Vol 26, No 1 (2019)
Editorial
Published online: 2019-03-14

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Blood pressure and glaucoma: At the crossroads between cardiology and ophthalmology

Janusz Skrzypecki1, Marcin Ufnal1, Jacek P. Szaflik2, Krzysztof J. Filipiak3
Pubmed: 30882185
Cardiol J 2019;26(1):8-12.

Abstract

Glaucoma is an optic nerve neuropathy of undetermined cause. Although many mechanisms are thought to be involved in the development and progression of the disease, only an increased intraocular pressure has been established as a clinically significant modifiable risk factor. Nevertheless, up to 40% of patients develop glaucoma without evidence of increased intraocular pressure. 

Ample evidence suggests that alterations in the control of arterial blood might negatively affect optic nerve function. However, evidence-based guidelines on the management of arterial blood pressure in glaucoma patients are lacking.
Regrettably, intraocular pressure is generally not included as a secondary end-point in clinical trials on arterial hypertension. Considering the relative simplicity of intraocular pressure measurements and large number of patients included in hypertension studies, the benefits of including intraocular pressure as a secondary end-point could be of a great value for improving care for glaucoma patients. Therefore, closer collaboration between cardiologists and ophthalmologists is needed. 

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References

  1. Weinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: a review. JAMA. 2014; 311(18): 1901–1911.
  2. Tham YC, Li X, Wong TY, et al. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014; 121(11): 2081–2090.
  3. Klein B, Klein R, Sponsel W, et al. Prevalence of glaucoma. he Beaver Dam Eye Study. Ophthalmology. 1992; 99(10): 1499–1504.
  4. He Z, Vingrys AJ, Armitage JA, et al. The role of blood pressure in glaucoma. Clin Exp Optom. 2011; 94(2): 133–149.
  5. Williams B, Mancia G, Spiering W, et al. 2018 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC). Blood Press. 2018; 27(6): 314–340.
  6. Wright JT, Williamson JD, Whelton PK, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015; 373(22): 2103–2116.
  7. Klein BEK, Klein R, Knudtson MD. Intraocular pressure and systemic blood pressure: longitudinal perspective: the Beaver Dam Eye Study. Br J Ophthalmol. 2005; 89(3): 284–287.
  8. Bonomi L, Marchini G, Marraffa M, et al. Vascular risk factors for primary open angle glaucoma: the Egna-Neumarkt Study. Ophthalmology. 2000; 107(7): 1287–1293.
  9. Mitchell P, Lee AJ, Rochtchina E, et al. Open-angle glaucoma and systemic hypertension: the blue mountains eye study. J Glaucoma. 2004; 13(4): 319–326.
  10. Langman MJS, Lancashire RJ, Cheng KK, et al. Systemic hypertension and glaucoma: mechanisms in common and co-occurrence. Br J Ophthalmol. 2005; 89(8): 960–963.
  11. Horwitz A, Klemp M, Jeppesen J, et al. Antihypertensive medication postpones the onset of glaucoma: evidence from a nationwide study. Hypertension. 2017; 69(2): 202–210.
  12. Skrzypecki J, Grabska-Liberek I, Przybek J, et al. A common humoral background of intraocular and arterial blood pressure dysregulation. Curr Med Res Opin. 2018; 34(3): 521–529.
  13. Sommer A, Tielsch J. Blood pressure, perfusion pressure, and open-angle glaucoma. Arch Ophthalmol. 2008; 126(5): 741; author reply 741–741; author reply 742.
  14. Melgarejo JD, Lee JH, Petitto M, et al. Glaucomatous Optic Neuropathy Associated with Nocturnal Dip in Blood Pressure: Findings from the Maracaibo Aging Study. Ophthalmology. 2018; 125(6): 807–814.
  15. Sommer A, Tielsch JM, Katz J, et al. Relationship between intraocular pressure and primary open angle glaucoma among white and black Americans. The Baltimore Eye Survey. Arch Ophthalmol. 1991; 109(8): 1090–1095.
  16. Gherghel D, Orgül S, Gugleta K, et al. Relationship between ocular perfusion pressure and retrobulbar blood flow in patients with glaucoma with progressive damage. Am J Ophthalmol. 2000; 130(5): 597–605.
