Association of Blood Pressure and Retinal Nerve Fiber Layer Rates of Thinning in Patients with Moderate to Advanced Glaucoma

IF 2.8 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma Pub Date : 2025-05-01 DOI:10.1016/j.ogla.2024.12.009

Judy Figueroa BS , Erica Su PhD , Vahid Mohammadzadeh MD , Sajad Besharati MD , Massood Mohammadi MD , Maryam Ashrafkhorasani MD , Simon K. Law MD, PharmD , Anne L. Coleman MD, PhD , Joseph Caprioli MD , Robert E. Weiss PhD , Kouros Nouri-Mahdavi MD, MS

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Abstract

Purpose

To investigate the influence of baseline blood pressure (BP) on retinal nerve fiber layer (RNFL) rates of change (RoCs) in glaucoma patients with central damage or moderate to severe disease.

Design

Prospective cohort study.

Participants

One hundred ten eyes with ≥ 4 RNFL OCT scans and ≥ 2 years of follow-up.

Methods

Global RNFL RoCs were modeled with a Bayesian hierarchical model with subject- and sector-level random effects. Influence of baseline systolic and diastolic BP measures and their interactions with intraocular pressure (IOP) on global RNFL RoCs was investigated in prognostic models adjusting for relevant baseline demographic and clinical measures.

Main Outcome Measures

Magnitude and direction of coefficients for BP, IOP, and their interaction for prediction of global RNFL RoCs. One-sided Bayesian P values denote posterior probability that a regression coefficient is greater than or less than zero, with P < 0.025 or P > 0.975 defining significance.

Results

Average (standard deviation) 24-2 visual field mean deviation (MD) at baseline, follow-up time, and number of OCT scans were −8.8 (6.0) dB, 4.3 (0.5) years, and 8.3 (1.4), respectively. In multivariable analyses, female sex, Hispanic ethnicity (vs. White ethnicity), better baseline 24-2 MD, higher contrast sensitivity at 12 cycles per degree, presence of diabetes, and thicker central cornea predicted faster RNFL thinning. Adjusted for covariates, lower diastolic BP combined with higher IOP predicted faster RNFL RoCs. Parallel multivariable models incorporating systolic BP showed similar effects. Among various BP/IOP combinations, eyes with IOP at the 90th percentile and diastolic (systolic) BP at 10th percentile demonstrated the fastest RNFL thinning rates (−0.554 and −0.539 μm/year).

Conclusions

Low BP and higher IOP at baseline predicted faster (worse) RNFL RoCs in glaucoma patients with central damage or moderate to advanced disease. Although there may be potential benefits to BP management in glaucoma patients, the therapeutic value of BP manipulation in glaucoma patients is yet to be established given the proven benefits of tight BP control in reducing cardiovascular morbidity and mortality.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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中晚期青光眼患者血压与视网膜神经纤维层变薄率的关系

目的：探讨基线血压（BP）对中枢损害或中重度青光眼患者视网膜神经纤维层（RNFL）变化率（RoC）的影响。设计：前瞻性队列研究。参与者：110只眼睛，RNFL光学相干断层扫描≥4次，随访≥2年。方法：采用贝叶斯分层模型对全球RNFL RoC进行建模，并考虑受试者和行业水平的随机效应。在调整相关基线人口统计学和临床测量的预后模型中，研究了基线收缩压和舒张压测量及其与眼内压（IOP）的相互作用对全球RNFL变化率的影响。主要结果和测量：BP、IOP系数的大小和方向，以及它们对预测全球RNFL RoC的相互作用。单侧贝叶斯p值表示回归系数大于或小于零的后验概率，p 0.975定义显著性。结果：基线时平均（SD） 24-2视野平均偏差（MD）、随访时间和OCT扫描次数分别为-8.8 (6.0)dB、4.3（0.5）年和8.3（1.4）年。在多变量分析中，女性、西班牙裔（相对于白人）、较好的基线24-2 MD、每度12周期时较高的对比敏感度、糖尿病的存在和较厚的中央角膜预示着更快的RNFL变薄。调整协变量后，较低的舒张压合并较高的IOP预示着更快的RNFL变化率。合并收缩压的平行多变量模型显示了类似的效果。在各种BP/IOP组合中，IOP为第90百分位和舒张（收缩压）BP为第10百分位的眼睛的RNFL变薄速率最快（-0.554和-0.539 μm/年）。结论：基线时低血压和高IOP预示中枢性损伤或中晚期疾病的青光眼患者RNFL变化率更快（更差）。虽然在青光眼患者中控制血压可能有潜在的好处，但由于严格控制血压在降低心血管发病率和死亡率方面的益处已得到证实，因此控制血压对青光眼患者的治疗价值尚未确定。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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