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. 2022 Mar;129(3):276-284.
doi: 10.1016/j.ophtha.2021.10.018. Epub 2021 Oct 22.

The Association among Blood Pressure, Blood Pressure Medications, and Glaucoma in a Nationwide Electronic Health Records Database

Eric B Lee  1 , Wendeng Hu  1 , Kuldev Singh  1 , Sophia Y Wang  2
Affiliations

The Association among Blood Pressure, Blood Pressure Medications, and Glaucoma in a Nationwide Electronic Health Records Database

Eric B Lee et al. Ophthalmology. 2022 Mar.

Abstract

Purpose: To measure the association among blood pressure (BP), BP medications, and glaucoma using the All of Us Research Program database.

Design: A retrospective, longitudinal cohort study leveraging a national electronic health record (EHR) database administered by the National Institutes of Health.

Participants: Eye patients in the All of Us Research Program database with at least 15 months of follow-up and 1 BP measurement.

Methods: Univariable and multivariable Cox regression models predicted the risk of developing incident open-angle glaucoma (OAG). Mean arterial pressure (MAP) and the number of BP medication classes were entered as time-varying predictors to account for changes over time.

Main outcome measures: The risk of developing incident OAG, as defined by billing diagnosis codes.

Results: Of 20 815 eligible eye patients who qualified for this study, 462 developed OAG. Low BP (MAP < 83.0 mmHg) was associated with increased risk of developing OAG (hazard ratio [HR], 1.32; 95% confidence interval [CI], 1.04-1.67). High BP (MAP > 101.3 mmHg) and the number of BP medication classes were not associated with OAG after adjustment for covariates. Other risk factors associated with OAG included being Black (HR, 3.31, 95% CI, 2.63-4.17), Hispanic or Latino (HR, 2.53, 95% CI, 1.94-3.28), Asian (HR, 2.22, 95% CI, 1.24-3.97), older in age (80+ years, HR, 20.1, 95% CI, 9.10-44.5), and diabetic (HR, 1.32, 95% CI, 1.04-1.67). Female gender was associated with decreased hazard of developing OAG (HR, 0.66, 95% CI, 0.55-0.80). No significant interaction was observed between MAP and the number of BP medications on the risk of developing OAG.

Conclusions: We found that low BP is associated with increased risk of developing OAG in a national longitudinal EHR database. We did not find evidence supporting a differential effect of medically treated and untreated low BP. This study adds to the body of literature implicating vascular dysregulation as a potential etiology for the development of OAG, particularly emphasizing the lack of influence of BP medications on this relationship.

Keywords: Blood pressure; Blood pressure medications; Electronic health records; Glaucoma; Risk factors.

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Conflict of interest statement

Conflict of Interest: No conflicting relationship exists for any author.

Figures

Figure 1:
Figure 1:
Flow chart illustrating the cohort inclusion and exclusion criteria
See this image and copyright information in PMC

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