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Hypertension offsets risk of developing glaucoma in black population

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STONY BROOK, N.Y. — People with systemic hypertension had half the relative risk of developing open-angle glaucoma of those without hypertension, according to a large study in a black population.

Lower blood pressure in relation to intraocular pressure (ie, perfusion pressure) at baseline increased the risk of developing glaucoma threefold, the study found. This is consistent with the hypothesis that there is a vascular component to glaucoma pathogenesis, the study authors said.

M. Cristina Leske, MD, MPH, and colleagues evaluated the relationship between open-angle glaucoma and hypertension in the study population of the Barbados Eye Studies, a study of almost 3,000 black residents of Barbados aged 40 and older.

Confirming other studies, Dr. Leske found that a higher IOP increased the risk of developing OAG, However, OAG developed throughout the IOP range; 66% of incident cases had baseline IOPs under 25 mm Hg.

After 4 years, 67 of the participants in the study (2.2%) developed open-angle glaucoma. Incidence increased with age, in men and in those with higher IOPs.

The 67 incident cases were older than the rest of the cohort (64 vs. 55 years), tended to have more males (49% vs. 41%), and had higher IOP (median IOP 21.3 mm Hg in the incident group vs. 17.7 mm Hg in the non-incidence group).

Systemic hypertension was frequent, affecting about 52% of black participants at baseline. Of those people, about half were on blood pressure-lowering medication. People with hypertension had a statistically significant decreased risk of OAG (P = .01) with about half the risk of people with lower blood pressures.

Lower perfusion pressure (defined as blood pressure minus IOP) at baseline approximately tripled the relative risk of OAG, which “suggests that low blood pressure relative to IOP increases the relative risk,” Dr. Leske et al wrote in the July issue of Archives of Ophthalmology.

“The same results were found in the subgroup of people with OAG and IOP greater than 21 mm Hg, suggesting that these results also apply to cases with higher IOP and are not limited to ‘normal-tension’ OAG,” she added.