Effect of Blood Pressure on Rates of Progression in Focal Ischemic vs. Generalized Cup Enlargement Glaucoma Phenotypes

IF 2.8 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma Pub Date : 2025-05-01 DOI:10.1016/j.ogla.2025.01.001

Marcus Guerreiro-Filho MD , Alessandro A. Jammal MD, PhD , Rohit Muralidhar BA , Rafael Scherer MD, PhD , Luiz F. Beniz MD , Douglas R. da Costa MD , Ivan M. Tavares MD, PhD , Felipe A. Medeiros MD, PhD

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Abstract

Purpose

To investigate the impact of blood pressure (BP) on rates of retinal nerve fiber layer (RNFL) thinning in glaucomatous eyes with focal ischemic (FI) vs. generalized cup enlargement (GE) optic disc phenotypes.

Design

Prospective cohort study.

Participants

The study included 122 eyes from 101 patients diagnosed with primary open-angle glaucoma. Eyes were classified as FI (n = 31, 25%) or GE (n = 91, 75%) based on masked grading of stereophotographs at baseline.

Methods

Subjects underwent comprehensive ophthalmic examinations, including intraocular pressure (IOP) measurement and spectral-domain OCT scans, every 6 months for an overall mean follow-up of 4.2 years ± 1.5 years. Brachial artery BP was measured concurrently, and mean arterial pressure (MAP), systolic arterial pressure (SAP), and diastolic arterial pressure (DAP) were calculated. Rates of global RNFL thickness change over time were assessed using linear mixed models, evaluating the impact of BP parameters in each optic disc phenotype, adjusting for IOP and other confounders. Interaction terms were used to test for differences in the effects of BP and IOP between the FI and GE phenotypes.

Main Outcome Measures

Effect of MAP, SAP, and DAP on rates of RNFL loss over time in FI and GE optic disc phenotypes.

Results

In the adjusted FI group models, each 10 mmHg decrease in MAP, SAP, and DAP was associated with −0.397 μm/year (P = 0.006), −0.211 μm/year (P = 0.029), and −0.471 μm/year (P = 0.005) faster RNFL thinning, respectively. In contrast, BP parameters were not significantly associated with RNFL loss in the GE group. In the multivariable model with interaction terms, the interaction between DAP and phenotype was statistically significant (P = 0.019), indicating the FI phenotype exhibited greater sensitivity to lower diastolic pressure compared to GE eyes. In contrast, interaction terms between IOP and optic disc phenotype were not significant in any of the models, suggesting a similar effect of IOP in both phenotypes.

Conclusions

Lower systemic BP levels were associated with faster RNFL thinning in the FI optic disc phenotype but not in the GE phenotype. These findings highlight the importance of considering both IOP and systemic BP when managing patients with the FI optic disc phenotype.

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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血压对局灶性缺血性青光眼与全身性杯状增大青光眼表型进展率的影响。

目的：探讨血压（BP）对伴有局灶性缺血性（FI）和全身性增大（GE）视盘表型的青光眼视网膜神经纤维层（RNFL）变薄率的影响。设计：前瞻性队列研究。参与者：该研究包括101例原发性开角型青光眼患者的122只眼睛。根据基线立体照片的模糊分级，将眼睛分为FI （n= 31,25%）或GE （n= 91,75%）。方法：每6个月进行一次全面眼科检查，包括眼内压（IOP）测量和光谱域光学相干断层扫描（SD-OCT），平均随访4.2年±1.5年。同时测量肱动脉血压，计算平均动脉压（MAP）、收缩压（SAP）和舒张压（DAP）。使用线性混合模型评估全球RNFL厚度随时间变化的比率，评估BP参数对每种视盘表型的影响，调整IOP和其他混杂因素。相互作用项用于测试FI和GE表型之间BP和IOP影响的差异。主要结局指标：MAP、SAP和DAP随时间对FI和GE视盘表型中RNFL损失率的影响。结果：在调整后的FI组模型中，MAP、SAP和DAP每降低10 mmhg分别与-0.397 μm/年（p=0.006）、-0.211 μm/年（p=0.029）和-0.471 μm/年（p=0.005）的RNFL变薄速度相关。相比之下，GE组的BP参数与RNFL损失无显著相关。在具有相互作用项的多变量模型中，DAP与表型之间的相互作用具有统计学意义（p=0.019），表明FI表型比GE眼对低舒张压表现出更大的敏感性。相比之下，IOP和视盘表型之间的相互作用项在任何模型中都不显著，表明IOP在两种表型中的作用相似。结论：在FI视盘表型中，较低的全身BP水平与更快的RNFL变薄有关，而在GE表型中则与此无关。这些发现强调了在治疗FI视盘表型患者时同时考虑IOP和全身性血压的重要性。

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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