Blood pressure and glaucoma

The possible correlation between glaucoma progression and blood pressure peaks is an interesting clinical issue, with significant consequences on patient management both from a cardiological and ocular perspective.

This sensitive topic was the subject of a recent retrospective cohort study, Long-Term Blood Pressure Variability and Visual Field Progression in Glaucoma.

Researchers from the Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute at the University of California (San Diego), led by Prof. Vincent Q. Pham. Pham, first highlighted how the correlation between blood pressure and ocular pressure has been studied before, establishing that altered self-regulation of the vasculature, especially at the optic nerve papilla, is a risk factor for glaucoma progression. However, whether these vascular changes are a cause or a consequence of glaucomatous pathology has not been fully clarified to date.

In the cohort study, published in November 2024, 985 patients with an average age of 61.2 years were enrolled, with a total of 1,674 eyes under observation. The pressure data collected were incorporated into multiple variable models to study the association of arterial blood pressure parameters, both systolic and diastolic, with mean intraocular pressure, correlating these changes with visual field losses.

The conclusion was that higher mean blood pressure levels and a higher standard deviation (SD) were associated with a more rapid progression of visual field damage in glaucomatous patients.

A study from 2023, Association of Blood Pressure With Rates of Macular Ganglion Cell Complex Thinning in Patients With Glaucoma, had already reported evidence of a correlation between baseline blood pressure values and the percentage of macular ganglion cell complex (GCC) thinning. 105 eyes of 105 patients with moderate to advanced glaucoma were observed and it was found that lower diastolic blood pressure at baseline was associated with faster thinning of the macular ganglion cell complex (GCC). This association was more pronounced at higher intraocular pressure levels.

The resulting indication is that diastolic blood pressure management could be considered among the therapeutic approaches in glaucomatous patients. Ophthalmologist and cardiologist should jointly perform a cardiovascular risk assessment and identify the optimal target blood pressure, both diastolic and systolic, to try to achieve.

There are multiple studies in the literature documenting the association between vascular risk factors, blood pressure and glaucoma pathogenesis. This association is of particular importance in patients with normal tension glaucoma.

The Collaborative Normal-Tension Glaucoma Study demonstrated the impact on glaucoma progression of vascular risk factors such as migraine or ocular haemorrhage.

The Low-Pressure Glaucoma Treatment Study also demonstrated that the use of systemic antihypertensive drugs can be a risk factor for the progression of visual field damage. Therefore, avoiding over-treatment of systemic hypertension seems to be an appropriate choice in patients at risk of glaucoma or with already diagnosed disease.

On the subject of glaucoma, see also:

• Systemic Diseases and the Risk of Glaucoma? - Italian Ophthalmologist
• Oestrogen and glaucoma - Oculist Italiano
• Glaucoma: the frontiers of research - Oculista Italiano

• Pham VQ, Nishida T, Moghimi S, et al. Long-Term Blood Pressure Variability and Visual Field Progression in Glaucoma. JAMA Ophthalmol. 2024 Nov 14:e244868. doi: 10.1001/jamaophthalmol.2024.4868. Epub ahead of print. PMID: 39541129; PMCID: PMC11565290.
• Mohammadzadeh V, Su E, Mohammadi M, Law SK, et al. Association of Blood Pressure With Rates of Macular Ganglion Cell Complex Thinning in Patients With Glaucoma. JAMA Ophthalmol. 2023 Mar 1;141(3):251-257. doi: 10.1001/jamaophthalmol.2022.6092. PMID: 36757702; PMCID: PMC9912170.
• De Moraes CG, Liebmann JM, Greenfield DS, et al; Low-pressure Glaucoma Treatment Study Group. Risk factors for visual field progression in the low-pressure glaucoma treatment study. Am J Ophthalmol. 2012;154(4):702-711. doi: 10.1016/j.ajo.2012.04.015