In glaucoma patients, low blood pressure is accompanied by vascular dysregulation

Abstract

BackgroundThere are many risk factors contributing to glaucomatous optic neuropathy. Beside increased intraocular pressure, vascular factors play a prominent role, particularly low blood pressure (BP), and vascular dysregulation. Both of them are essential components of the Flammer syndrome. The aim of this retrospective study was to evaluate whether in glaucoma patients there is a relationship between vascular dysregulation and the BP.MethodsMedical records of 57 unselected glaucoma patients were retrospectively studied.ResultsBased on the outcome of the capillaroscopy, patients were divided in a group of patients with vascular dysregulation, also called long-stoppers (flow cessation for 13 s or more), and a group of patients with normal vascular regulation, also called short-stoppers (flow cessation for 12 s or less). BP was significantly lower in the group of long-stoppers than in the group of short-stoppers. This applies for both systolic (p = 0.028) and diastolic BP (p = 0.036). The regression analysis revealed also a significant inverse relationship between the duration of blood flow cessation and the systolic (p = 0.025) and diastolic BP (p = 0.016). After adjustment for age, gender, use of antihypertensive therapy, and excluding patients taking calcium channel blockers, the relationship was still significant for systolic (p = 0.025) and diastolic BP (p = 0.003).ConclusionsIn glaucoma patients, vascular dysregulation (as defined by response in the nailfold capillaroscopy to a cold provocation) and low BP are statistically related. This is in line with the observation that Flammer syndrome subjects have both primary vascular dysregulation and low BP and that Flammer syndrome is a risk factor for glaucomatous optic neuropathy, at least in normal tension glaucoma patients. The detection of vascular factors in glaucoma patients may lead to a more efficient treatment, better tailored to the individual patient.

Microcirculatory model predicts blood flow and autoregulation range in the human retina: in vivo investigation with laser speckle flowgraphy

“…More details on this calculation can be found in Supplemental Material S2A (see https://doi.org/10.6084/m9.figshare.12738590.v1). Glaucoma subjects were excluded from this analysis because, in these subjects, perfect AR is less safe as an assumption (12,114).…”

Autonomic Dysfunction and Blood Pressure in Glaucoma Patients: The Lifelines Cohort Study

“…Compared to normal subjects, glaucoma patients exhibit blood flow abnormalities in vessels of the optic nerve head, 18 retina, 18 retrobulbar tissue, 19 and choroid. 18 , 20 , 21 With limited information regarding autonomic dysfunction involvement, several researchers proposed that ocular vessel disturbances are linked to plasma levels of endothelin-1, 22 systemic blood pressure, 23 , 24 and vasospasm. 25 Autonomic function reflects the effect of parasympathetic nervous system activity on the heart.…”

A comprehensive map of disease networks and molecular drug discoveries for glaucoma

“…The analysis of diseases linked to glaucoma genes showed that cardiovascular diseases were most closely associated with glaucoma 50 . Previous research pointed to an abnormal hemorheological pattern in glaucoma patients, with increased plasma viscosity leading to the hypoperfusion of the ophthalmic artery, which can potentially aggravate optic nerve injury 51 . Other research has suggested that peripheral vascular endothelial dysfunction may be related to the progression of glaucoma 52 .…”