Key result
Lower heart rate variability linked to ~5% higher glaucoma risk per unit drop.
Why the study?
The relationship between glaucoma and measurements related to autonomic dysfunction, including heart rate variability and blood pressure, required investigation.
Does autonomic dysfunction (low HRV) and high blood pressure increase the risk of glaucoma in adults?
Cohort (n=86,841)
Does autonomic dysfunction (low HRV) and high blood pressure increase the risk of glaucoma in adults?
Odds Ratio: 0.95 (95% CI 0.92–0.99)
p-value: p=0.005
Low heart rate variability and high blood pressure are associated with an increased risk of glaucoma, suggesting autonomic dysfunction and vascular factors play a role in its pathophysiology.
Extends observational links between autonomic dysfunction, BP, and glaucoma; hypothesis-generating and should not yet change practice.
Purpose: We investigated relationship of glaucoma with measurements related to autonomic dysfunction, including heart rate variability (HRV) and blood pressure (BP). Methods: Glaucoma was defined using a questionnaire-based algorithm for 86,841 LifeLines Cohort Study participants. Baseline HRV (root mean square of successive differences [RMSSD]) was calculated from resting electrocardiograms; systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP) were oscillometric-based measurements. We used a generalized linear mixed model, adjusted for age, age square, sex, body mass index, and familial relationships to assess the relationship of baseline HRV and BP (continuous and quartiles), hypertension, and antihypertensive medication with glaucoma at follow up (median, 3.8 years). Results: The odds ratio (OR) of glaucoma was 0.95 (95% confidence interval [CI], 0.92-0.99) per unit increase in log-transformed RMSSD (in ms), indicating that autonomous dysfunction (low HRV) is associated with a higher risk of glaucoma. Per 10-mm Hg increase in BP, we found ORs of 1.03 (95% CI, 1.01-1.05; P = 0.015) for SBP, 1.01 (95% CI, 0.97-1.05; P = 0.55) for DBP, 1.03 (95% CI, 1.00-1.06; P = 0.083) for MAP, and 1.04 (95% CI, 1.01-1.07; P = 0.006) for PP. The OR for the lowest versus highest RMSSD quartile was 1.15 (95% CI, 1.05-1.27; P = 0.003). The ORs for the highest versus second quartile were 1.09 (95% CI, 0.99-1.19; P = 0.091) for SBP and 1.13 (95% CI, 1.02-1.24; P = 0.015) for PP. Glaucoma was more common among hypertensives (OR, 1.25; 95% CI, 1.16-1.35; P < 0.001); among those using angiotensin-converting enzyme (ACE) inhibitors (OR, 1.35; 95% CI, 1.18-1.55; P < 0.001); and among those using calcium-channel blockers (OR, 1.19; 95% CI, 1.01-1.40; P = 0.039). Conclusions: Low HRV, high SBP, high PP, and hypertension were associated with glaucoma. Longitudinal studies may elucidate if autonomic dysregulation and high BP also predict glaucoma incidence.
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Asefa et al. (2020) conducted a cohort in Glaucoma (n=86,841). Autonomic dysfunction (low HRV) and high blood pressure vs. Normal HRV and normal blood pressure was evaluated on Glaucoma at follow-up (OR 0.95, 95% CI 0.92-0.99, p=0.005). Low heart rate variability (OR 0.95 per unit increase in log-RMSSD) and high systolic blood pressure (OR 1.03 per 10-mm Hg increase) were associated with a higher risk of glaucoma.
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