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Long-Term Blood Pressure Variability and Visual Field Progression in Glaucoma
Vincent Q Pham1, Takashi Nishida1, Sasan Moghimi1
1Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California, San Diego, La Jolla.
JAMA Ophthalmology
|November 14, 2024
Summary
Long-term blood pressure variability is linked to faster visual field progression in glaucoma patients. This suggests blood pressure fluctuations may influence how intraocular pressure affects glaucoma progression.
Area of Science:
- Ophthalmology
- Cardiology
- Public Health
Background:
- Glaucoma is a leading cause of irreversible blindness worldwide.
- Visual field (VF) progression is a key indicator of glaucoma severity and impact.
- The role of systemic factors, such as blood pressure, in glaucoma progression is an area of active research.
Purpose of the Study:
- To investigate the association between blood pressure parameters and the rate of visual field progression in patients with glaucoma.
- To determine if blood pressure variability modifies the relationship between intraocular pressure and visual field loss.
Main Methods:
- Retrospective cohort study utilizing longitudinal data from two large glaucoma studies.
- Included patients with suspected or confirmed glaucoma who underwent regular blood pressure and visual field testing.
- Multivariable mixed-effects models were used to analyze the association between blood pressure parameters (mean and standard deviation) and visual field mean deviation loss, controlling for intraocular pressure.
Main Results:
- Higher mean blood pressure and higher standard deviation of blood pressure were significantly associated with faster rates of visual field mean deviation loss.
- An interaction was observed where higher blood pressure variability exacerbated the effect of intraocular pressure on visual field progression.
- These associations were significant for both mean arterial pressure and diastolic arterial pressure.
Conclusions:
- Long-term blood pressure variability, characterized by both higher mean levels and greater fluctuation, is associated with accelerated visual field progression in glaucoma.
- Blood pressure variability may act as a crucial modifier in the pathogenesis of glaucoma, influencing the impact of intraocular pressure on optic nerve damage.
- These findings underscore the importance of monitoring and managing blood pressure in glaucoma patients to potentially slow disease progression.
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