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Editors Selection IGR 14-1

Risk factors: Incidence OAG and antihypertensives

Comment by Joel Schuman on:

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

See also comment(s) by Ivan Goldberg •

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Müskens et al. (1411) report on an investigation of the relationship of antihypertensive medications and incident open angle glaucoma. The authors used a prospective population based data set, the Rotterdam Study. In their words, 'The Rotterdam Study is a prospective population-based cohort study of individuals aged 55 years and older living in the Ommoord district of Rotterdam […] Of the original eligible cohort of 10,275 individuals, 7983 persons (78%) participated in the study. For the present study, a subset of 3842 participants was used for whom ophthalmologic examination data at baseline and follow-up were available. Mean follow-up time was 6.5 years (range, 5.0‐9.4 years).' The authors investigated six classes of systemic antihypertensive medications, including low or high ceiling diuretics, beta-blockers, calcium channel blockers, angiotensin converting enzyme inhibitors, and angiotensin II antagonists. They used records from seven pharmacies in the Ommoord region, which are all tied to a single computer network to register all prescriptions from January 1, 1991 through the present. Eye examinations were performed in a standardized routine fashion.

This study does not support the avoidance of beta-blockers or diuretics in glaucoma or the use of calcium channel blockers for the treatment of glaucoma

While none of the systemic antihypertensive drugs were associated with incident open angle glaucoma using univariate analysis, using multivariate analysis the authors found that calcium channel blockers were associated with a statistically significantly increased risk of incident glaucoma (OR 1.8, 95%CI 1.04-3.2, p = 0.037). There was a trend for the use of systemic beta-blockers to be protective, but this did not reach statistical significance even in the multivariate analysis. The strongest risk factors were age (per year OR 1.1, 95% CI 1.02‐1.08, p = 0.001) and the use of glaucoma medications (OR 4.8, 95% CI 2.2‐10.4, p = 0.001). As in previous studies, there was a statistically significant effect for IOP increasing the odds ratio by 10% per mmHg, and as stated above, the odds ratio for incident glaucoma was increased by 10% per year of age as well.

This study does not support the avoidance of beta-blockers or diuretics in glaucoma or the use of calcium channel blockers for the treatment of glaucoma. With regard to calcium channel blockers it is possible that there was a selection bias by physicians treating the subjects with systemic hypertension. A viable hypothesis might be that calcium channel blockers were chosen as the particular anti-hypertensive agent due to the presence of vasospasm, a condition also associated with glaucoma. In this case the glaucoma would be associated with calcium channel blockers only in that the drug was being used to treat a glaucoma risk factor, and the calcium channel blockers would not be causally related to incident glaucoma. This is a strong population based prospective study with excellent and complete data. The fact that age and intraocular pressure showed odds ratios similar to those seen in other incident glaucoma studies testifies to the consistency of this study with previous work in other populations. The fact that systemic antihypertensive agents were so weakly related to incident glaucoma is encouraging in terms of the treatment of systemic hypertension being unlikely to interact in a meaningful way with regard to the development of glaucoma.

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