Systemic hypertension associated with primary open angle glaucoma
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Pre-existing systemic hypertension is associated with primary open angle glaucoma, according to a population-based case-control study published in the American Journal of Ophthalmology.
“This study also adds to the evidence that POAG is associated with prior migraine, obstructive sleep apnea syndrome and hypotension,” Tung-Mei Kuang, MD, of the department of ophthalmology at Taipei Veterans General Hospital, School of Medicine at National Yang-Ming University and Research Center of Sleep Medicine at the College of Medicine in Taipei Medical University, and colleagues wrote.
Data from the Taiwan National Health Insurance Research Database was used in this study. Patients with first-time diagnosis of primary open angle glaucoma were identified from January 2010 to December 2015. Selected patients had at least two claims of primary open angle glaucoma diagnoses with prescriptions for topical antiglaucoma medications. Hypertension exposure was described as preceding primary open angle glaucoma diagnosis.
A total of 112,460 primary open angle glaucoma patients and 449,840 control subjects were included in this study.
Researchers found that those with primary open angle glaucoma were more likely to have diabetes (P < .001), hypotension (P < .001), obstructive sleep apnea (P < .001) and coronary heart disease (P = .024) than the control subjects. Of all participants, 296,975 had hypertension prior to the index date, with hypertension prevalence higher among those with primary open angle glaucoma (56.5%) than controls (51.9%).
Patients with pre-existing hypertension were 31% more likely to be diagnosed with primary open angle glaucoma than control subjects. Primary open angle glaucoma was significantly associated with prior hypertension (OR = 1.31) along with migraine (OR = 1.17), hypotension (OR = 1.61) and obstructive sleep apnea (OR = 1.25).
“Findings suggest that [eye care providers] should alert patients with glaucoma to have their blood pressure regularly monitored, and internists should refer hypertensive patients periodically for complete ophthalmological evaluation,” the researchers wrote.
Perspective
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Mark Eltis, OD, FAAO
Hypotension has been previously linked to normotensive glaucoma, and this association has led some to erroneously believe that hypertension could be protective against glaucoma. In fact, there may be a negative association between glaucoma and hypertension, as suggested by Kuang and colleagues. The idea that one health condition can decrease our risks for another is nice to hope for, but is likely not true. Any deviation from a state of health will likely have net negative consequences across the board. Could both high and low blood pressure be glaucoma risk factors? Probably so.
The mechanism for hypotension’s association with glaucoma is thought to be decreased ocular perfusion pressure. Hypertension on the other hand may increase aqueous production and ultimately increase IOP. Stay tuned, as specific mechanisms are poorly understood.
The associations of both hypotension and possibly hypertension with glaucoma suggests that a healthy lifestyle where blood pressure is normal is ideal. We must be proactive and measure the blood pressure of glaucoma patients, as it is a symptomless systemic disease. Further, family physicians should also be informed and encouraged to send hypertensive patients for ocular evaluation just as they send diabetic patients for annual screening.
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