Association Between Pulse Pressure and Primary Open-Angle Glaucoma

Background: Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness worldwide. Other systemic vascular risk factors (e.g., pulse pressure) can affect the perfusion of the optic nerves and the progression of glaucoma. The objective is to examine the relationship between PP and PAOG and between PP and PAOG severity. Material and Methods: This was an analytic cross-sectional study at the hospital that included 110 cases of primary open-angle glaucoma. The difference between the maximum and minimum blood pressures was used to determine pulse pressure. All participants were examined systematically including intraocular pressure (IOP), gonioscopy, assessment of optic disc, standard automated perimetry (SAP) and retinal nerve fiber layer (RNFL) measurements by optical coherence tomography (OCT). Data was analyzed using SPSS version 25.0. Results: The average age of the participants was 58.6 ± 9.8 years, and 54.5% of the study population were males. PP was significantly correlated with the severity of glaucoma (p<0.001). Patients with the higher pulse pressure ≥60 mmHg exhibited significantly higher intraocular pressure, increased cup-to-disc ratio, decreased RNFL thickness, and poorer visual field mean deviation than the patients with the lower pulse pressure. There was a positive correlation of PP with intraocular pressure (r=0.42) and the cup-to-disc ratio (r=0.51) and negative correlations for RNFL thickness (r=−0.56) and the VF mean deviation (r=−0.49) (all p<0.001). Multivariate logistic regression revealed that PP ≥60 mmHg was an independent predictor of moderate to severe POAG (adjusted OR 3.84, 95% CI 1.55–9.51; p=0.004). Conclusion: PP is independently linked to the severity of primary OAG, and may be a useful non-invasive vascular biomarker to identify patients at increased risk of disease progression. When evaluating the progression of glaucoma, routine PP evaluation can be used in addition to ophthalmic exam and may help in the general management of glaucoma.

Keywords: Primary open angle glaucoma, PP, IOP, RNFL, OPTF, VRF.