Hypertension, Perfusion Pressure, and Primary Open-angle Glaucoma

OBJECTIVE: To evaluate the association of vascular factors with primary open-angle glaucoma (POAG). DESIGN: A population-based prevalence survey of ocular disease among black and white residents. SETTING: Communities of east Baltimore, Md. PARTICIPANTS: A stratified cluster sample of 5308 residents 40 years of age or older. MAIN OUTCOME MEASURES: Primary open-angle glaucoma as defined by demonstrable glaucomatous optic nerve damage based on visual fields and/or optic disc findings. Intraocular pressure level was not a criterion for diagnosis. RESULTS: Systolic and diastolic blood pressure showed modest, positive association with POAG. The effect of blood pressure on POAG was modified by age, with a stronger association among older subjects. Lower perfusion pressure (blood pressure-intraocular pressure) was strongly associated with an increased prevalence of POAG, with a sixfold excess for those in the lowest category of perfusion pressure. CONCLUSION: These results suggest that POAG is associated with an alteration in factors related to ocular blood flow and a breakdown of autoregulation.