POAG risk greater with higher systolic, pulse pressures
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An increased risk for primary open-angle glaucoma was found in individuals with higher systolic blood and pulse pressures, while no statistically significant link was found in those with elevations in diastolic or mean arterial pressures.
“The relationship between blood pressure and [primary open-angle glaucoma] remains poorly understood,” Carmelo Macri, of the University of Adelaide and Royal Adelaide Hospital in Australia, and colleagues wrote in Investigative Ophthalmology & Visual Science. “Comparing results among studies is complicated by their different approaches to representing blood pressure, inconsistent definitions of high and low blood pressure, incomplete range of blood pressure parameters included and boundaries used to discretize categories.”
To evaluate a full range of blood pressure parameters and how they relate to incident primary open-angle glaucoma (POAG), Macri and colleagues enrolled 484,268 individuals without glaucoma, aged 40 to 69 years, from the UK Biobank. All participants had at least one systolic blood pressure (SBP) and diastolic blood pressure (DBP) measurement at baseline.
Routine blood pressure measurements were recorded at the initial assessment visit, follow-up assessment visit, initial imaging visit and follow-up imaging visit, with mean arterial pressure (MAP) and pulse pressure (PP) calculated from SBP and DBP readings.
Researchers identified incident POAG events through primary care data, hospital inpatient admissions and assessment visits. The primary outcome of interest was relative hazard of incident POAG.
During the study, 43,642 individuals recorded two SBP measurements, 9,396 recorded three, and 494 individuals recorded four. Researchers reported 2,390 incident POAG events over 5,715,480 person-years of follow-up, with a median follow-up of 12.08 years.
According to results, higher SBP and PP were associated with an increased risk for incident POAG (P = 0.038 for SBP, P < 0.001 for PP) when compared with SBP and PP in the normal range. Notably, SBP of 130 mm Hg to 140 mm Hg or 140 mm Hg to 150 mmHg was associated with a 1.16 higher hazard of incident POAG, while PP greater than 70 mm Hg was associated with a 1.13 higher risk for incident glaucoma.
No statistically significant associations were reported for DBP or MAP with incident glaucoma in the multivariable models. The findings in this study support past studies that show an association between systolic hypertension and an increased risk for POAG, researchers wrote.
“The varied prognostic significance of these differing blood pressure parameters appears to mirror that seen for systemic cardiovascular risk in older patients and adds weight to the potential role of systemic vascular dysfunction in the pathogenesis of POAG,” Macri and colleagues wrote. “Systolic hypertension may thus represent a potential modifiable risk factor for POAG, although further studies are required to characterize this relationship better.”
Perspective
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Glaucoma is a multifactorial disease with a myriad of risk factors having been studied over the years to better help us assess our patients’ disease state and risk of progression. The majority of these risk factors are not modifiable. In regard to blood pressure parameters, both low ocular perfusion pressure and low DBP have traditionally been shown to be associated with an increased risk of progressive disease.
This current study highlights the potential role of additional blood pressure metrics, which may increase our understanding of the role of the vascular system in glaucoma’s pathogenesis and, importantly, have the capability to be modified. Given that this is a cohort study involving 484,268 individuals from a large biobank, it is very difficult to apply this information on an individual basis in our respective clinics. However this study does underscore that there is likely an optimal optic nerve head vascular environment that may be achievable in the future through personalized blood pressure management. Ultimately, we as practitioners need to be cognizant of the overall systemic health of our patients and consider how the intensity or lack of intensity of medical management has the potential to alter glaucoma care.
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