Relationship between Blood Pressure and Rates of Glaucomatous Visual Field Progression: The Vascular Imaging in Glaucoma Study

Abstract

PurposeTo examine the relationship between systemic arterial blood pressure (BP) and the rate of change in standard automated perimetry (SAP) in eyes with glaucoma and glaucoma suspects. DesignProspective cohort study. Participants124 eyes (91 glaucoma, 33 suspects) of 64 subjects (mean age 68.4±7.6 years) followed at the Bascom Palmer Eye Institute, Palm Beach Gardens, FL. MethodsParticipants underwent ophthalmic examination, BP measurement, and SAP at 4-month intervals. 24-hour ambulatory blood pressure monitoring (ABPM) was acquired at the baseline visit. Linear mixed models (adjusted for inclusion of both eyes, age, gender, race, intraocular pressure, baseline severity, and central corneal thickness) were used to investigate the effect of BP on the rates of SAP mean deviation (MD) change over time. Main Outcome MeasuresEffect of baseline 24-hour and follow-up mean arterial (MAP), systolic (SBP), and diastolic blood pressure (DBP) on change in SAP MD. ResultsEyes had an average of 8.9±1.5 SAP exams over 28.3±6.0 months of follow-up. The median rate of MD change was 0.14dB/year (range -1.21 to 0.96dB/year) with 9 (7%) eyes presenting moderate to fast progression (MD change ≤ -0.50 dB/year). Each 10mmHg lower in 24-hour average MAP and SBP were associated with -0.171 dB/year (P=0.045) and -0.137 dB/year (P=0.023) faster rates of MD loss. Lower mean SBP during follow up was significantly (P = 0.003) associated with MD progression. ConclusionsLower baseline 24-hour ABPM measurements, as well as low SBP during follow-up, were significantly associated with faster rates of glaucomatous SAP progression and may be used as a predictor of risk of glaucomatous progression.