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Blood Pressure, Perfusion Pressure, and Open-angle Glaucoma

Alfred Sommer, MD, MHS; James Tielsch, PhD
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Arch Ophthalmol. 2008;126(5):741-742. doi:10.1001/archopht.126.5.741-a
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The causal relationship between blood and perfusion pressures and the risk of open-angle glaucoma remains enigmatic. The recent article from the Rotterdam Study1 adds new insights by exploring these relationships separately for those with presumptive normal- and high-tension glaucoma. The results are, as they often are, confusing. The seemingly strong relationship we observed between diastolic perfusion pressure and the risk of primary open-angle glaucoma in the Baltimore Eye Study2 was most apparent from examining the association between perfusion pressure as a continuous variable. Similarly, we also did not find an overall relationship between blood pressure and the risk of glaucoma when all patients were pooled, but when they were stratified for age, a potentially important relationship was revealed: younger patients with systemic hypertension had a reduced risk of glaucoma, while risk was increased in older patients. This was consistent with our prior hypothesis: the optic nerve potentially benefits from the high perfusion pressure accompanying relatively normal vessels early in life, but as the vessels become rigid and narrow, these chronic vascular changes that limit flow become the dominant influence. As these 2 relationships were most apparent at the extremes of age, they need to be specifically investigated. It would be enlightening to have the authors of the Rotterdam Study examine these relationships in a similar fashion.

AUTHOR INFORMATION

Correspondence: Dr Sommer, Departments of Epidemiology, Ophthalmology, and International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Ste E6527, Baltimore, MD 21205 (asommer@jhsph.edu).

Financial Disclosure: None reported.

REFERENCES

Hulsman  CA, Vingerling  JR, Hofman  A, Witteman  JC, de Jong  PT. Blood pressure, arterial stiffness, and open-angle glaucoma: the Rotterdam Study. Arch Ophthalmol 2007;125 (6) 805- 812
PubMed
Tielsch  JM, Katz  J, Sommer  A, Quigley  HA, Javitt  JC. Hypertension, perfusion pressure, and primary open-angle glaucoma: a population-based assessment. Arch Ophthalmol 1995;113 (2) 216- 221
PubMed

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Hulsman  CA, Vingerling  JR, Hofman  A, Witteman  JC, de Jong  PT. Blood pressure, arterial stiffness, and open-angle glaucoma: the Rotterdam Study. Arch Ophthalmol 2007;125 (6) 805- 812
PubMed
Tielsch  JM, Katz  J, Sommer  A, Quigley  HA, Javitt  JC. Hypertension, perfusion pressure, and primary open-angle glaucoma: a population-based assessment. Arch Ophthalmol 1995;113 (2) 216- 221
PubMed

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