Purpose

To measure the association among blood pressure (BP), BP medications, and glaucoma using the All of Us Research Program database.

Design

A retrospective, longitudinal cohort study leveraging a national electronic health record (EHR) database administered by the National Institutes of Health.

Participants

Eye patients in the All of Us Research Program database with at least 15 months of follow-up and 1 BP measurement.

Methods

Univariable and multivariable Cox regression models predicted the risk of developing incident open-angle glaucoma (OAG). Mean arterial pressure (MAP) and the number of BP medication classes were entered as time-varying predictors to account for changes over time.

Main Outcome Measures

The risk of developing incident OAG, as defined by billing diagnosis codes.

Results

Of 20 815 eligible eye patients who qualified for this study, 462 developed OAG. Low BP (MAP < 83.0 mmHg) was associated with increased risk of developing OAG (hazard ratio [HR], 1.32; 95% confidence interval [CI], 1.04–1.67). High BP (MAP > 101.3 mmHg) and the number of BP medication classes were not associated with OAG after adjustment for covariates. Other risk factors associated with OAG included being Black (HR, 3.31, 95% CI, 2.63–4.17), Hispanic or Latino (HR, 2.53, 95% CI, 1.94–3.28), Asian (HR, 2.22, 95% CI, 1.24–3.97), older in age (80+ years, HR, 20.1, 95% CI, 9.10–44.5), and diabetic (HR, 1.32, 95% CI, 1.04–1.67). Female gender was associated with decreased hazard of developing OAG (HR, 0.66, 95% CI, 0.55–0.80). No significant interaction was observed between MAP and the number of BP medications on the risk of developing OAG.

Conclusions

We found that low BP is associated with increased risk of developing OAG in a national longitudinal EHR database. We did not find evidence supporting a differential effect of medically treated and untreated low BP. This study adds to the body of literature implicating vascular dysregulation as a potential etiology for the development of OAG, particularly emphasizing the lack of influence of BP medications on this relationship.

中文翻译：

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全国电子健康记录数据库中血压、血压药物和青光眼之间的关联

目的

使用 All of Us Research Program 数据库测量血压 (BP)、BP 药物和青光眼之间的关联。

设计

一项利用美国国立卫生研究院管理的国家电子健康记录 (EHR) 数据库的回顾性纵向队列研究。

参加者

我们所有人研究计划数据库中的眼科患者至少进行了 15 个月的随访和 1 次血压测量。

方法

单变量和多变量 Cox 回归模型预测了发生开角型青光眼 (OAG) 的风险。输入平均动脉压 (MAP) 和 BP 药物类别的数量作为随时间变化的预测因子，以说明随时间的变化。

主要观察指标

开发事件 OAG 的风险，如计费诊断代码所定义。

结果

在符合本研究资格的 20815 名符合条件的眼科患者中，462 名患上了 OAG。低血压 (MAP < 83.0 mmHg) 与发生 OAG 的风险增加相关（风险比 [HR]，1.32；95% 置信区间 [CI]，1.04–1.67）。调整协变量后，高血压（MAP > 101.3 mmHg）和 BP 药物类别的数量与 OAG 无关。与 OAG 相关的其他风险因素包括黑人（HR，3.31，95% CI，2.63-4.17）、西班牙裔或拉丁裔（HR，2.53，95% CI，1.94-3.28）、亚裔（HR，2.22，95% CI， 1.24–3.97），年龄较大（80 岁以上，HR，20.1，95% CI，9.10–44.5）和糖尿病（HR，1.32，95% CI，1.04–1.67）。女性性别与发生 OAG 的风险降低相关（HR，0.66，95% CI，0.55–0.80）。未观察到 MAP 与 BP 药物数量对发生 OAG 风险的显着相互作用。

结论

我们发现低血压与国家纵向 EHR 数据库中发生 OAG 的风险增加有关。我们没有发现证据支持药物治疗和未治疗的低血压有不同的影响。这项研究增加了将血管失调作为 OAG 发展的潜在病因的文献主体，特别强调了 BP 药物对这种关系缺乏影响。