Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School Singapore, Singapore.
Singapore Eye Research Institute, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE), Singapore; NTU Institute of Health Technologies, Singapore.
Ophthalmology. 2021 Mar;128(3):393-400. doi: 10.1016/j.ophtha.2020.07.051. Epub 2020 Jul 31.
To evaluate the association between different classes of antihypertensive medication with retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GC-IPL) thickness in a nonglaucomatous multiethnic Asian population.
Population-based, cross-sectional study.
A total of 9144 eyes for RNFL analysis (2668 Malays, 3554 Indians, and 2922 Chinese) and 8549 eyes for GC-IPL analysis (2460 Malays, 3230 Indians, and 2859 Chinese) aged 44 to 86 years.
Participants underwent standardized systemic and ocular examinations and interviewer-administered questionnaires for collection of data on medication and other variables. Intraocular pressure (IOP) readings were obtained by Goldmann applanation tonometry before pupil dilation for fundoscopy and OCT imaging. Blood pressure (BP) was measured with an automatic BP monitor. Mean arterial pressure (MAP) was defined as diastolic BP plus 1/3 (systolic BP - diastolic BP). Regression models were used to investigate the association of antihypertensive medication with OCT measurements of RNFL and GC-IPL.
Average and sectoral RNFL and GC-IPL thickness.
After adjusting for age, gender, ethnicity, MAP, IOP, body mass index (BMI), and presence of diabetes, we found that participants taking any type of antihypertensive medication (β = -0.83; 95% confidence interval [CI], -1.46 to -0.02; P = 0.01), specifically angiotensin-converting enzyme inhibitors (ACEIs) (β = -1.66; 95% CI, -2.57 to -0.75; P < 0.001) or diuretics (β = -1.38; 95% CI, -2.59 to -0.17; P < 0.05), had thinner average RNFL in comparison with participants who were not receiving antihypertensive treatment. Use of a greater number of antihypertensive medications was significantly associated with thinner average RNFL (P for trend = 0.001). This association was most evident in the inferior RNFL quadrant in participants using ACEIs (β = -2.44; 95% CI, -3.99 to -0.89; P = 0.002) or diuretics (β = -2.76; 95% CI, -4.76 to -0.76; P = 0.007). A similar trend was noted in our analysis of macular GC-IPL thickness.
Use of 2 or more antihypertensive medications, ACEI, and diuretics were associated with a loss of structural markers of retinal ganglion cell health in a multiethnic Asian population.
评估在非青光眼的多种族亚洲人群中，不同类别的降压药物与视网膜神经纤维层（RNFL）和神经节细胞内丛状层（GC-IPL）厚度之间的关联。
基于人群的横断面研究。
共纳入 9144 只眼进行 RNFL 分析（2668 名马来人、3554 名印度人和 2922 名中国人）和 8549 只眼进行 GC-IPL 分析（2460 名马来人、3230 名印度人和 2859 名中国人），年龄为 44 至 86 岁。
参与者接受了标准化的系统和眼部检查，并接受了问卷调查，以收集有关药物和其他变量的数据。在进行眼底镜和 OCT 成像之前，使用 Goldmann 压平眼压计对瞳孔扩张前的眼内压（IOP）进行测量。血压（BP）使用自动血压监测仪进行测量。平均动脉压（MAP）定义为舒张压加 1/3（收缩压-舒张压）。回归模型用于研究降压药物与 OCT 测量的 RNFL 和 GC-IPL 之间的关联。
平均和扇形 RNFL 和 GC-IPL 厚度。
在调整年龄、性别、种族、MAP、IOP、体重指数（BMI）和糖尿病存在后，我们发现服用任何类型降压药物的参与者（β=-0.83；95%置信区间，-1.46 至-0.02；P=0.01），特别是血管紧张素转换酶抑制剂（ACEIs）（β=-1.66；95%置信区间，-2.57 至-0.75；P<0.001）或利尿剂（β=-1.38；95%置信区间，-2.59 至-0.17；P<0.05）与未接受降压治疗的参与者相比，RNFL 平均厚度较薄。使用更多种类的降压药物与平均 RNFL 变薄显著相关（P 趋势=0.001）。这种关联在使用 ACEIs（β=-2.44；95%置信区间，-3.99 至-0.89；P=0.002）或利尿剂（β=-2.76；95%置信区间，-4.76 至-0.76；P=0.007）的参与者中，在下象限的 RNFL 中最为明显。在我们对黄斑 GC-IPL 厚度的分析中也观察到了类似的趋势。
在多种族亚洲人群中，使用 2 种或更多种降压药物、ACEI 和利尿剂与视网膜节细胞健康的结构标志物丧失有关。
