Mechanistic links between systemic hypertension and open angle glaucoma

Abstract

Systemic hypertension or hypertension is a very common chronic age-related disease worldwide. It is typically characterized by a sustained elevation of blood pressure, particularly when the systolic blood pressure and/or diastolic blood pressure are of more than 140 mmHg and 90 mmHg, respectively. If hypertension is not well controlled, it may lead to an increased risk of stroke and heart attack. It has been shown that hypertension is linked with various ocular diseases, including cataract, diabetic retinopathy, age-related macular degeneration, and glaucoma. Glaucoma is the leading cause of irreversible blindness worldwide. Primary open angle glaucoma is the most common form of the disease and is usually characterized by an increase in intraocular pressure (IOP). This condition, together with normal tension glaucoma, constitutes open angle glaucoma. Systemic hypertension has been identified as a risk factor for open angle glaucoma. It is speculated that blood pressure is involved in the pathogenesis of open angle glaucoma by altering IOP or ocular blood flow, or both. Recent evidence has shown that both extremely high and low blood pressure are associated with increased risk of open angle glaucoma. Additional pathogenic mechanisms, including increased inflammation likely to be involved in the development and progression of these two diseases, are discussed.

The Association between Vascular Abnormalities and Glaucoma—What Comes First?

“…Regarding hemodynamics, a notable association between glaucoma and systemic cardiovascular diseases, such as diabetes mellitus (DM) [5][6][7], high blood pressure (BP) [8,9], low BP [10], and nocturnal dipping [11] has been documented, suggesting an elevated incidence of glaucoma in affected individuals. These observations highlight the potential influence of hemodynamic factors on glaucoma development and progression [12,13]. Abnormal vascular function can also influence the secretion and drainage of aqueous humor (AH), thus affecting IOP regulation [14].…”

Mendelian randomization study updates the effect of hypertension on the risk of primary open-angle glaucoma

“…As one of the most common cardiovascular diseases, hypertension may have a role on POAG through its effect on IOP, OPP and blood vessel alterations [4][5][6]. Some studies have found that hypertension is associated with higher prevalence and progression of glaucoma [5,7].…”