Hypertension, Perfusion Pressure, and Primary Open-angle Glaucoma

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Abstract
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.