Blood Pressure Variability Linked to Glaucoma Progression

TOPLINE:

Fluctuations in blood pressure over an extended period, along with their interaction with mean blood pressure or intraocular pressure, are associated with a more rapid visual field progression in patients with suspected or confirmed glaucoma.

METHODOLOGY:

• Researchers conducted a retrospective cohort study to investigate the association between blood pressure parameters and visual field progression over time in patients with glaucoma.
• They analyzed the longitudinal data of 1674 eyes from 985 participants (57.2% women) with suspected (n = 777) or confirmed (n = 897) glaucoma who were selected from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study between November 2000 and December 2022.
• Blood pressure measurements were taken; mean and SD values of systolic arterial pressure, diastolic arterial pressure, and mean arterial pressure were calculated.
• Visual field assessments were performed using 24-2 Swedish Interactive Thresholding Algorithm standard tests.
• Participants were followed up for a mean period of 8 years, with averages of 7.5, 10.3, and 11.5 visits per person for the assessment of blood pressure, intraocular pressure, and visual field progression, respectively.

TAKEAWAY:

• Higher variability in mean arterial (β, −0.22 dB/y per 1-mm Hg higher; P = .001) and diastolic arterial pressure (β, −0.16 dB/y per 1-mm Hg higher; P = .001) was associated with faster visual field progression.
• The interaction between higher mean blood pressure and higher variability in blood pressure was associated with faster changes in annual deviation in both mean arterial (β, 0.02 dB/y per 1-mm Hg higher; P = .001) and diastolic arterial pressure (β, 0.02 dB/y per 1-mm Hg higher; P
• Similarly, the interaction between higher variability in blood pressure and higher mean intraocular pressure demonstrated faster changes in annual mean deviation in both mean arterial (β, 0.01 μm per 1-mm Hg higher; P = .003) and diastolic arterial pressure (β, 0.01 μm per 1-mm Hg higher; P = .001).

IN PRACTICE:

“These findings suggest that long-term variability of blood pressure may be a modifier of the association between intraocular pressure and [visual field] progression in glaucoma,” the authors of the study wrote. “A more integrated approach to glaucoma management is warranted, focusing on closer BP monitoring, timely eye care referrals, and attention to OPP [ocular perfusion pressure] and BP fluctuations,” they added.

SOURCE:

This study was led by Vincent Q. Pham, of the Viterbi Family Department of Ophthalmology at the University of California San Diego, and was published online on November 14, 2024, in JAMA Ophthalmology.

LIMITATIONS:

Blood pressure measurements were limited to office visits, which did not capture the full range of daily fluctuations or account for factors such as white coat syndrome, psychological stress, lifestyle variations, and medication adherence. This study did not account for antihypertensive medications or their potential effects on blood pressure control and glaucoma progression.

DISCLOSURES:

This study was supported by grants from the National Eye Institute, National Institutes of Health, Research to Prevent Blindness, and other sources. Some authors reported receiving grants, personal fees, and nonfinancial support; serving on advisory boards; and having many other ties with several institutions and pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.