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Editors Selection IGR 7-2

Systemic hypertension and glaucoma

Comment by Selim Orgül on:

12371 Intraocular pressure over the clinical range of blood pressure: blue mountains eye study findings, Mitchell P; Lee AJ; Wang JJ et al., American Journal of Ophthalmology, 2005; 140: 131-132

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The Blue Mountain study, an Australian population-based survey obtained during the years 1992-1994 and evaluating 82.4% of the residents aged 49 and older within a homogenous population, has already provided us with many important findings. One of its strengths resides in clearly traceable criteria used to establish the diagnosis of the addressed conditions. In the present analysis, Mitchell et al. (471) report the results of a comparison between systemic blood pressure and intraocular pressure measured under standardized conditions. A previous analysis of this survey had already shown a strong association between systolic blood pressure and intraocular pressure (Rochtchina et al.: Clin Experiment Ophthalmol 2002). After excluding patients with glaucoma, subjects using ocular hypotensive medications or patients with a history of cataract surgery, the authors noted a span of approximately 3 mmHg excursion in intraocular pressure over a range of systolic BP levels between <110 and >200 mmHg, as well as over a range of diastolic BP levels between <70 and >120 mmHg.

A span of approximately 3 mmHg excursion in intraocular pressure exists over a range of systolic BP levels between <110 and >200 mmHg, as well as over a range of diastolic BP levels between <70 and >120 mmHg

The correlation between systemic blood pressure and intraocular pressure was highly significant, even after adjusting for confounding parameters reported in previous studies. Having excluded the upper part of the spectrum of intraocular pressure readings, the authors were wise in not making pathophysiological conjectures about their findings. However, comparing their findings to data reported for corneal thickness, the authors observe that systemic blood pressure has a similar bearing on intraocular pressure readings as corneal thickness. Is this a veiled message to the readership? Indeed, although the currently known correlations are all interesting from a point of view of pathophysiological considerations, especially in glaucoma, it seems not practical to correct for all the possible factors influencing intraocular pressure readings. We may perhaps be well advised just to consider any pressure level at which glaucomatous damage is progressing as to be too high for the affected eye. Alternatively, factors not related to intraocular pressure may play a role, but this line of thinking has not yet found undisputed acceptance and not enough is known about the therapeutic options.

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