Blood pressure and glaucoma

Abstract

Although intraocular pressure (IOP) is considered the main risk factor for the development of glaucoma and the only parameter subject to treatment, there is sufficient evidence to suggest that glaucoma may continue to progress despite lowering patients' IOP to targeted levels. Several studies have implicated vascular risk factors in the pathogenesis of glaucoma. Among them, blood pressure (BP) and ocular perfusion pressure have become increasingly important. Although clinicians cannot currently visualise ocular blood flow directly, they can easily measure glaucoma patients' BP and IOP to calculate their ocular perfusion pressure and quantify the vascular changes. The purpose of this review article is to discuss the relationship between BP and IOP, BP and glaucoma, and perfusion pressure and glaucoma. We discuss the importance of autoregulation to maintain the adequate perfusion of the optic nerve head, and suggest that ocular perfusion pressure and its fluctuation may be parameters that need to be measured in glaucoma patients.

Regulation of Optic Nerve Head Blood Flow during Combined Changes in Intraocular Pressure and Arterial Blood Pressure

“…[33][34][35] A complete description of the theory how low OPP may be involved in glaucoma pathogenesis has been summarized in recent reviews. 36,37 With regard to the present data, it is of interest that ONHBF appears to have relatively little regulatory capacity when IOP is increased.…”

Antihypertensive Medication Postpones the Onset of Glaucoma

“…4 Since then, the impact of BP on glaucoma has received greater attention as more evidence has mounted. [5][6][7] Despite the increasing evidence of an association between BP and glaucoma, the exact relationship is complex. In this matter, epidemiological and case-control studies have shown diverse results, and some studies have presented evidence of a correlation between high BP and glaucoma, [5][6][7][8][9][10][11] whereas other studies have linked glaucoma and low-tension glaucoma with low BP.…”

“…[5][6][7] Despite the increasing evidence of an association between BP and glaucoma, the exact relationship is complex. In this matter, epidemiological and case-control studies have shown diverse results, and some studies have presented evidence of a correlation between high BP and glaucoma, [5][6][7][8][9][10][11] whereas other studies have linked glaucoma and low-tension glaucoma with low BP.12-17 The controversies have been discussed and related to the complexity of BP not only influencing IOP and ocular perfusion pressure, but also increasing the risk of compromised peripheral vascular capacity and a dysfunctional autoregulation. 5,[17][18][19] Recognized high BP is treated with many different antihypertensive medications, and growing evidence acknowledges that such treatment is associated with glaucoma.…”

Intraocular pressure and ocular perfusion during hemodialysis

“…Nowadays, the concept of OPP and its identification of this as an important risk factor for the development and progression of glaucoma have brought together the vascular and mechanical components of glaucoma. Costa et al, believe that it is the balance between IOP and arterial pressure, influenced by the autoregulatory capacity of the eye that determine whether an individual will develop optic disc damage or not (26) . Some authors suggested that glaucoma patients with an exaggerated nocturnal reduction in systemic arterial pressure have an altered OPP outside the period of arterial pressure reduction, which is possibly related to a general vascular dysregulation (27) .…”