Figueroa Judy, Su Erica, Mohammadzadeh Vahid, Besharati Sajad, Mohammadi Massood, Ashrafkhorasani Maryam, Law Simon K, Coleman Anne L, Caprioli Joseph, Weiss Robert E, Nouri-Mahdavi Kouros
Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Department of Ophthalmology, University of Louisville, Louisville, Kentucky.
Ophthalmol Glaucoma. 2025 May-Jun;8(3):285-292. doi: 10.1016/j.ogla.2024.12.009. Epub 2025 Jan 3.
To investigate the influence of baseline blood pressure (BP) on retinal nerve fiber layer (RNFL) rates of change (RoCs) in glaucoma patients with central damage or moderate to severe disease.
Prospective cohort study.
One hundred ten eyes with ≥ 4 RNFL OCT scans and ≥ 2 years of follow-up.
Global RNFL RoCs were modeled with a Bayesian hierarchical model with subject- and sector-level random effects. Influence of baseline systolic and diastolic BP measures and their interactions with intraocular pressure (IOP) on global RNFL RoCs was investigated in prognostic models adjusting for relevant baseline demographic and clinical measures.
Magnitude and direction of coefficients for BP, IOP, and their interaction for prediction of global RNFL RoCs. One-sided Bayesian P values denote posterior probability that a regression coefficient is greater than or less than zero, with P < 0.025 or P > 0.975 defining significance.
Average (standard deviation) 24-2 visual field mean deviation (MD) at baseline, follow-up time, and number of OCT scans were -8.8 (6.0) dB, 4.3 (0.5) years, and 8.3 (1.4), respectively. In multivariable analyses, female sex, Hispanic ethnicity (vs. White ethnicity), better baseline 24-2 MD, higher contrast sensitivity at 12 cycles per degree, presence of diabetes, and thicker central cornea predicted faster RNFL thinning. Adjusted for covariates, lower diastolic BP combined with higher IOP predicted faster RNFL RoCs. Parallel multivariable models incorporating systolic BP showed similar effects. Among various BP/IOP combinations, eyes with IOP at the 90th percentile and diastolic (systolic) BP at 10th percentile demonstrated the fastest RNFL thinning rates (-0.554 and -0.539 μm/year).
Low BP and higher IOP at baseline predicted faster (worse) RNFL RoCs in glaucoma patients with central damage or moderate to advanced disease. Although there may be potential benefits to BP management in glaucoma patients, the therapeutic value of BP manipulation in glaucoma patients is yet to be established given the proven benefits of tight BP control in reducing cardiovascular morbidity and mortality.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
研究基线血压（BP）对患有中心损害或中度至重度疾病的青光眼患者视网膜神经纤维层（RNFL）变化率（RoC）的影响。
前瞻性队列研究。
110只眼睛，有≥4次RNFL OCT扫描且随访时间≥2年。
采用具有个体和扇区水平随机效应的贝叶斯分层模型对整体RNFL RoC进行建模。在针对相关基线人口统计学和临床指标进行调整的预后模型中，研究基线收缩压和舒张压测量值及其与眼压（IOP）的相互作用对整体RNFL RoC的影响。
用于预测整体RNFL RoC的BP、IOP及其相互作用的系数大小和方向。单侧贝叶斯P值表示回归系数大于或小于零的后验概率，P<0.025或P>0.975定义为具有统计学意义。
基线时、随访期和OCT扫描次数的平均（标准差）24-2视野平均缺损（MD）分别为-8.8（6.0）dB、4.3（0.5）年和8.3（1.4）。在多变量分析中，女性、西班牙裔（与白人相比）、更好的基线24-2 MD、每度12周时更高的对比敏感度、糖尿病的存在以及更厚的中央角膜预测RNFL变薄更快。在对协变量进行调整后，较低的舒张压与较高的眼压共同作用预测RNFL RoC更快。纳入收缩压的平行多变量模型显示出类似的效果。在各种BP/IOP组合中，眼压处于第90百分位数且舒张压（收缩压）处于第10百分位数的眼睛显示出最快的RNFL变薄率（分别为-0.554和-0.539μm/年）。
在患有中心损害或中度至重度疾病的青光眼患者中，基线时低血压和高眼压预测RNFL RoC更快（更差）。尽管对青光眼患者进行血压管理可能有潜在益处，但鉴于严格控制血压在降低心血管发病率和死亡率方面已证实的益处，青光眼患者中血压调控的治疗价值尚未确立。
本文末尾的脚注和披露中可能存在专有或商业披露信息。
