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Editors Selection IGR 9-4

Risk factors: Incidence OAG and antihypertensives

Comment by Ivan Goldberg on:

19997 Systemic antihypertensive medication and incident open-angle glaucoma, Müskens RP; de Voogd S; Wolfs RC et al., Ophthalmology, 2007; 114: 2221-2226

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Müskens et al. (1411) performed a prospective, population-based stu dy which assessed a subset of sub-jects within the Rotterdam Study for an association of systemic anti-hypertensives with the development of open-angle glaucoma (iOAG). Subjects aged 55 years and over, using systemic anti-hypertensive medications were reviewed after an average 6.5 (5.0-9.4) years. This cohort was affected by death (19%) and refusal for second assessment (22%). Use of systemic anti-hypertensive agents was with a fully automated pharmaceutical data collection system. Possible association was adjusted for age, gender, duration of tre-atment, intra-ocular pressure (IOP) levels, and ocular hypotensive therapy, as well as for the presence and severity of hypertension and cardiovascular diseases. Of 3842 participants, 87 developed open-angle glaucoma. This relatively small number handicaps the power of sub-analyses for specific classes of anti-hypertensive agents. Compared with no OAG subjects, OAG patients had higher baseline IOP, and were older. There was a weakly statistically significant increased Odds Ratio (OR) of iOAG and calcium channel blocker use (1.8: 1.04 ‐ 3.2, P = 0.037), while beta-blockers (BBs) showed a mild reduction in OR (0.6: 0.3 ‐ 1.02, P = 0.06), and diuretics and angiotensin-converting enzyme inhibitors showed no association. As the authors discuss, it is far from clear what these results mean for the doctors treating patients with glaucoma and hypertension. Have the results been biased by patient selection for calcium-channel blockers (CCBs) by their generalists? Would patients with so-called vasospastic syndromes (migraine, Raynaud's phenomenon) benefit from the vasodilation effects of CCBs, but others be disadvantaged by the blood pressure reduction-induced fall in optic nerve head perfusion pressure? The study did not report on these conditions. Are BBs apparently "protective" because they also reduce IOP? Intriguing as these results are, based on them, no fi rm recommendations can be made to clinicians treating patients with open-angle glaucoma and systemic hypertension. Additional research is needed.

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