Long-Term Blood Pressure Variability and Visual Field Progression in POAG

Key Takeaways

• Higher systolic blood pressure variability was associated with faster visual field progression in this primary open-angle glaucoma cohort.
• Disc hemorrhage was more common in eyes with progression and remained a significant predictor in Cox proportional-hazard analysis.
• Intraocular pressure variability and diastolic blood pressure variability were not significantly associated with progression rates in this analysis.

Higher long-term systolic blood pressure variability was linked to faster visual field worsening in a prospective cohort of patients with primary open-angle glaucoma, where progression occurred in 45% of eyes. Investigators followed 157 eyes from 157 patients with a mean baseline age of 56.3 ± 13.6 years. The association was most evident for systolic rather than diastolic variability.

Researchers assessed blood pressure variability and intraocular pressure variability during follow-up by dividing the standard deviation by the mean. Baseline, mean, maximum, and minimum blood pressure measures were then combined separately for systolic and diastolic pressure with principal component analysis, and the first principal component for each set was included as a covariate in adjusted models. Eyes with progression also had more disc hemorrhage than nonprogressing eyes, at 36.6% versus 15.1% (P=0.002).

In this prospective cohort study, Cox proportional-hazard analysis identified disc hemorrhage and higher systolic blood pressure variability as significant predictors of visual field progression. Disc hemorrhage carried a hazard ratio of 2.60 (95% CI, 1.58-4.28; P<0.001), and higher systolic variability carried a hazard ratio of 1.12 (95% CI, 1.00-1.24; P=0.040). Linear mixed-effect modeling also linked systolic variability to faster progression, with a coefficient of -0.127 dB/year per 1% increase, while intraocular pressure variability and diastolic variability were not significant (P=0.284 and P=0.859).

The authors described long-term blood pressure variability, particularly systolic variability, as a possible independent risk factor for accelerated visual field progression in primary open-angle glaucoma. The association remained observational within this primary open-angle glaucoma cohort.