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Editors Selection IGR 7-1

Bloodflow: Treated systemic hypertension and progression

Comment by George Cioffi on:

16822 Does treated systemic hypertension affect progression of optic nerve damage in glaucoma suspects?, Punjabi OS; Stamper RL; Bostrom AG et al., Current Eye Research, 2007; 32: 153-160

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Punjabi et al. (64) seeks to answer a long-standing question related to the care of glaucoma patients; does the treatment of systemic hypertension alter glaucomatous progression? In this retrospective analysis of more than 100 patients suspected of having glaucoma, comparisons between individuals treated for high blood pressure and those without systemic hypertension were drawn. Therefore, the first point that the authors correctly make is that this is not an analysis to establish the benefit of treating systemic hypertension. The aim of this study is to see if the co-morbidity of systemic hypertension (in this case treated) represents a risk factor for progressive glaucoma. The authors chose various HRT parameters followed over at least a 4-year period to monitor the relative stability of the optic nerve structure. HRT change was assessed using regression modeling of the slopes of the plotted HRT parameters over time in the two groups.

While acknowledging the shortcomings of a retrospective cohort study, the authors found that treated systemic hypertension was a risk factor for progressive optic nerve cupping and retinal nerve fiber layer loss over time.

Cardiovascular disease and glaucoma are almost certainly intertwined

This finding does not advocate for or against the treatment of systemic hypertension, but instead begs the question, is the apparent progression due to the treatment or the disease? Moreover, we should ask if anti-hypertensive medications affect the HRT parameters in some way unrelated to the actual progression of glaucoma. Finally, with larger sample sizes, we may also be able to examine the individual classes of high blood pressure medications and their effects on the optic nerve. There, of course, is no way to answer all of these questions with the present data, but the finding once again points to how little we know about the relationship of systemic hypertension and glaucoma. The authors are commended for adding to our knowledge of the potential relationships between these diseases. The relative contribution of ocular bloodflow parameters to the health of the optic nerve remains evasive, but we are slowly understanding that systemic cardiovascular disease and glaucoma are almost certainly intertwined.

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