Higher blood pressure predicts functional glaucoma progression in males with open angle glaucoma

Abstract

Purpose: To examine blood pressure, ocular perfusion pressure and functional disease progression in patients with open-angle glaucoma (OAG) over a 5-year period.

Methods: 111 OAG patients (Mean age 65 yr; 43 male, 68 female) were assessed for intraocular pressure (IOP), systolic blood pressure (SBP), mean arterial pressure (MAP), systolic perfusion pressure (SPP), diastolic perfusion pressure (DPP), ocular perfusion pressure (OPP), mean perfusion pressure (MPP) and functional glaucoma progression with Humphrey Visual field every 6 months over 5 years. 74 patients (Mean age 70 yr; 30 male, 44 female) were assessed at 5-year follow-up. Functional progression was defined as two consecutive visits with mean deviation decrease ≥2 and/or Advanced Glaucoma Intervention Study score increase ≥2 compared to baseline. Mixed-model ANCOVA was used to test for significant change from baseline to 5-year follow-up. Time to progression was analyzed using Cox proportional hazards models. Interactions were tested to determine if the effects of the factors on progression time differed by sex.

Results: In male and female OAG patients over 5 years, IOP, blood pressures and perfusion pressures all decreased (p<0.05). In males and females, respectively, IOP was 17 mmHg (95% CI 15-18) and 17 mmHg (15-18) at baseline and 16 mmHg (14-18) and 15 mmHg (13-16) at 5 years. SBP was 136 mmHg (130-142) and 135 mmHg (129-141) at baseline and 130 mmHg (123-137) and 129 mmHg (122-135) at 5 years. DBP was 82 mmHg (78-86) and 84 mmHg (80-87) at baseline and 79 mmHg (74-83) and 84 mmHg (80-87) at 5 years. MAP was 100 mmHg (96-104) and 101 mmHg (97-105) at baseline and 96 mmHg (91-100) and 94 mmHg (90-98) at 5 years. Higher SBP, DBP, MAP, SPP, DPP, OPP and MPP were all associated with shorter time to functional progression in males (p≤0.01) but not in females, leading to a significant sex difference (p≤0.02).

Conclusions: Higher blood pressure was predictive of glaucomatous functional progression in males but not in females. These data suggest that vascular factors may play a different role in the functional progression of the disease according to sex.