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Association Between 24-Hour Blood Pressure and Rates of Retinal Nerve Fiber Layer Progression in Glaucoma: The Vascular Imaging in Glaucoma Study.

Davis B Zhou·Alessandro A Jammal·Richard Donkor·David S Greenfield
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Abstract

PURPOSE: Low systemic blood pressure (BP) has been implicated as a risk factor for glaucoma progression. The purpose of this study was to investigate the association between 24-hour BP and rates of retinal nerve fiber layer (RNFL) loss in eyes with primary open-angle glaucoma. DESIGN: Prospective cohort study. PARTICIPANTS: Seventy-nine eyes from 42 subjects with glaucoma (mean age, 68.5 &#xb1; 7.6 years) enrolled in the Vascular Imaging in Glaucoma Study at the Bascom Palmer Eye Institute. METHODS: Participants underwent 24-hour ambulatory BP monitoring at baseline. Follow-up evaluations were conducted at 4-month intervals and included ophthalmic examination, BP measurement, and peripapillary RNFL thickness measurement with spectral-domain optical coherence tomography. The association between BP and RNFL loss over time was assessed using linear mixed-effects models adjusted for age, sex, race, baseline RNFL thickness, central corneal thickness, and intraocular pressure. MAIN OUTCOME MEASURES: The effect of baseline 24-hour mean arterial pressure (MAP), systolic BP (SBP), and diastolic BP (DBP) on the rate of average RNFL loss over time. RESULTS: Eyes underwent an average of 13 &#xb1; 3 optical coherence tomography exams over 43 &#xb1; 10 months of follow-up. The mean rate of RNFL loss was -0.34 &#xb1; 0.64 &#xb5;m/y (median: -0.32; interquartile range: -0.66 to -0.04 &#xb5;m/y). After adjusting for confounding factors, every 10 mm Hg lower in 24-hour minimum MAP, SBP, and DBP was associated with -0.542 &#xb5;m/y (P < .001), -0.360 &#xb5;m/y (P = .003), and -0.458 &#xb5;m/y (P = .008) faster RNFL loss, respectively. Eyes in the lowest quartile of average 24-hour MAP (81-90 mm Hg) and minimum 24-hour DBP (35-47 mm Hg) experienced significantly faster progression compared to those in the highest quartile, with differences of -0.68 &#xb5;m/y (P = .017) and -0.63 &#xb5;m/y (P = .030), respectively. CONCLUSIONS: Lower systemic BP, especially minimum MAP, SBP, and DBP measured by 24-hour ambulatory BP monitoring, is associated with faster rates of RNFL loss in primary open-angle glaucoma eyes. 24-hour BP monitoring may help predict glaucoma patients at greater risk of progression.

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HumansFemaleProspective StudiesMaleTomography, Optical CoherenceIntraocular PressureAgedDisease ProgressionRetinal Ganglion CellsNerve FibersGlaucoma, Open-AngleBlood PressureBlood Pressure Monitoring, AmbulatoryMiddle AgedVisual FieldsFollow-Up StudiesOptic DiskTonometry, OcularRisk FactorsJournal Article

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Davis B Zhou, Alessandro A Jammal, Richard Donkor, David S Greenfield. 2026-06-21. Association Between 24-Hour Blood Pressure and Rates of Retinal Nerve Fiber Layer Progression in Glaucoma: The Vascular Imaging in Glaucoma Study.. https://doi.org/10.1016/j.ajo.2026.06.023

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