Blood Pressure and Glaucoma—A Complex Relationship

Tanna, Angelo P.

doi:10.1001/jamaophthalmol.2022.6515

Cited by 2 publications

(4 citation statements)

References 7 publications

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“…Hypotension and hypertension have been identified as risk factors for glaucoma [ 6 , 18 – 23 ]. These conflicting findings result in a complex link between blood pressure and glaucoma [ 24 ]. In this study, we proposed that above and beyond the absolute level, dysregulations in the 24-h blood pressure defined as repetitive, and extreme drops in MAP due to excessive reading-to-reading MAP variability might be an alternative mechanism involved in open-angle glaucoma.…”

Section: Discussionmentioning

confidence: 99%

“…These estimates would not correspond to the association of OPP level with glaucoma risk per se but to IOP and blood pressure levels instead. This has been described as a potential statistical flaw [ 26 ], limiting the use of OPP as a risk factor for glaucoma [ 24 ]. We did not disentangle such a flaw but we rather examined OPP and MAP using a different perspective, that is, reading-to-reading MAP variability.…”

Section: Discussionmentioning

confidence: 99%

“…The value of x so obtained was 0.815 for estimating 24-h VIM map . To study extreme and drastic drops in MAP, the five readings with the largest drops compared with the previous reading in individual 24-h recordings were selected -the time elapsed in between was used to quantify the duration of dips/blips.…”

Section: Twenty-four Hour Blood Pressure Level and Dysregulationsmentioning

confidence: 99%

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Effect of 24-h blood pressure dysregulations and reduced ocular perfusion pressure in open-angle glaucoma progression

Melgarejo,

Van Eijgen,

Wei

et al. 2023

Journal of Hypertension

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Background: Low ocular perfusion pressure (OPP), which depends on the mean arterial pressure (MAP) and intraocular pressure (IOP), is associated with glaucoma. We studied 24-h MAP dysregulations and OPP in relation to the progression of glaucoma damage. Methods: We retrospectively analyzed 155 normal-tension glaucoma (NTG) and 110 primary open-angle glaucoma (POAG) patients aged 18 years old followed at the University Hospital Leuven with repeated visual field tests (n = 7000 measures, including both eyes) who underwent 24-h ambulatory blood pressure monitoring. Twenty-four-hour MAP dysregulations were variability independent of the mean (VIM), and the five lowest dips in MAP readings over 24 h. OPP was the difference between 2/3 of the MAP and IOP. Glaucoma progression was the deterioration of the visual field, expressed as decibel (dB) changes in mean deviation analyzed by applying multivariable linear mixed regression models. Results: The mean age was 68 years (53% were women). High 24-h VIMmap was associated with glaucoma progression in POAG (P < 0.001) independently of the 24-h MAP level. The estimated changes in mean deviation in relation to dip MAP measures ranged from −2.84 dB [95% confidence interval (CI) −4.12 to −1.57] to −2.16 dB (95% CI −3.46 to −0.85) in POAG. Reduced OPP along with high variability and dips in MAP resulted in worse mean deviation deterioration. Conclusion: The progression of glaucoma damage associates with repetitive and extreme dips in MAP caused by high variability in MAP throughout 24 h. This progression exacerbates if 24-h MAP dysregulations occur along with reduced OPP.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Twenty-four Hour Blood Pressure Level and Dysregulationsmentioning

confidence: 99%

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Effect of 24-h blood pressure dysregulations and reduced ocular perfusion pressure in open-angle glaucoma progression

Melgarejo,

Van Eijgen,

Wei

et al. 2023

Journal of Hypertension

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“…First, not all studies support an association of these vascular factors with glaucoma and report contrasting results. For instance, several of them demonstrated that both high and low BPs were associated with an increased risk of glaucoma, and that low nighttime BP or excessive dipping reportedly could affect glaucoma progression [24,27,28], while others did not find any correlation or they suggested that extremes in BP tend to overwhelm or disrupt the autoregulatory mechanisms [26,29]. Although many studies propose diabetes as a POAG risk factor, that issue remains controversial [26,30].…”

Section: Prediction Of Glaucoma Based On Systemic Findingsmentioning

confidence: 99%

Glaucoma Prediction Models Based on Ocular and Systemic Findings

Landau Prat,

Kapelushnik,

Arazi

et al. 2023

Ophthalmic Res

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Introduction: Our aim was to explore the impact of various systemic and ocular findings on predicting the development of glaucoma. Methods: Medical records of 37,692 consecutive patients examined at a single medical center between 2001-2020 were analyzed using machine learning algorithms. Systemic and ocular features were included. Univariate and multivariate analyses followed by Cat Boost and Light Gradient-Boosting Machine (GBM) prediction models were performed. Main outcome measures were systemic and ocular features associated with progression to glaucoma. Results: 7,880 patients (mean age 54.7±12.6 years, 5520 males [70.1%]) were included in a 3-year prediction model, 314 patients (3.98%) had a final diagnosis of glaucoma. The combined model included 185 systemic and 42 ocular findings, and reached a ROC AUC of 0.84. The associated features were: intraocular pressure (48.6%), cup-to-disc ratio (22.7%), age (8.6%), mean corpuscle volume (MCV) of red blood cells (RBC) trend (5.2%), urinary system disease (3.3%), MCV (2.6%), creatinine level trend (2.1%), monocyte count trend (1.7%), ergometry metabolic equivalent task score (1.7%), dyslipidemia duration (1.6%), prostate-specific antigen level (1.2%), and musculoskeletal disease duration (0.5%). The ocular prediction model reached a ROC AUC of 0.86. Additional features included were: age-related macular degeneration (10.0%), anterior capsular cataract (3.3%), visual acuity (2.0%), and peripapillary atrophy (1.3%). Conclusions: Ocular and combined systemic-ocular models can strongly predict the development of glaucoma in the forthcoming 3 years. Novel progression indicators may include anterior subcapsular cataracts, urinary disorders, and complete blood test results (mainly increased MCV and monocyte count).

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Blood Pressure and Glaucoma—A Complex Relationship

Cited by 2 publications

References 7 publications

Effect of 24-h blood pressure dysregulations and reduced ocular perfusion pressure in open-angle glaucoma progression

Effect of 24-h blood pressure dysregulations and reduced ocular perfusion pressure in open-angle glaucoma progression

Glaucoma Prediction Models Based on Ocular and Systemic Findings

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