Effects of Inter-Arm Systolic Blood Pressure Differences on Visual Field Progression in Primary Glaucoma

Objective: To investigate the effects of inter-arm systolic blood pressure differences (IASBPD) on visual field progression in primary glaucoma patients with controlled intraocular pressure. Methods: In this prospective clinical study, 69 primary glaucoma patients (69 eyes) who had visited Changsha Aier Eye Hospital from August 2013 to November 2018 and who had at least 5 reliable visual reportson file were selected. According to the guided progression analysis (GPA) of the Humphrey Field Analyzer, subjects were divided into two groups, the visual field progression group and the non-progression group. All of the patients underwent multiple sets of sequential blood pressure measurements on both arms. A student t test, Fisher's exact test and logistic regression analysis were used for data analysis. Results: Thirty-four patients (34 eyes) were included in the analysis, among which 15 patients (15 eyes) were in the progression group and the other 19 patients (19 eyes) were in non-progression group. The IASBPD of the two groups was 10.6±9.0 mmHg (1 mmHg=0.133 kPa) and 5.3±2.8 mmHg, respectively, and IASBPD in the progression group was 5.26 mmHg (95% credibility interval: 0.14-10.37 mmHg) higher than that in the non-progression group (t=-2.177, P=0.045). There were no significant differences in pulse pressure, mean arterial pressure, or diastolic ocular perfusion pressure between the two groups (t=0.946, -1.118, -1.967, all P>0.05). Logistic regression analysis showed that an IASBPD of ≥10 mmHg was a risk factor for visual field progression (OR=20.310, P=0.022). Participants were also stratified into two groups with an IASBPD of <10 mmHg (n=26) and ≥10 mmHg (n=8). The rates of visual field progression for the two groups were 30.8% and 87.5%, and rates of retinal nerve fiber layer thickness progression were 42.3% and 87.5%, respectively (P=0.011, 0.030). Conclusions: Increased IASBPD may be one of the risk factors for visual field progression in primary glaucoma patients with controlled intraocular pressure. Key words: primary glaucoma; intraocular pressure; visual field; inter-arm systolic blood pressure differences