Angiotensin inhibitors, blockers associated with delayed glaucoma surgical intervention
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Key takeaways:
- A small but statistically significant protective effect of treated hypertension was observed in patients with glaucoma.
- Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers were associated with delayed glaucoma progression and surgical intervention.
Treating but not overtreating hypertension is key in patients with glaucoma, according to a speaker.
“Greater than 50% of patients with glaucoma have hypertension,” James J. Armstrong, MD, PhD, said at the American Glaucoma Society meeting. “They may or may not be on treatment for it when they come through the clinic, asking simple questions like, ‘Will high or low blood pressure worsen my glaucoma, or will certain blood pressure-lowering drugs affect my glaucoma?’ To answer that, overall the current literature supports the role of vascular factors as part of the multifactorial etiology of open-angle glaucoma.”
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Patients have access to three classes of antihypertensive medication, Armstrong said, including thiazide diuretics, calcium channel blockers (CCBs), and angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). Armstrong and colleagues conducted a retrospective survival analysis of 25,146 patients with a glaucoma diagnosis to determine if treatment with ACEIs and ARBs delay surgical intervention more than other antihypertensive treatments. Time to surgical intervention was the study’s primary outcome.
Of the patients, 11,555 had hypertension, of which 7,251 used CCBs or thiazide diuretics and 4,304 used ACEIs or ARBs. Over 25 years of follow-up, a small but statistically significant protective effect of treated hypertension was observed (HR = 0.89; 95% CI, 0.81-0.98). This protective effect was primarily driven by ACEIs and ARBs (HR = 0.84; 95% CI, 0.74-0.95). CCBs and thiazide diuretics had a “slightly detrimental” effect (HR = 1.1; 95% CI, 0.96-1.27).
“When it comes to the choice of treatment, making sure the primary care provider is aware that ACEIs and ARBs are associated with delayed progression and as we have now shown are associated with delayed surgical intervention will allow a more holistic evaluation of the risks and benefits when choosing a class of blood pressure-lowering medications,” Armstrong said.
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Armstrong JJ, et al. Reduced rates of glaucoma surgery associated with systemic inhibition of the angiotensin system: A retrospective cohort study of systemic antihypertensive drug exposures on time to surgical intervention in glaucoma patients. Presented at: American Glaucoma Society meeting; March 2-5, 2023; Austin, Texas.
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