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Abstract #3525 Published in IGR 4-2
Incident open-angle glaucoma and blood pressure
Leske MC; Wu SY; Nemesure B; Hennis AArchives of Ophthalmology 2002; 120: 954-959
BACKGROUND: The risk of open-angle glaucoma (OAG) may be related to low blood pressure (BP) relative to intraocular pressure (IOP), i.e., to low perfusion pressure (PP). Alternatively, systemic hypertension may increase OAG risk. OBJECTIVE: To clarify these possible relationships by evaluating hypertension and PP (where PP = BP - IOP) as risk factors for incident OAG in a black population. DESIGN: Population-based cohort study (85% participation); simple random sample of residents of Barbados, West Indies, aged 40 years and older. PARTICIPANTS: Two thousand nine hundred and eighty-nine black participants at risk; 67 developed OAG after 4 years (2.2% incidence). MAIN OUTCOME MEASURE: Adjusted relative risk (RR) of OAG from logistic regression analyses. RESULTS: The four-year risk increased markedly with baseline IOP. With an IOP less than or equal to 17 mmHg, incidence was 0.7%, increasing to 18.3% with IOP greater than 25 mmHg, for a 25-fold increase in RR. However, OAG developed throughout the IOP range and two thirds of incident cases had baseline IOP less than 25 mmHg. Baseline hypertension was associated with a halving of the RR of OAG (RR, 0.49; 95% confidence interval [CI], 0.29-0.85); the RR also tended to decrease as systolic BP increased (p = 0.07). Consistent with these findings, a lower baseline PP increased RR (systolic PP < 101 mmHg, 2.6 (95% CI, 1.3-4.9); diastolic PP < 55 mmHg, 3.2 [95% CI, 1.6-6.6]; mean PP < 42 mmHg, 3.1 (95% CI, 1.6-6.0)). CONCLUSIONS: As baseline IOP increased, the risk of OAG substantially increased. In contrast, persons with systemic hypertension at baseline had half the RR, suggesting that hypertension does not increase (and may decrease) the four-year risk of OAG. Lower PP at baseline increased RR approximately three-fold, a result consistent with the vascular hypothesis of OAG pathogenesis.
Dr. M.C. Leske, Department of Preventive Medicine, School of Medicine, University of New York at Stony Brook, L3 HSC Room 086, Stony Brook, NY 11794-8036, USA. cleske@notes.cc.sunysb.edu
Classification:
9.2.2 Other risk factors for glaucoma (Part of: 9 Clinical forms of glaucomas > 9.2 Primary open angle glaucomas)
