Abstract
Purpose :
We recently demonstrated that baseline diastolic blood pressure (BP) and its interaction with intraocular pressure (IOP) were predictors of macular ganglion cell complex rates of change in a cohort of patients with moderate to severe glaucoma. We further investigated the role of baseline BP measures on rates of change of retinal nerve fiber layer (RNFL) thickness in the same cohort.
Methods :
94 eyes (94 patients) from the Advanced Glaucoma Progression Study with ≥ 4 RNFL OCT scans and ≥2 years of follow-up were included. RNFL rates of change at 12 clock-hour sectors and globally were estimated with a Bayesian hierarchical model with both subject and sector-level random effects and residuals. The influence of systolic and diastolic baseline BP measures on global RNFL rates of change was investigated in prognostic models adjusting for relevant baseline demographic and clinical measures including gender, race, age, presence of diabetes or hypertension, treatment of hypertension, IOP, central corneal thickness (CCT), axial length, contrast sensitivity, and 24-2 mean deviation (MD). We report one-sided Bayesian p-values 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 :
Average (SD) 24-2 visual field MD, follow-up time, and the number of OCT images per eye in the study cohort were –8.50 (5.6) dB, 4.3 (0.5) years, and 8.3 (1.4) images, respectively. On multivariable analyses, female sex (p=0.007), Hispanic or Asian race (p<0.001), higher IOP (p<0.001), higher contrast sensitivity at 12 cpd (p=0.005), presence of diabetes (p=0.017), and thicker CCT (p=0.021) predicted faster RNFL thinning (Table). Adjusted for the above covariates, the combined influence of lower diastolic BP (DBP) and higher IOP at baseline predicted faster RNFL rates of change (p<0.001). Parallel multivariable models incorporating systolic BP measures at baseline failed to show a significant effect.
Conclusions :
A combination of lower diastolic blood pressure and higher IOP at baseline predicted faster (worse) RNFL rates of decay in patients with moderate to advanced glaucoma. These findings are consistent with those from prognostic models based on macular structural rates of change and confirm the role of baseline diastolic BP on subsequent structural progression.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.