Glaucoma-related visual field loss linked to higher, variable blood pressure
Key takeaways:
- Greater variability of blood pressure over time was linked to faster visual field progression in patients with glaucoma.
- This association was strongest in the context of higher mean blood pressure and IOP.
Among patients with suspected or confirmed glaucoma, higher average blood pressure and greater variability in blood pressure were associated with faster visual field loss, according to a study published in JAMA Ophthalmology.
Previous research has revealed a link between blood pressure (BP) and glaucoma progression, according to the researchers. However, “the impact of BP fluctuations on the progression of glaucoma remains unclear,” Vincent Q. Pham, BS, of the Hamilton Glaucoma Center at UC San Diego Health Shiley Eye Institute, and colleagues wrote.
This inspired the researchers to perform a retrospective cohort study of patients with suspected or confirmed glaucoma to investigate the association between BP and visual field progression over time.
The trial included 985 adults (57.2% women; mean age, 61.2 years; 61.7% white; 32.6% Black) who were enrolled in the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. Researchers measured BP — including systolic arterial pressure (SAP) and diastolic arterial pressure (DAP) — visual field and IOP from November 2000 to December 2022 at biannual visits.
In total, the researchers assessed 1,674 eyes, of which 897 were diagnosed with primary open-angle glaucoma (POAG); the remaining 777 had suspected glaucoma. Mean follow-up was 8 years.
Overall, the mean rate of visual field mean deviation change over follow-up was –0.13 dB per year. Greater standard deviation of mean arterial pressure (B = –0.22 dB/y per 1-mm Hg higher; P = .001) and DAP (B = –0.16 dB/y per 1-mm Hg higher; P = .001) were associated with faster visual field mean deviation loss.
According to mixed-effect models, the interaction of greater mean BP and greater BP variability — which the researchers indicated was a surrogate of long-term variability — was linked to faster annual mean deviation changes for MAP (0.02 dB/y per 1-mm Hg higher; P = .001) and DAP (0.02 dB/y per 1-mm Hg higher; P < .001).
Similarly, the interaction between greater BP variability and greater mean IOP was associated with faster annual mean deviation changes for mean arterial pressure (0.01 m per 1-mm Hg higher; P = .003) and DAP (0.01 m per 1-mm Hg higher; P = .001).
The researchers noted several limitations to this study, including: BP was measured only at office visits, and information on antihypertensive drugs was not included in the analysis.
“Our findings suggest that the effects of IOP and BP parameters are not independent of each other and highlight a potential association between BP variability and glaucoma progression as measured by [visual field mean deviation],” they wrote.
Perspective
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The relationship between BP, IOP and glaucoma progression is complex, and our understanding of how exactly BP and IOP conspire to influence progression continues to evolve.
With this retrospective cohort study of longitudinal data, Pham and colleagues found that higher BP and a greater variability of BP were associated with faster visual field progression, possibly suggesting that BP variability may be a modifier of the association between mean BP and glaucomatous progression and the association between IOP and visual field loss.
Interestingly, the increased risk for progression created by both higher and more variable BP is consistent with what we already believe about IOP, in that it isn’t just the peak that is of concern, but also the instability created by the highs and lows of these fluctuations.
While further corroboration of these data would be beneficial, our current understanding of how the peaks and valleys affect IOP and the progression of glaucoma leads us to believe that this similar correlation with BP variability is probably correct. Although we have yet to find the link, it is logical to think that it is somehow all connected.
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