Höhn René, Mirshahi Alireza, Nickels Stefan, Schulz Andreas, Wild Philipp S, Blettner Maria, Pfeiffer Norbert
Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany.
Department of Ophthalmology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
Br J Ophthalmol. 2017 Dec;101(12):1633-1637. doi: 10.1136/bjophthalmol-2016-309993. Epub 2017 Apr 12.
Intraocular pressure (IOP) is well known to be associated with blood pressure and other cardiovascular risk factors. The influence of systemic cardiovascular, in particular antihypertensive, medication on IOP is still controversial. This study analyses the association between the use of cardiovascular medications and IOP in a large European cohort.
The Gutenberg Health Study is a population-based, prospective,observational cohort study in mid-western Germany. IOP was measured using a non-contact tonometer. The medication classes examined were peripheral vasodilators, diuretics, β-blockers (overall, selective and non-selective), calcium channel blockers, renin-angiotensin blockers (overall, ACE inhibitors and angiotensin-receptor blockers), nitrates, other antihypertensive medications, aspirin and statins. Subjects with missing IOP values, topical IOP-lowering medication or previous ocular surgery were excluded. In total, 13 527 subjects were enrolled in this study. Association analyses between medication use and IOP were performed using multivariable linear regression (p<0.0038).
Neither selective nor non-selective systemic β-blocker intake was associated with statistically significant lower IOP (-0.12 mm Hg, p=0.054 and -0.70 mm Hg, p=0.037, respectively). IOP was not associated with the use of ACE inhibitors after adjustment for body mass index, systolic blood pressure and central corneal thickness (0.11 mm Hg; p=0.07).
None of the cardiovascular medications, in particular systemic β-blocking agents, showed an association with IOP in non-glaucoma subjects. The long-term drift phenomenon of topical and systemic β-blocker might explain this result. Our results suggest that systemic β-blockers have a negligible effect on IOP reduction.
众所周知，眼压（IOP）与血压及其他心血管危险因素相关。全身性心血管药物，尤其是抗高血压药物对眼压的影响仍存在争议。本研究分析了欧洲一个大型队列中使用心血管药物与眼压之间的关联。
古登堡健康研究是一项在德国中西部开展的基于人群的前瞻性观察性队列研究。使用非接触眼压计测量眼压。所检查的药物类别包括外周血管扩张剂、利尿剂、β受体阻滞剂（总体、选择性和非选择性）、钙通道阻滞剂、肾素 - 血管紧张素阻滞剂（总体、ACE抑制剂和血管紧张素受体阻滞剂）、硝酸盐、其他抗高血压药物、阿司匹林和他汀类药物。排除眼压值缺失、局部使用降眼压药物或既往有眼部手术史的受试者。本研究共纳入13527名受试者。使用多变量线性回归进行药物使用与眼压之间的关联分析（p<0.0038）。
选择性或非选择性全身性β受体阻滞剂的摄入均未与眼压有统计学意义的降低相关（分别为-0.12 mmHg，p = 0.054和-0.70 mmHg，p = 0.037）。在调整体重指数、收缩压和中央角膜厚度后，眼压与ACE抑制剂的使用无关（0.11 mmHg；p = 0.07）。
在非青光眼受试者中，没有一种心血管药物，尤其是全身性β受体阻滞剂，显示出与眼压有关联。局部和全身性β受体阻滞剂的长期漂移现象可能解释了这一结果。我们的结果表明，全身性β受体阻滞剂对降低眼压的作用可忽略不计。
