Purpose

To investigate the effect of systemic arterial blood pressure (BP) on rates of progressive structural damage over time in glaucoma.

Design

Retrospective cohort study.

Participants

A total of 7501 eyes of 3976 subjects with glaucoma or suspected of glaucoma followed over time from the Duke Glaucoma Registry.

Methods

Linear mixed models were used to investigate the effects of BP on the rates of retinal nerve fiber layer (RNFL) loss from spectral-domain OCT (SD-OCT) over time. Models were adjusted for intraocular pressure (IOP), gender, race, diagnosis, central corneal thickness (CCT), follow-up time, and baseline disease severity.

Main Outcome Measure

Effect of mean arterial pressure (MAP), systolic arterial pressure (SAP), and diastolic arterial pressure (DAP) on rates of RNFL loss over time.

Results

A total of 157 291 BP visits, 45 408 IOP visits, and 30 238 SD-OCT visits were included. Mean rate of RNFL change was −0.70 μm/year (95% confidence interval, −0.72 to −0.67 μm/year). In univariable models, MAP, SAP, and DAP during follow-up were not significantly associated with rates of RNFL loss. However, when adjusted for mean IOP during follow-up, each 10 mmHg reduction in mean MAP (−0.06 μm/year; P = 0.007) and mean DAP (−0.08 μm/year; P < 0.001) but not SAP (−0.01 μm/year; P = 0.355) was associated with significantly faster rates of RNFL thickness change over time. The effect of the arterial pressure metrics remained significant after additional adjustment for baseline age, diagnosis, sex, race, follow-up time, disease severity, and corneal thickness.

Conclusions

When adjusted for IOP, lower MAP and DAP during follow-up were significantly associated with faster rates of RNFL loss, suggesting that levels of systemic BP may be a significant factor in glaucoma progression.

中文翻译：

---

大量临床人群的血压和青光眼进展

目的

研究全身动脉血压 (BP) 对青光眼随时间推移进行性结构损伤率的影响。

设计

回顾性队列研究。

参加者

杜克青光眼登记处对 3976 名青光眼或疑似青光眼受试者的 7501 只眼睛进行了长期随访。

方法

使用线性混合模型研究随着时间的推移，BP 对谱域 OCT (SD-OCT) 视网膜神经纤维层 (RNFL) 损失率的影响。模型根据眼压（IOP）、性别、种族、诊断、中央角膜厚度（CCT）、随访时间和基线疾病严重程度进行调整。

主要成果衡量标准

平均动脉压 (MAP)、动脉收缩压 (SAP) 和动脉舒张压 (DAP) 对 RNFL 随时间损失率的影响。

结果

总共包括 157 291 次 BP 就诊、45 408 次 IOP 就诊和 30 238 次 SD-OCT 就诊。RNFL 变化的平均率为-0.70 μm/年（95% 置信区间，-0.72 至-0.67 μm/年）。在单变量模型中，随访期间的 MAP、SAP 和 DAP 与 RNFL 损失率没有显着相关性。然而，在随访期间根据平均 IOP 进行调整时，平均 MAP（-0.06 μm/年；P = 0.007）和平均 DAP（-0.08 μm/年；P < 0.001）每降低 10 mmHg，但 SAP 则不然（-0.01） μm/年；P = 0.355）与 RNFL 厚度随时间的变化率显着加快相关。在对基线年龄、诊断、性别、种族、随访时间、疾病严重程度和角膜厚度进行额外调整后，动脉压指标的影响仍然显着。

结论

根据 IOP 进行调整后，随访期间较低的 MAP 和 DAP 与更快的 RNFL 损失率显着相关，这表明全身血压水平可能是青光眼进展的一个重要因素。