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Daniel Shafiee Kermany, Chelsey Krambeer, Michael Jansen, Jana Waters, Sepehr Bahadorani, Wayne Tie, Michael Singer; Systemic Antihypertensive Use Increases the Incidence of Glaucoma Progression. Invest. Ophthalmol. Vis. Sci. 2017;58(8):730.
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© ARVO (1962-2015); The Authors (2016-present)
A reduction in blood pressure (BP) may reduce ocular perfusion pressure (OPP) which can promote glaucoma progression, especially in those with elevated intraocular pressures (IOP). This study tests the hypothesis that systemic antihypertensive drugs can increase the incidence of glaucoma progression by reducing the OPP.
The data presented is from a 10-year retrospective analysis of an electronic medical record database from Medical Center Ophthalmology Associates in San Antonio, Texas. Glaucoma suspects were isolated and analyzed for diagnosis of disease progression with a chi-squared test of independence and logical regression, controlling for systemic antihypertensive use, hypertension diagnoses, ethnicity, and gender.
Of the 6625 glaucoma suspects on systemic antihypertensives, 2133 (32.2%) showed progression to glaucoma, while of the control group of 1045 glaucoma suspects not on systemic antihypertensives but still diagnosed with hypertension, 245 (23.4%) showed progression (p=1.617e-08). These results show a 37.6% increase in the risk of glaucoma progression for glaucoma suspects on systemic antihypertensives. When controlled for ethnicity and gender, the effect of antihypertensives is still significant (p=1.9e-07), the effect of race is significant (p<0.05), and the effect of gender is insignificant (p=0.919). The differences in progression between the different antihypertensives were not significant, except for beta blockers, which shows a progression rate increase significantly higher than the other drugs (n=5038, p=7.321e-05). See table.
Systemic antihypertensive use was associated with significantly increased risk of glaucoma progression. This increase in risk was consistent among the different classes of antihypertensive drugs. However, beta blockers, which induced vasodilation in addition to lowering heart rate, are correlated with a greater progression rate compared to other antihypertensives which only cause vasodilation. These results suggest that the decrease in BP caused by these systemic drugs may reduce the OPP in glaucoma suspects by increasing the difference between intraocular pressure and ocular perfusion pressure. This may cause glaucoma progression especially since patients are directed to take these drugs before sleep, when the prone body position further increases IOP levels and decreases BP.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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