Blood pressure association with primary open angle glaucoma severity
Reviewed by Su Young

This prospective observational study involved 47 patients diagnosed with primary open angle glaucoma (POAG) examined to investigate their postural blood pressure response and its potential correlation with the severity of glaucomatous optic neuropathy (GON). Participants underwent intraocular pressure and systemic arterial blood pressure measurements, including systolic blood pressure (SBP) and diastolic blood pressure (DBP), in both seated and recumbent positions following a 20-minute rest period. Mean arterial blood pressure (MABP) was calculated for both positions, and the percentage difference between seated and recumbent SBP, DBP, and MABP was determined to calculate postural dip. Participants were categorised into three groups: non dippers, normal dippers, and exaggerated dippers, with percentage dips of <10%, ≥10%≤20%, and >20%, respectively. Optical coherence tomography was utilised to measure retinal nerve fibre layer thickness (RNFLT), serving as a structural biomarker of GON severity. Retinal nerve fibre layer thickness was significantly lower in individuals classified as exaggerated dippers compared to those categorised as non dippers and normal dippers. A negative correlation was observed between postural dip and average RNFLT, suggesting that greater postural dip was associated with more severe GON, regardless of age and intraocular pressure. Linear regression analysis also demonstrated significant association between postural dip and lower RNFL thickness, independent of potential confounding factors. However, no significant associations were found between hypertension or antihypertensive medication and postural dip. The authors conclude by highlighting the potential clinical significance of assessing postural blood pressure response in POAG patients as a simple yet valuable tool for evaluating systemic vascular dysregulation and assessing the risk of GON.

Association of postural blood pressure response with disease severity in primary open angle glaucoma.
Ismail AA, Sadek SH, Kamal MA, Hatata RM.
JOURNAL OF GLAUCOMA
2024;33(4):225–39.