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  • High Blood and Pulse Pressures Raise Risk of POAG

    By Lynda Seminara
    Selected by Prem S. Subramanian, MD, PhD
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    Journal Highlights

    Investigative Ophthalmology & Visual Science
    2022;63(13):3

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    IOP remains the only modifiable factor to slow progression of primary open-angle glaucoma (POAG), but the relationship between blood pressure (BP) and POAG is not well understood. Most evidence of a possible link between BP and POAG is from cross-sectional research, but only a few studies demon­strated a significant correlation. Mean arterial pressure (MAP) was included in some investigations, but the for­mulas differed. Pulse pressure (PP) is rarely examined, despite its link to cardiovascular disease and death. Macri et al. looked at the strength and shape of associations between incident POAG and systolic BP, diastolic BP, MAP, and PP. They found that high systolic BP and PP raised the risk of POAG.

    This prospective study involved 484,268 people listed in the U.K. Biobank who did not have glaucoma at the time of enrollment. Incident POAG events were documented at assessment visits, during in-patient hospital ad­missions, and from primary care data. Repeated measurements of systolic and diastolic BP, MAP, and PP were analyzed as time-varying covariables. All parameters were modeled as both categorical and continuous nonlinear variables. Both univariate and multi­variate assessments were conducted. The primary outcome measure was the relative hazard ratio (HR) for incident POAG.

    During the 5,715,480 person-years of follow-up (median, 12.08 years), there were 2,390 incident POAG events. Multivariable analyses demonstrated that relative to normal systolic BP and PP (systolic BP, 120-130 mm Hg; PP, 40-50 mm Hg), higher levels of each increased the likelihood of incident POAG (linear trends: p = .038 for systolic BP, p < .001 for PP). The HR for incident POAG was 1.16 points higher for systolic BP in the range of 130 to 150 mm Hg. The ratio was 1.13 points higher when PP exceeded 70 mm Hg. In multivariable models, there was no significant relationship between incident glaucoma and diastolic BP or MAP. The findings were similar for univariate analyses and for BP modeled as continuous variables.

    These results suggest that among the BP parameters explored in this study, systolic BP and PP appear to be the most relevant to glaucoma risk. “The varied prognostic significance of these differing BP parameters appears to mirror that seen for systemic cardiovas­cular risk in older patients,” said the au­thors; this lends support to a potential role for systemic vascular dysfunction in the pathogenesis of POAG. Although the findings warrant further investi­gation, the authors noted that systolic hypertension may have potential as a modifiable risk factor for POAG.

    The original article can be found here.