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Rene Hoehn, Alireza Mirshahi, Andreas Schulz, Philipp Wild, Karl J Lackner, Maria Blettner, Norbert Pfeiffer; Intraocular pressure: Association with blood pressure lowering medication and seasonal variations in the Gutenberg Health Study. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4287.
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To determine associations between intraocular pressure and blood pressure lowering medication, cardiovascular diseases and seasons in an adult European cohort.
The Gutenberg Health Study (GHS) is a population-based, prospective, observational cohort study in the Rhine-Main Region in mid-western Germany with a total of 15,010 participants. Their age range was 35-74 years at enrollment. Participants underwent a standardized protocol including a non-contact tonometry, central corneal thickness measurement and a thorough general examination focused on cardiovascular parameters. Antihypertensives were assessed according to the Anatomical Therapeutic Chemical (ATC) Classification System (C02 - C04, C07 - C09). Participants with missing IOP values, topical IOP-lowering medication, or previous ocular surgery including corneal laser treatment were excluded. Thus, 13,529 participants were included in the analysis. Association analyses with antihypertensives and cardiovascular diseases were performed using a linear regression adjusted by central corneal thickness in ATC groups and a stepwise linear regression model, respectively.
The overall mean IOP (±standard deviation) was 14.2 ±2.8 mm Hg. Higher IOP showed a weak association with the intake of renin-angiotensin system blockers (0.26 mm Hg; P<.0001), but no association was found with beta-blockers, diuretics, peripheral vasodilators, calcium antagonists or other antihypertensives. Higher IOP was associated with diabetes (β= 0.32, P<.001), smoking (β= 0.5, P<.001), and serum cholesterol (β= 0.005, P=0.0021). We found no association between IOP and myocardial infarction, chronic heart failure, peripheral arterial disease, coronary artery disease, atrial fibrillation or stroke. IOP was higher in the winter (14.5 ±2.8 mm Hg) than in the fall (14.2 ±2.7 mm Hg), spring and summer (14.1 ±2.7 mm Hg respectively). The monthly mean IOP was lower from May to October (13.9 - 14.1 mm Hg) than from November to April (14.4 - 14.6 mm Hg).
A positive, but clinically not relevant association was identified between IOP and renin-angiotensin system inhibitors. No association was found with other antihypertensives, in particular not with systemic beta-blocking agents, or cardiovascular diseases. We confirmed seasonal variations in IOP distribution, namely higher mean values between November and April.
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