Lower Diastolic Blood Pressure: A Risk Factor for Faster GCC Rates of Progression in Patients with Moderate to Advanced Glaucoma

Abstract

Purpose : There is scant data in the literature on the association of baseline blood pressure (BP) measures and subsequent structural rates of change in glaucoma. We investigated the influence of various baseline BP measures on change rates of macular ganglion cell complex (GCC) thickness in patients with moderate to advanced glaucoma.

Methods : 105 eyes (105 patients) from the Advanced Glaucoma Progression Study with >4 OCT scans and ≥2 years of follow-up were included. Longitudinal rates of GCC change at superpixels and globally were estimated with a Bayesian hierarchical model with both subject and superpixel-level random effects and residuals. The influence of various baseline BP measures on global GCC rates of change were investigated based on prognostic models adjusting for relevant baseline demographic and clinical measures including gender, ethnicity, age, presence of diabetes, intraocular pressure (IOP), central corneal thickness (CCT), axial length (AL), contrast sensitivity, and 10-2 mean deviation (MD). We report one-sided Bayesian p-values defined as the posterior probability that a given regression coefficient is greater than or less than zero with p<0.025 used to identify statistical significance.

Results : The average (SD) 10-2 visual field (VF) MD of the study cohort was –8.3 (5.3) dB. The average (SD) follow-up time and number of OCT images per eye were 3.6 (0.44) years and 7.4 (1.1). On multivariable analyses, female gender (p=0.003), higher IOP (p=0.013), thicker CCT (p<0.001), shorter AL (p=0.001), higher contrast sensitivity at 12 cycles per degree (p=0.02) and better 10-2 MD (p=0.019) at baseline predicted faster macular GCC deterioration (Table 1). Adjusted for the above covariates, a lower diastolic BP (DBP) at baseline predicted worse GCC rates of change (p<0.001). Parallel multivariable models incorporating various other BP measures at baseline showed that lower diastolic perfusion pressure, lower mean arterial pressure and lower mean arterial perfusion pressure predicted faster GCC rates of change (all p0.001).

Conclusions : Our newly designed hierarchical Bayesian model properly estimates global and regional macular structural rates of change. A decrease in various DBP measures at baseline predicts faster (worse) macular GCC rates of decline in patients with moderate to advanced glaucoma.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.