Download PDF
Calcium channel blocker use is associated with glaucoma, according to researchers from the U.K.’s National Institute for Health and Care Research’s Biomedical Research Centre, in London, and colleagues. The scientists found that people who used calcium channel blockers—commonly prescribed for hypertension—had, on average, 39% higher odds of glaucoma compared with people who did not take them.1
Calcium channel blocker use was also associated with thinner macular retinal nerve fiber layer (mRNFL) and macular ganglion cell–inner plexiform layer (mGCIPL)—both objective, structural glaucoma-related parameters. There was no link found between calcium channel blocker use and IOP.
The cross-sectional study findings suggest that calcium channel blockers may represent a modifiable risk factor for glaucoma, the authors wrote.
|
PILL CHECK. Hypertension drugs are associated with glaucoma, according to a new study.
|
Study details. For their investigation, the scientists analyzed data drawn from 427,480 patient records from the UK Biobank with an ICD code for open-angle or other form of glaucoma. Of these participants, 41,023 had macular spectral-domain OCT imaging and 97,100 had IOP findings. The median age of participants whose records were analyzed was 58, 54% were women, 94.8% were White, and 7.8% used calcium channel blockers. The researchers adjusted for various factors including sociodemographic, lifestyle, medical, and other factors. They reported that dihydropyridines, the class of calcium channel blockers that includes amlodipine, were the most commonly used subtype (88.4%), followed by benzothiazepines (9.1%). Both medications were associated with higher odds of glaucoma, but not of elevated IOP.
The researchers’ analysis of OCT-derived inner retinal layer thicknesses also supports the association between calcium channel blocker use and glaucoma. OCT data revealed that calcium channel blockers were linked to thinner mRNFL thickness (–0.16 μm) and thin ner mGCIPL thickness (–0.34 μm) compared with nonusers. Dihydropyridine use in particular was associated with thinner mRNFL and mGCIPL. This finding runs counter to some previous research that suggests calcium channel blockers are neuroprotective, said lead study author Alan Kastner, MD, MSc, at the Clínica Oftalmología Pasteur, in Santiago, Chile.
No associations were found with other classes of antihypertensive agents and glaucoma, including diuretics, renin-angiotensin system inhibitors, and systemic beta-blockers. Dr. Kastner said additional analysis of IOP data from close to 100,000 participants revealed no link between calcium channel blocker use and IOP, suggesting that other IOP-independent mechanisms of glaucomatous neurodegeneration may be involved. “These mechanisms may be related to the effects of calcium channel blockers on the vasculature of the optic nerve head,” he said.
Reflections on the research. In an accompanying editorial, Paula Anne Newman-Casey, MD, MS, and Rithambara Ramachandran, MD, at the University of Michigan, Ann Arbor, noted the debate over the use of calcium channel blockers as a potential treatment for normal-tension glaucoma. They also pointed to contradictory evidence over calcium channel blockers’ impact on IOP and open-angle glaucoma. They wrote that analyses of data from publicly funded and publicly available datasets, like the UK Biobank, can provide critical new information as aging global and U.S. demographics lead to rising glaucoma cases—helping ophthalmologists better understand the unintended consequences to eye health of prescription medicines taken by people with multiple chronic conditions.2
Are Rx changes needed? The adverse association of calcium channel blockers with glaucoma should not affect care for most patients, Dr. Kastner said. “However, for patients whose glaucoma is worsening despite a very low IOP, we need to think about other factors playing a role. If those patients are on calcium channel blockers, ophthalmologists should discuss the evidence of our study with them and with their general physician and consider changing their antihypertensives.”
—Miriam Karmel
___________________________
1 Kastner A et al. JAMA Ophthalmol. 2023;141(10):956-964.
2 Newman-Casey PA, Ramachandran R. JAMA Ophthalmol. 2023;141(10):964-965.
___________________________
Relevant financial disclosures: Dr. Kastner—None.
For full disclosures and the disclosure key, see below.
Full Financial Disclosures
Dr. Kastner None.
Dr. Grant None.
Dr. Busik Ceramedix: C.
Dr. Sheheitli None
Dr. Trivizki Carl Zeiss Meditec, Perceive Bio: S; AbbVie, Roche, Bayer: L; Truemed: C.
Disclosure Category
|
Code
|
Description
|
Consultant/Advisor |
C |
Consultant fee, paid advisory boards, or fees for attending a meeting. |
Employee |
E |
Hired to work for compensation or received a W2 from a company. |
Employee, executive role |
EE |
Hired to work in an executive role for compensation or received a W2 from a company. |
Owner of company |
EO |
Ownership or controlling interest in a company, other than stock. |
Independent contractor |
I |
Contracted work, including contracted research. |
Lecture fees/Speakers bureau |
L |
Lecture fees or honoraria, travel fees or reimbursements when speaking at the invitation of a commercial company. |
Patents/Royalty |
P |
Beneficiary of patents and/or royalties for intellectual property. |
Equity/Stock/Stock options holder, private corporation |
PS |
Equity ownership, stock and/or stock options in privately owned firms, excluding mutual funds. |
Grant support |
S |
Grant support or other financial support from all sources, including research support from government agencies (e.g., NIH), foundations, device manufacturers, and\or pharmaceutical companies. Research funding should be disclosed by the principal or named investigator even if your institution receives the grant and manages the funds. |
Stock options, public or private corporation |
SO |
Stock options in a public or private company. |
Equity/Stock holder, public corporation |
US |
Equity ownership or stock in publicly traded firms, excluding mutual funds (listed on the stock exchange). |
|
More from this month’s News in Review