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. 2023 Mar 1;141(3):251-257.
doi: 10.1001/jamaophthalmol.2022.6092.

Association of Blood Pressure With Rates of Macular Ganglion Cell Complex Thinning in Patients With Glaucoma

Vahid Mohammadzadeh  1 , Erica Su  2 , Massood Mohammadi  1 , Simon K Law  1 , Anne L Coleman  1 , Joseph Caprioli  1 , Robert E Weiss  2 , Kouros Nouri-Mahdavi  1
Affiliations

Association of Blood Pressure With Rates of Macular Ganglion Cell Complex Thinning in Patients With Glaucoma

Vahid Mohammadzadeh et al. JAMA Ophthalmol. .

Abstract

Importance: There are scarce data on the association of blood pressure measures with subsequent macular structural rates of change in patients with glaucoma.

Objective: To investigate the association of baseline blood pressure measures with rates of change of the macular ganglion cell complex in patients with central or moderate to advanced glaucoma damage at baseline.

Design, setting, and participants: This prospective cohort study, conducted from August 2021 to August 2022, used data from patients in the Advanced Glaucoma Progression Study at the University of California, Los Angeles. Participants were between 39 and 80 years of age and had more than 4 macular imaging tests and 2 or more years of follow-up.

Exposures: A diagnosis of glaucoma with either central damage or a visual field mean deviation worse than -6 dB.

Main outcomes and measures: The main outcome was the association of blood pressure measures with ganglion cell complex rates of change. Macular ganglion cell complex thickness rates of change were estimated with a bayesian hierarchical model. This model included relevant demographic and clinical factors. Blood pressure measures, intraocular pressure, and their interactions were added to the model to assess the association of baseline blood pressure measures with global ganglion cell complex rates of change.

Results: The cohort included 105 eyes from 105 participants. The mean (SD) age, 10-2 visual field mean deviation, and follow-up time were 66.9 (8.5) years, -8.3 (5.3) dB, and 3.6 (0.4) years, respectively, and 67 patients (63.8%) were female. The racial and ethnic makeup of the cohort was 15 African American (14.3%), 23 Asian (21.9%), 12 Hispanic (11.4%), and 55 White (52.4%) individuals based on patient self-report. In multivariable analyses, female sex, history of taking blood pressure medications, higher intraocular pressure, thicker central corneal thickness, shorter axial length, higher contrast sensitivity at 12 cycles per degree, and higher baseline 10-2 visual field mean deviation were associated with faster ganglion cell complex thinning. Lower diastolic blood pressure was associated with faster rates of ganglion cell complex thinning at higher intraocular pressures. For intraocular pressures of 8 and of 16 mm Hg (10% and 90% quantiles, respectively), every 10 mm Hg-lower increment of diastolic blood pressure was associated with 0.011 μm/y slower and -0.130 μm/y faster rates of ganglion cell complex thinning, respectively.

Conclusions and relevance: In this cohort study, a combination of lower diastolic blood pressure and higher intraocular pressure at baseline was associated with faster rates of ganglion cell complex thinning. These findings support consideration of evaluating and addressing diastolic blood pressure as a therapeutic measure in patients with glaucoma if supported by appropriate clinical trials.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Caprioli reported receiving grants from the Simms/Mann Family Foundation, the Payden Memorial Foundation, and Research to Prevent Blindness during the conduct of the study. Dr Weiss reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study. Dr Nouri-Mahdavi reported receiving grants from Heidelberg Engineering outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Posterior Mean Ganglion Cell Complex (GCC) Thickness Over Time for 4 Combinations of Low or High Diastolic Blood Pressure (DBP) and Low or High Intraocular Pressure (IOP)
Low DBP was 70 mm Hg (10% quantile) and high DBP, 94 mm Hg (90% quantile); low IOP was 16 mm Hg (90% quantile) and high IOP, 8 mm Hg (10% quantile). Other continuous covariates were set to their mean values, and categorical covariates were set to their reference categories.
Figure 2.
Figure 2.. Heat Map of Posterior Mean Ganglion Cell Complex Slope as a Function of Diastolic Blood Pressure (DBP) and Intraocular Pressure (IOP) With Other Continuous Covariates Set to Their Mean Values and Categorical Covariates Set to Their Reference Categories
Dots indicate the unique values of IOP and DBP.
See this image and copyright information in PMC

Comment in

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