Higher Blood Pressure Levels and Variability Linked to Faster Glaucoma Progression: JAMA
Researchers have found that higher mean blood pressure (BP) values and increased BP variability are correlated with higher speed of visual field progression in glaucoma patients. A new study was recently published in JAMA Ophthalmology which was conducted by Pham and colleagues.
Glaucoma is one of the leading causes of irreversible blindness. Its development is strongly influenced by risk factors related to systemic and ocular conditions. While intraocular pressure (IOP) is most commonly associated with increased risk, BP is very important as well. This prospective study aimed to analyze changes in BP levels, variability of BP, and visual field changes in patients with glaucoma over time.
The longitudinal data of this study followed participants from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. BP and visual field testing was offered to participants between November 2000 and December 2022.
Sample size: 985 adult patients (1,674 eyes).
Demographics: Mean age was 61.2 years, 57.2% were women, 61.7% were white, and 32.6% were Black.
BP measurements: Mean BP was 131.6/76.1 mm Hg.
Follow-up duration: Mean follow-up was 8 years.
Visual field progression: Mean deviation change rate was -0.13 dB/year.
Key findings of the study were:
Higher BP levels and visual field changes:
• Mean arterial pressure: 0.02 dB/year per 1-mm Hg higher (P=0.001).
• Diastolic arterial pressure: 0.02 dB/year per 1-mm Hg higher (P<0.001).
BP variability and IOP interaction:
• Mean arterial pressure: 0.01 μm per 1-mm Hg higher (P=0.003).
• Diastolic arterial pressure: 0.01 μm per 1-mm Hg higher (P=0.001).
Variability impact:
• Patients with higher BP variability experienced more significant highs and lows, potentially compromising optic nerve perfusion.
Compared with previous observations, higher mean levels of BP and increased variability were significantly associated with more rapid deterioration of the visual field, thus demanding an integrated management of BP and IOP in the care of glaucoma patients. Further studies are required to define the impact of any strategies to manage BP on reducing glaucoma-related vision loss over the long-term.
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