Antihypertensive Medication Postpones the Onset of Glaucoma

Abstract

G laucoma is the second most common irreversible cause of blindness worldwide.1 It is becoming increasingly important in the context of an aging world population.1,2 It possesses a considerable challenge to public health because blindness and visual impairment is costly and have a huge impact on life quality. 3 Raised intraocular pressure (IOP) remains the only successful treatable factor to reduce the progression of glaucoma. Yet, glaucoma is multifactorial, and the understanding of the pathology is incomplete. More than 2 decades ago, the first study to suggest that blood pressure (BP) should be considered in glaucoma treatment was published. 4 Since then, the impact of BP on glaucoma has received greater attention as more evidence has mounted. [5][6][7] Despite the increasing evidence of an association between BP and glaucoma, the exact relationship is complex. In this matter, epidemiological and case-control studies have shown diverse results, and some studies have presented evidence of a correlation between high BP and glaucoma, [5][6][7][8][9][10][11] whereas other studies have linked glaucoma and low-tension glaucoma with low BP.12-17 The controversies have been discussed and related to the complexity of BP not only influencing IOP and ocular perfusion pressure, but also increasing the risk of compromised peripheral vascular capacity and a dysfunctional autoregulation. 5,[17][18][19] Recognized high BP is treated with many different antihypertensive medications, and growing evidence acknowledges that such treatment is associated with glaucoma. [20][21][22] In this matter, antihypertensive medication may conflict with ocular perfusion and autoregulation. 20,23 Although studies have shown a correlation between antihypertensive treatment and glaucoma, these studies have mostly been trials in small numbers of patients with minimal follow-up periods. 1,14,24 Moreover, to the best of our knowledge, no previous study has benefited from a complete data sample from an entire population norimportantly-estimated the causal effect of antihypertensive treatment on the risk of developing glaucoma.The main outcome in our study is the treatment for glaucoma. We hypothesized, before embarking on the empirical analysis, that treatment with antihypertensive medication could have an ambiguous effect on the development Abstract-The aim was to investigate the impact of antihypertensive medication on the onset of glaucoma. Data from the complete Danish population between 40 and 95 years of age were used in the period from 1996 to 2012, covering >2.6 million individuals. The National Danish Registry of Medicinal Products Statistics was used to identify all claimed prescriptions for glaucoma medication and antihypertensive drugs. We first investigated basic correlations in the data and found that patients treated with antihypertensive medication, at any time during the study period, had a significantly higher overall relative risk (RR) of glaucoma, even when controlling for age and sex (with a RR of 1.31 and P<0.0001). Furthermor...

Systemic Medication Associations with Presumed Advanced or Uncontrolled Primary Open-Angle Glaucoma

“…36 A registry database study from Denmark recently reported a positive association between antihypertensive medication and glaucoma overall, but a protective association of antihypertensive medication on the development of newly diagnosed glaucoma. 37 This study defined glaucoma by the use of any glaucoma medication, and therefore it is unclear whether the associations reported were driven by POAG, ocular hypertension, or other forms of glaucoma, such as angleclosure glaucoma or some of the secondary glaucomas. For example, it may be that antihypertensive treatment reduces the incidence of retinal vein occlusion and diabetic retinopathy, thereby reducing the risk of neovascular glaucoma.…”

U-shaped effect of blood pressure on structural OCT metrics and retinal blood flow autoregulation in ophthalmologically healthy subjects

“…20 The confounding contribution of individual antihypertensive medications, whether neuroprotective or detrimental, remains inconclusive. [21][22][23][24][25] We would like to stress here that, since there are benefits to intensive BP control with regards to cardiovascular disease, our results should not be considered as a case for milder treatment of AHT in general. 51,52 However, since a J or U-shaped effect is reported in both fields when intensive treatment becomes too intensive, our results could be a starting point for discussion with cardiologists in individual cases where, for example, glaucoma continues to deteriorate despite adequate IOP control.…”

“…17,18 On the other hand, while arterial hypertension (AHT) is also frequently reported as a risk factor for glaucoma, conflicting results exist on whether BP reduction exacerbates or protects from GON, possibly depending on individual medication effects and on how aggressive the treatment strategy is. [19][20][21][22][23][24][25][26] . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.…”

Blood pressure and glaucoma: At the crossroads between cardiology and ophthalmology

“…Thessaloniki Eye Study showed that treatment with antihypertensive drugs, adjusted for a level of blood pressure, is associated with a more pronounced progression of glaucoma [26]. In contrast, Horwitz et al [11] proves that although systemic hypertension is associated with an increased prevalence of glaucoma, onset of the optic nerve neuropathy is delayed by an intake of antihypertensive drugs.…”

“…The Blue Mountains Eye Study suggested that hypertension itself might be a risk factor for glaucoma, regardless of ABP and IOP correlation [9]. Additionally, data from the British General Practitioner Research Database and studies by Horwitz et al suggest that patients with glaucoma are more often diagnosed with hypertension than the general population [10,11].…”