Clinical parameters associated with blood pressure in patients with primary open-angle glaucoma and exfoliation...

Blood pressure (BP) characteristics in different glaucoma subtypes remain unclear. This study investigated the relationship between BP parameters and glaucoma subtypes using electronic medical records (EMR) analyzed by a Bidirectional Encoder Representations from Transformers (BERT)-based system.

We retrospectively analyzed 12,322 visits from 920 patients (590 with primary open-angle glaucoma [POAG] and 330 with exfoliation glaucoma [EXG]) at Shimane University Hospital. EMR data were automatically extracted using a previously validated BERT natural language processing model.

Multivariate analysis showed that systolic BP was significantly associated with age, pulse rate, intraocular pressure (IOP), filtration surgery history, and number of glaucoma medications. Diastolic BP correlated with gender, pulse rate, IOP, glaucoma type, filtration surgery history, and number of glaucoma medications. EXG patients demonstrated significantly lower diastolic BP compared to POAG patients (77.9 mmHg vs. 79.6 mmHg, p < 0.001), while showing higher systolic BP (146.6 mmHg vs. 141.2 mmHg, p < 0.001) and pulse pressure (68.8 mmHg vs. 60.7 mmHg, p < 0.001). However, stratified analyses revealed that these differences were most evident in patients younger than 60 years, whereas in older age groups the differences diminished, suggesting an interaction between disease subtype and age.

The increased BP variability observed in EXG patients may be attributable to systemic manifestations of exfoliation syndrome. Together with the age-stratified findings, these results suggest that both disease subtype and aging influence BP profiles in glaucoma. This study demonstrates the effectiveness of BERT-based EMR analysis while revealing distinct BP characteristics in EXG patients that may reflect underlying vascular pathology.