He Zheng, Vingrys Algis J, Armitage James A, Bui Bang V
Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia.
Clin Exp Optom. 2011 Mar;94(2):133-49. doi: 10.1111/j.1444-0938.2010.00564.x. Epub 2011 Jan 24.
Although intraocular pressure (IOP) remains an important risk factor for glaucoma, it is clear that other factors can also influence disease development and progression. More recently, the role that blood pressure (BP) has in the genesis of glaucoma has attracted attention, as it represents a clinically modifiable risk factor and thus provides the potential for new treatment strategies beyond IOP reduction. The interplay between blood pressure and IOP determines the ocular perfusion pressure (OPP), which regulates blood flow to the optic nerve. If OPP is a more important determinant of ganglion cell injury than IOP, then hypotension should exacerbate the detrimental effects of IOP elevation, whereas hypertension should provide protection against IOP elevation. Epidemiological evidence provides some conflicting outcomes of the role of systemic hypertension in the development and progression of glaucoma. The most recent study showed that patients at both extremes of the blood pressure spectrum show an increased prevalence of glaucoma. Those with low blood pressure would have low OPP and thus reduced blood flow; however, that people with hypertension also show increased risk is more difficult to reconcile. This finding may reflect an inherent blood flow dysregulation secondary to chronic hypertension that would render retinal blood flow less able to resist changes in ocular perfusion pressure. Here we review both clinical and experimental studies that have attempted to clarify the relationships among blood pressure, OPP and blood flow autoregulation in the pathogenesis of glaucoma.
尽管眼压（IOP）仍然是青光眼的一个重要危险因素，但很明显其他因素也会影响疾病的发生和发展。最近，血压（BP）在青光眼发病机制中的作用引起了关注，因为它是一个临床上可调节的危险因素，因此为降低眼压之外的新治疗策略提供了潜力。血压和眼压之间的相互作用决定了眼灌注压（OPP），而眼灌注压调节视神经的血流。如果眼灌注压比眼压更重要地决定神经节细胞损伤，那么低血压应会加剧眼压升高的有害影响，而高血压应能提供对眼压升高的保护作用。流行病学证据对于系统性高血压在青光眼发生和发展中的作用给出了一些相互矛盾的结果。最近的研究表明，血压范围两端的患者青光眼患病率均有所增加。血压低的人眼灌注压会低，从而血流减少；然而，高血压患者也显示出风险增加，这一点更难解释。这一发现可能反映了继发于慢性高血压的内在血流调节异常，这会使视网膜血流更难以抵抗眼灌注压的变化。在此，我们综述了试图阐明青光眼发病机制中血压、眼灌注压和血流自动调节之间关系的临床和实验研究。
