Association of Blood Pressure With Rates of Macular Ganglion Cell Complex Thinning in Patients With Glaucoma

Abstract

ImportanceThere are scarce data on the association of blood pressure measures with subsequent macular structural rates of change in patients with glaucoma.ObjectiveTo investigate the association of baseline blood pressure measures with rates of change of the macular ganglion cell complex in patients with central or moderate to advanced glaucoma damage at baseline.Design, Setting, and ParticipantsThis prospective cohort study, conducted from August 2021 to August 2022, used data from patients in the Advanced Glaucoma Progression Study at the University of California, Los Angeles. Participants were between 39 and 80 years of age and had more than 4 macular imaging tests and 2 or more years of follow-up.ExposuresA diagnosis of glaucoma with either central damage or a visual field mean deviation worse than −6 dB.Main Outcomes and MeasuresThe main outcome was the association of blood pressure measures with ganglion cell complex rates of change. Macular ganglion cell complex thickness rates of change were estimated with a bayesian hierarchical model. This model included relevant demographic and clinical factors. Blood pressure measures, intraocular pressure, and their interactions were added to the model to assess the association of baseline blood pressure measures with global ganglion cell complex rates of change.ResultsThe cohort included 105 eyes from 105 participants. The mean (SD) age, 10-2 visual field mean deviation, and follow-up time were 66.9 (8.5) years, –8.3 (5.3) dB, and 3.6 (0.4) years, respectively, and 67 patients (63.8%) were female. The racial and ethnic makeup of the cohort was 15 African American (14.3%), 23 Asian (21.9%), 12 Hispanic (11.4%), and 55 White (52.4%) individuals based on patient self-report. In multivariable analyses, female sex, history of taking blood pressure medications, higher intraocular pressure, thicker central corneal thickness, shorter axial length, higher contrast sensitivity at 12 cycles per degree, and higher baseline 10-2 visual field mean deviation were associated with faster ganglion cell complex thinning. Lower diastolic blood pressure was associated with faster rates of ganglion cell complex thinning at higher intraocular pressures. For intraocular pressures of 8 and of 16 mm Hg (10% and 90% quantiles, respectively), every 10 mm Hg–lower increment of diastolic blood pressure was associated with 0.011 μm/y slower and –0.130 μm/y faster rates of ganglion cell complex thinning, respectively.Conclusions and RelevanceIn this cohort study, a combination of lower diastolic blood pressure and higher intraocular pressure at baseline was associated with faster rates of ganglion cell complex thinning. These findings support consideration of evaluating and addressing diastolic blood pressure as a therapeutic measure in patients with glaucoma if supported by appropriate clinical trials.

Association of Postural Blood Pressure Response With Disease Severity in Primary Open Angle Glaucoma

“…1 Conversely, systemic hypotension especially nocturnal blood pressure dip and medication-induced hypotension in hypertensive patients have been consistently associated with a higher incidence of glaucoma and a higher rate of progression. 15,23,24 It has been suggested that blood pressure alterations in both hypertension and hypotension exert their effect on the optic nerve either directly through ischemic damage or indirectly through elevated IOP in the case of ocular hypertension. 1,25 Therefore, complex regulation of SABP, IOP, and OPP is needed to maintain adequate perfusion of ONH under different hemodynamic and metabolic conditions.…”

Blood Pressure and Glaucoma—A Complex Relationship

“…In this issue of JAMA Ophthalmology, Mohammadzadeh et al 3 add important information to our understanding of the influence of BP on glaucoma progression. They report the association of baseline BP parameters, IOP, and other covariates on the rate of change in macular ganglion cell complex (GCC) thickness in a cohort of 105 participants, mostly with open-angle glaucoma, monitored prospectively for a mean of 3.6 years.…”

Macular Optical Coherence Tomography—From Diagnosis to Prognostication

“…The article by Mohammadzadeh and coauthors investigates longitudinal trend-based assessment of optical coherence tomography (OCT) macular thickness measures, specifically the ganglion cell and inner plexiform layers (GCIPL; Cirrus OCT; Carl Zeiss Meditec). The association between imaging assessed macular thickness and glaucoma was first proposed and then demonstrated by Zeimer and colleagues .…”

“…Instead of simply detecting the presence or absence of disease, Mohammadzadeh and colleagues looked at the risk of future progression from preperimetric to manifest glaucoma with visual field defect associated with the rate of thinning of the GCIPL. The authors found that the rate of GCIPL thinning conveyed a significant risk of progression to perimetric glaucoma, with a hazard ratio (HR) of 2.4 for every 1 μm per year faster rate of minimum GCIPL thinning.…”

“…Mohammadzadeh and colleagues conclude that both ONH and macular OCT imaging should be considered in the management of eyes with suspected glaucoma. The literature is clear in light of this and prior studies demonstrating the value of macular OCT in the detection of glaucoma, the longitudinal assessment of glaucoma, and the prediction of glaucoma progression.…”