  17. Zheng Y, Wong TY, Mitchell P, et al. Distribution of ocular perfusion pressure and its relationship with open-angle glaucoma: the singapore malay eye study. Invest Ophthalmol Vis Sci. 2010; 51(7): 3399–3404.
  18. Levine RM, Yang A, Brahma V, et al. Management of blood pressure in patients with glaucoma. Curr Cardiol Rep. 2017; 19(11): 109.
  19. Memarzadeh F, Ying-Lai M, Chung J, et al. Blood pressure, perfusion pressure, and open-angle glaucoma: the Los Angeles Latino Eye Study. Invest Ophthalmol Vis Sci. 2010; 51(6): 2872–2877.
  20. Charlson ME, de Moraes CG, Link A, et al. Nocturnal systemic hypotension increases the risk of glaucoma progression. Ophthalmology. 2014; 121(10): 2004–2012.
  21. Bowe A, Grünig M, Schubert J, et al. Circadian variation in arterial blood pressure and glaucomatous optic neuropathy: a systematic review and meta-analysis. Am J Hypertens. 2015; 28(9): 1077–1082.
  22. Millar-Craig MW, Bishop CN, Raftery EB. Circadian variation of blood-pressure. Lancet. 1978; 1(8068): 795–797.
  23. Pillunat KR, Spoerl E, Jasper C, et al. Nocturnal blood pressure in primary open-angle glaucoma. Acta Ophthalmol. 2015; 93(8): e621–e626.
  24. Flammer J, Pache M, Resink T. Vasospasm, its role in the pathogenesis of diseases with particular reference to the eye. Prog Retin Eye Res. 2001; 20(3): 319–349.
  25. Johnson PC. Autoregulation of blood flow. Circ Res. 1986; 59(5): 483–495.
  26. Topouzis F, Wilson MR, Harris A, et al. Association of open-angle glaucoma with perfusion pressure status in the Thessaloniki Eye Study. Am J Ophthalmol. 2013; 155(5): 843–851.
  27. Khawaja AP, Chan MPY, Broadway DC, et al. Systemic medication and intraocular pressure in a British population: the EPIC-Norfolk Eye Study. Ophthalmology. 2014; 121(8): 1501–1507.
  28. Zheng W, Dryja TP, Wei Z, et al. Systemic Medication Associations with Presumed Advanced or Uncontrolled Primary Open-Angle Glaucoma. Ophthalmology. 2018; 125(7): 984–993.
  29. Krasińska B, Karolczak-Kulesza M, Krasiński Z, et al. Effects of the time of antihypertensive drugs administration on the stage of primary open-angle glaucoma in patients with arterial hypertension. Blood Press. 2012; 21(4): 240–248.
  30. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018; 71(19): 2199–269.
  31. De Moraes CG, Cioffi GA, Weinreb RN, et al. New recommendations for the treatment of systemic hypertension and their potential implications for glaucoma management. J Glaucoma. 2018; 27(7): 567–571.
  32. Drawz PE, Pajewski NM, Bates JT, et al. Effect of Intensive Versus Standard Clinic-Based Hypertension Management on Ambulatory Blood Pressure: Results From the SPRINT (Systolic Blood Pressure Intervention Trial) Ambulatory Blood Pressure Study. Hypertension. 2017; 69(1): 42–50.
  33. Skrzypecki J, Ufnal M. Drug resistant hypertension: no simple way out. Kidney Blood Press Res. 2015; 40(1): 66–76.
  34. Krum H, Schlaich MP, Sobotka PA, et al. Percutaneous renal denervation in patients with treatment-resistant hypertension: final 3-year report of the Symplicity HTN-1 study. Lancet. 2014; 383(9917): 622–629.
  35. Bhatt DL, Kandzari DE, O'Neill WW, et al. A controlled trial of renal denervation for resistant hypertension. N Engl J Med. 2014; 370(15): 1393–1401.
  36. Townsend RR, Mahfoud F, Kandzari DE, et al. Catheter-based renal denervation in patients with uncontrolled hypertension in the absence of antihypertensive medications (SPYRAL HTN-OFF MED): a randomised, sham-controlled, proof-of-concept trial. Lancet. 2017; 390(10108): 2160–2170.
  37. Brooks AM, Gillies WE. Ocular beta-blockers in glaucoma management. Clinical pharmacological aspects. Drugs Aging. 1992; 2(3): 208–221.
  38. Becker B, Pettit TH, Gay AJ. Topical epinephrine therapy of open-angel glaucoma. Arch Ophthalmol. 1961; 66: 219–225.
  39. Mansouri K, Weinreb RN, Liu JHK. Efficacy of a contact lens sensor for monitoring 24-h intraocular pressure related patterns. PLoS One. 2015; 10(5): e0125530.
  40. Dunbar GE, Shen BY, Aref AA. The Sensimed Triggerfish contact lens sensor: efficacy, safety, and patient perspectives. Clin Ophthalmol. 2017; 11: 875–882.