Relationship between Blood Pressure and Rates of Glaucomatous Visual Field Progression: The Vascular Imaging in Glaucoma Study

Abstract

Purpose: To examine the relationship between systemic arterial blood pressure (BP) and the rate of change in standard automated perimetry (SAP) in eyes with glaucoma and suspected glaucoma.

Design: Prospective cohort study.

Participants: One hundred twenty-four eyes (91 eyes with glaucoma, 33 eyes with suspected glaucoma) of 64 patients (mean age, 68.4 ± 7.6 years) followed up at the Bascom Palmer Eye Institute, Palm Beach Gardens, Florida.

Methods: Participants underwent ophthalmic examination, BP measurement, and SAP at 4-month intervals. At the baseline visit, 24-hour ambulatory blood pressure monitoring (ABPM) was acquired. Linear mixed models (adjusted for inclusion of both eyes, age, sex, race, intraocular pressure, baseline severity, and central corneal thickness) were used to investigate the effect of BP on the rates of SAP mean deviation (MD) change over time.

Main outcome measures: Effect of baseline 24-hour and follow-up mean arterial pressure (MAP), systolic BP (SBP), and diastolic BP on change in SAP MD.

Results: Eyes underwent an average of 8.9 ± 1.5 SAP examinations over 28.3 ± 6.0 months of follow-up. The median rate of MD change was 0.14 dB/year (range, -1.21 to 0.96 dB/year) with 9 eyes (7%) showing moderate to fast progression (MD change, ≤ -0.50 dB/year). Each 10 mmHg lower in 24-hour average MAP and SBP were associated with -0.171 dB/year (P = 0.045) and -0.137 dB/year (P = 0.023) faster rates of MD loss. Lower mean SBP during follow-up was associated significantly (P = 0.003) with MD progression.

Conclusions: Lower baseline 24-hour ABPM measurements, as well as low SBP during follow-up, were associated significantly with faster rates of glaucomatous SAP progression and may be used as a predictor of risk of glaucomatous progression.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Keywords: Blood pressure; Glaucoma; Glaucoma progression; Optic nerve; Visual field.