Low blood pressure is a significant risk factor for developing incident OAG


A retrospective study used a US national database to assess the relationship between blood pressure (BP) and the development of incident open-angle glaucoma (OAG).

Study design

This study focused on a cohort of participants in the National Institute of Health’s All of Us Research Database program. Eye patients with at least 15 months of follow-up who did not have a glaucoma diagnosis were included in the study. In addition to evaluating potential links between BP and OAG, investigators also looked at whether BP medications modify this relationship.


Of the 20,815 participants included in this study, 462 developed OAG over the follow-up period (86.0–104.6 months). Multivariate analyses indicated that low mean arterial pressure was a significant factor in OAG development (hazard ratio [HR] 1.32). The number of BP medications was a risk factor for OAG based on multivariate analysis (>3 classes of medications: HR 1.28), but this was not found to be significant.


People who volunteer for these studies may not represent the entire population. They may be hypervigilant with their BP monitoring, and despite the fact that the number of BP medications was not significantly associated with OAG, overtreating BP may be an explanation. As well, there are often issues around proper diagnoses in studies where coding and electronic health record data are used.

Clinical significance

Blood pressure and ocular perfusion are important in the development of OAG. While this study cannot comment on progression, these data may be more meaningful in the primary care setting where patients are generally treated for high BP. The lack of significant association between BP medication and OAG diagnosis is somewhat perplexing. This could be due to limited granularity of knowing the BP across all times of day. However, BP levels remain paramount over the number of BP medications regarding development of primary OAG, and patients with low BP who are glaucoma suspects should be counseled on either having more frequent screening or discussing BP goals with their primary care clinician.

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