The association between blood pressure, blood pressure medications, and glaucoma in a nationwide electronic health records database

Abstract Purpose To measure the association between blood pressure, blood pressure medications, and glaucoma using the All of Us Research Program database. Design A retrospective, longitudinal cohort study leveraging a national electronic health records database administered by the National Institute of Health. Subjects, Participants and/or Controls Eye patients in the All of Us Research Program database with at least fifteen months of follow up and one blood pressure (BP) measurement. Methods, Intervention, or Testing Univariable and multivariable Cox regression models predicted the risk of developing incident open angle glaucoma (OAG). Mean arterial pressure (MAP) and the number of BP medication classes were entered as time-varying predictors to account for changes over time. Main Outcome Measures The risk of developing incident OAG, as defined by billing diagnosis codes. Results Of 20815 eligible eye patients who qualified for this study, 462 developed OAG. Low blood pressure (MAP 101.3 mmHg) and the number of BP medication classes were not associated with OAG after adjustment for covariates. Other risk factors associated with OAG included being Black (HR 3.31, 95% CI 2.63 - 4.17), Hispanic or Latino (HR 2.53, 95% CI 1.94 - 3.28), Asian (HR 2.22, 95% CI 1.24 - 3.97), older in age (80+ years, HR 20.1, 95% CI 9.10 – 44.5), and diabetic (HR 1.32, 95% CI 1.04 - 1.67). Female gender was associated with decreased hazard of developing OAG (HR 0.66, 95% CI 0.55 - 0.80). No significant interaction was observed between MAP and the number of BP medications on the risk of developing OAG. Conclusions We found that low blood pressure is associated with increased risk of developing OAG in a national longitudinal electronic health records database. We did not find evidence supporting a differential effect of medically treated and untreated low BP. This study adds to the body of literature implicating vascular dysregulation as a potential etiology for the development of OAG, particularly emphasizing the lack of influence of blood pressure medications on this relationship.