Low diastolic BP may be associated with ganglion cell complex damage in glaucoma
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The combination of low diastolic blood pressure and high IOP in patients with moderate to advanced glaucoma was associated with faster ganglion cell complex thinning rates, according to a study.
A total of 105 eyes of 105 participants in the Advanced Glaucoma Progression Study were included in the analysis. They all underwent clinical examination and macular OCT imaging every 6 months to monitor macular structural changes.
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After adjusting for confounding factors, lower diastolic blood pressure (DBP) combined with higher IOP was associated with faster rates of ganglion cell complex (GCC) thinning. “These results support the idea of an intricate interaction between DBP and IOP,” the authors wrote.
Both high and low blood pressure (BP) influence blood flow to the optic nerve and can therefore contribute to optic nerve damage in eyes with glaucoma, they said. High BP can cause atherosclerosis, with consequent reduced blood flow leading to retinal ganglion cell damage. Low BP, on the other hand, can cause compensatory vasoconstriction and reduced blood flow.
The results of this study suggest that evaluating and addressing DBP could be considered as a therapeutic measure in patients with glaucoma.
“Some studies have demonstrated that higher DBP, after adjusting for [systolic blood pressure], may not be a risk factor for cardiovascular diseases. As a lower DBP, but not [systolic blood pressure], was found to be a factor associated with progressive GCC thinning in our study, avoiding low DBP may be considered as a safe therapeutic approach for slowing the course of glaucoma progression,” the authors wrote.
However, they recommended a multidisciplinary approach to balance prevention of further glaucoma damage and prevention of cardiovascular disease.
“Cardiovascular risk assessment and treatment of patients with glaucoma in conjunction with their internist may be indicated to optimize BP in these patients,” they said.
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