry is maximized, the Ca++ concentration response relationship in porcine long posterior ciliary artery was shifted to the right in an apparent competitive manner by betaxolol, reflecting a 5.6-fold reduction in the sensitivity to Ca++. Conversely, nitroprusside reduced the Ca++ sensitivity three-fold in a noncompetitive fashion; not only shifting the Ca++ concentration response relationship to the right, but also depressing the maximum by 57%. Porcine long posterior ciliary arterial segments precontracted to a similar degree with U-46619, in which voltage-gated Ca++ entry is only one component of many specific cell signalling transduction mechanisms contributing to the precontraction, exhibited a sensitivity to betaxolol that was six-fold less than to nitroprusside, but two-fold greater than to timolol and 20-fold greater than to carteolol. These results are consistent with an obvious direct vascular relaxing capacity for beta adrenoceptor antagonists that primarily represents a capacity for inhibiting voltage-gated Ca++ entry in vascular smooth muscle. Additionally, the differential potencies of these three beta adrenoceptor antagonists characterized in this study suggests that this property is much more likely to contribute to any potentially beneficial effects of betaxolol than carteolol or timolol.