Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA Ophthalmology. https://doi.org/10.1001/jamaophthalmol.2024.4868 Vincent Q. Pham et al.
Points
- This cohort study examined the impact of long-term blood pressure variability and mean blood pressure on visual field (VF) progression in 1674 eyes from 985 glaucoma patients over a mean follow-up of 8 years.
- Higher mean blood pressure and blood pressure variability were associated with faster VF progression, with a worsening VF mean deviation by 0.02 dB per 1-mm Hg increase in mean arterial and diastolic pressures.
- Increased blood pressure variability and higher mean IOP were significantly linked to more rapid VF progression, suggesting combined effects on glaucoma progression.
- The average VF mean deviation change rate was −0.13 dB/year, with higher blood pressure variability accelerating this decline.
- Adequate blood pressure management, especially minimizing variability, may slow glaucoma progression, particularly in patients with elevated IOP.
Summary
This cohort study explored the association between long-term blood pressure variability and visual field (VF) progression in patients with glaucoma. The study included 1674 eyes from 985 patients with suspected or confirmed glaucoma who underwent blood pressure and VF testing between November 2000 and December 2022. The primary outcomes measured were the mean and standard deviation (SD) of blood pressure, alongside intraocular pressure (IOP) parameters. Multivariable mixed-effect models assessed the relationship between these blood pressure parameters and VF mean deviation loss, adjusting for potential confounders.
The results indicated that both higher mean blood pressure and higher SD of blood pressure were significantly associated with faster VF progression. Specifically, for every 1-mm Hg increase in mean arterial pressure, the annual VF mean deviation change worsened by 0.02 dB (95% CI, 0.01-0.04; P = .001). Similarly, for each 1-mm Hg increase in diastolic arterial pressure, the mean deviation worsened by 0.02 dB (95% CI, 0.01-0.03; P < .001). Additionally, higher blood pressure variability (SD) and higher mean IOP were linked to faster VF progression, with significant interaction terms observed for both mean arterial pressure and diastolic pressure (P < .001 for all). Over the study’s mean follow-up of 8.0 years, the VF mean deviation change rate was −0.13 dB/y (95% CI, −0.16 to −0.10).
The findings suggest that long-term blood pressure variability, alongside mean blood pressure, may influence VF progression in glaucoma. This association implies that blood pressure management, particularly in terms of reducing variability, could be an essential modifier of disease progression in glaucoma patients, particularly in those with elevated IOP.
Link to the article: https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2826006
References Pham, V. Q., Nishida, T., Moghimi, S., Girkin, C. A., Fazio, M. A., Liebmann, J. M., Zangwill, L. M., & Weinreb, R. N. (2024). Long-term blood pressure variability and visual field progression in glaucoma. JAMA Ophthalmology. https://doi.org/10.1001/jamaophthalmol.2024.4868
