The Relevance of Arterial Blood Pressure in the Management of Glaucoma Progression: A Systematic Review

Abstract

Background: Glaucoma is one of the leading causes of global blindness and is expected to co-occur more frequently with vascular morbidities in the upcoming years, as both are aging-related diseases. Yet, the pathogenesis of glaucoma is not entirely elucidated and the interplay between intraocular pressure, arterial blood pressure (BP) and ocular perfusion pressure is poorly understood.

Objectives: This systematic review aims to provide clinicians with the latest literature regarding the management of arterial BP in glaucoma patients.

Methods: A systematic search was performed in Medline, Embase, Web of Science and Cochrane Library. Articles written in English assessing the influence of arterial BP and systemic antihypertensive treatment of glaucoma and its management were eligible for inclusion. Additional studies were identified by revising references included in selected articles.

Results: 80 Articles were included in this systemic review. A bimodal relation between BP and glaucoma progression was found. Both high and low BP increase the risk of glaucoma. Glaucoma progression was, possibly via ocular perfusion pressure variation, strongly associated with nocturnal dipping and high variability in the BP over 24 h.

Conclusions: We concluded that systemic BP level associates with glaucomatous damage and provided recommendations for the management and study of arterial BP in glaucoma. Prospective clinical trials are needed to further support these recommendations.

Keywords: 24-h ABPM; blood pressure; blood pressure variability; glaucoma; hypertension; nocturnal dipping.

Figure 1.

Figure of a simplified, individual example of a 24-h ABPM with overlay of recommended BP levels. The recommendations are based on the cited references that are also mentioned in the manuscript text, where the daytime upper limits are derived from the ACA/AHA hypertension guidelines. This includes the daytime systolic optimum between 107 and 130 mm Hg, the daytime diastolic optimum between 63 and 80 mm Hg, the nocturnal MAP Dresden safety range between 65 and 90 mm Hg and the nocturnal diastolic optimum between 60 and 70 mm Hg. High BP variability features in this review as glaucoma progression risk factor, however clear cut-off values have not been put forward yet.^,, This patient exhibits all mentioned risk factors for glaucoma progression except overall nocturnal MAP that is still in the Dresden safety range. These overlays could visually aid the clinician in evaluating 24-h ABPMs. ABPM, ambulatory blood pressure measurement; DBP, diastolic blood pressure; MAP, mean arterial pressure; SBP, systolic blood pressure.