Hypotensive Medication, Statins, and the Risk of Glaucoma

Owen, Christopher G.; Carey, Iain M.; Shah, Sunil; Wilde, Stephen De; Wormald, Richard; Whincup, Peter H.; Cook, Derek G

doi:10.1167/iovs.09-4821

Cited by 44 publications

(58 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In conclusion, we respectfully disagree with inclusion of the case-control studies by Owen et al 2 in both the systematic review and meta-analysis and the cross-sectional study by Khawaja et al 3 in the systematic review. In carrying out the meta-analysis, there is still room for discussion on the assignment of suspected glaucoma to incidence or progression outcome.…”

Section: Figurecontrasting

confidence: 73%

Statin Use and Open-Angle Glaucoma: Evidence From Observational Studies

Fung

Chan

et al. 2017

Invest. Ophthalmol. Vis. Sci.

View full text Add to dashboard Cite

We read with interest the systematic review and meta-analysis on the effect of statins on intraocular pressure (IOP) and glaucoma incidence and progression by McCann et al. 1 We would like to discuss the appropriateness of inclusion of studies in the systematic review, placement of studies in the metaanalysis, and the process of appraising the quality of evidence of the included studies. APPROPRIATENESS OF INCLUSION OF STUDIES IN THE SYSTEMATIC REVIEWThe authors claim that the systematic review was to evaluate the effect of statins on glaucoma; the inclusion of studies with nonglaucoma cases could lead to erroneous conclusions. The authors included the case-control study by Owen et al., 2 which defined cases based on a combination of diagnostic codes for glaucoma or ocular hypertension and codes for prescription specific to glaucoma treatment. In the definition of glaucoma, ocular hypertension is not a subtype of glaucoma. There was also a lack of information on the proportion of cases with a diagnostic code of ocular hypertension in the study. With the large uncertainty on the proportion of cases with glaucoma, this case-control study must be excluded from both the systematic review and meta-analysis.In addition, one of the purposes of the systematic review was to

show abstract

Section: Figurecontrasting

confidence: 73%

Statin Use and Open-Angle Glaucoma: Evidence From Observational Studies

Fung

Chan

et al. 2017

Invest. Ophthalmol. Vis. Sci.

View full text Add to dashboard Cite

show abstract

“…Thus, hypertension was defined as a patient receiving ≥2 antihypertensive compounds. Because previous studies have shown a decreased risk of glaucoma in patients treated with systemic β-blockers or calcium channel inhibitors, 16,23,[35][36][37] it seems reasonable to interpret the present observed reduction of the risk of developing glaucoma in patients treated with antihypertensive as a causal effect of particular antihypertensive drugs. …”

mentioning

confidence: 48%

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown an association between antihypertensive medication and glaucoma (but the evidence is still scarce). [19][20][21]35 However, no previous study has investigated the causal effect of antihypertensive medication on glaucoma.Although the overall risk of treatment with antiglaucomatous drugs is increased in patients taking antihypertensive medication, we show that commenced treatment with antihypertensive drugs postpones the onset of glaucoma, or treatment with an antiglaucomatous drugs, and leads to a reduction in the trend of glaucoma by around 43%.We cannot know if the estimates could be affected by an increased avoidance of glaucomatous diagnostics after the onset of antihypertensive treatment. Furthermore, the present analysis assumes that there is no algorithm in the medical care system that leads to patients who start antihypertensive medication being more or less likely to be examined for glaucoma.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Antihypertensive Medication Postpones the Onset of Glaucoma

et al. 2017

View full text Add to dashboard Cite

G laucoma is the second most common irreversible cause of blindness worldwide.1 It is becoming increasingly important in the context of an aging world population.1,2 It possesses a considerable challenge to public health because blindness and visual impairment is costly and have a huge impact on life quality. 3 Raised intraocular pressure (IOP) remains the only successful treatable factor to reduce the progression of glaucoma. Yet, glaucoma is multifactorial, and the understanding of the pathology is incomplete. More than 2 decades ago, the first study to suggest that blood pressure (BP) should be considered in glaucoma treatment was published. 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.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. [20][21][22] In this matter, antihypertensive medication may conflict with ocular perfusion and autoregulation. 20,23 Although studies have shown a correlation between antihypertensive treatment and glaucoma, these studies have mostly been trials in small numbers of patients with minimal follow-up periods. 1,14,24 Moreover, to the best of our knowledge, no previous study has benefited from a complete data sample from an entire population norimportantly-estimated the causal effect of antihypertensive treatment on the risk of developing glaucoma.The main outcome in our study is the treatment for glaucoma. We hypothesized, before embarking on the empirical analysis, that treatment with antihypertensive medication could have an ambiguous effect on the development Abstract-The aim was to investigate the impact of antihypertensive medication on the onset of glaucoma. Data from the complete Danish population between 40 and 95 years of age were used in the period from 1996 to 2012, covering >2.6 million individuals. The National Danish Registry of Medicinal Products Statistics was used to identify all claimed prescriptions for glaucoma medication and antihypertensive drugs. We first investigated basic correlations in the data and found that patients treated with antihypertensive medication, at any time during the study period, had a significantly higher overall relative risk (RR) of glaucoma, even when controlling for age and sex (with a RR of 1.31 and P<0.0001). Furthermor...

show abstract

“…Previous studies on systemic medications and IOP indicated that lower IOP is associated with systemic β-blockers9 10 and nitrates10 and revealed effects that included an increased risk of developing glaucoma for statins11 and calcium channel blockers 12. In a study of a UK primary care database, oral selective β 1 -blocker intake was associated with a reduced risk of developing glaucoma 13. However, the evidence remains inconclusive regarding the effect of systemic cardiovascular medications on IOP.…”

Section: Introductionmentioning

confidence: 99%