Relationship between long-term blood pressure fluctuations and visual field progression in primary open-angle glaucoma: a prospective cohort study

BACKGROUND: This study aimed to evaluate the association between long-term blood pressure (BP) variability (BPVR) and visual field (VF) progression in patients with primary open-angle glaucoma (POAG). METHODS: In this prospective cohort study, linear mixed-effect models were used to assess the associations between BP metrics and VF progression rates. BPVR and intraocular pressure (IOP) variability during the follow-up period were calculated by dividing the respective standard deviation values by the mean values. Correlated non-fluctuating BP metrics (baseline, mean, maximum, and minimum BP) were combined using principal component analysis separately for systolic BP (SBP) and diastolic BP (DBP). The first principal component was included as a covariate. Interactions between covariates and time from baseline were modelled to evaluate their effects on VF progression rates. RESULTS: A total of 157 eyes of 157 patients with POAG (mean baseline age, 56.3 ± 13.6 years) were included. VF progression was observed in 71 eyes (45%). These eyes showed a significantly higher incidence of disc haemorrhage (DH) than eyes without VF progression (36.6% vs. 15.1%, P = 0.002). In Cox proportional-hazard analysis, the presence of DH (hazard ratio [HR]: 2.60, 95% confidence interval [CI]: 1.58-4.28, P < 0.001) and higher systolic BPVR (SBPVR; HR: 1.12, 95% CI 1.00 to 1.24, P = 0.040) were significant predictors of VF progression. Additionally, SBPVR was significantly associated with faster VF progression (coefficient: - 0.127 dB/year per 1% increase, 95% CI - 0.247 to - 0.008, P = 0.037), whereas IOP variability (P = 0.284) and diastolic BPVR (DBPVR; P = 0.859) were not significantly associated with the progression rates. CONCLUSIONS: Long-term BP variability, particularly SBPVR, may be an independent risk factor for accelerated VF progression in POAG. Monitoring BP variability may help identify patients at higher risk of disease progression.