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The Rotterdam Study

Caroline A. A. Hulsman, MD, PhD; Johannes R. Vingerling, MD, PhD; Albert Hofman, MD, PhD; Jacqueline C. M. Witteman, PhD; Paulus T. V.M. de Jong, MD, PhD

Arch Ophthalmol. 2007;125(6):805-812.

Objective  To investigate cross-sectional associations among blood pressures (BPs), arterial stiffness, and open-angle glaucoma (OAG).

Methods  Study participants came from the population-based Rotterdam Study. The baseline examination phase took place after an extensive home interview from March 20, 1990, to June 17, 1993, and the third phase between March 19, 1997, and December 16, 1999. Cases were classified into high-tension OAG (htOAG) and normal-tension OAG (ntOAG), according to an intraocular pressure greater than 21 mm Hg or 21 mm Hg or less. Pulse pressure was the difference between systolic and diastolic BP. Diastolic perfusion pressure was the difference between diastolic BP and the intraocular pressure; indicators of arterial stiffness were carotid-femoral pulse wave velocity and carotid distensibility. Associations were evaluated with logistic regression analysis, adjusted for age, sex, body mass index, smoking, diabetes mellitus, serum cholesterol level, and BP-lowering treatment.

Results  A total of 5317 participants were included in this study. In participants with a higher pulse pressure, the prevalence of htOAG was elevated (odds ratio [OR] per standard deviation, 1.32; 95% confidence interval [CI], 1.03-1.69). In persons treated for systemic hypertension, low diastolic perfusion pressure (<50 mm Hg) was inversely associated with ntOAG (OR, 0.25; 95% CI, 0.10-0.63) and positively associated with htOAG (OR, 4.68; 95% CI, 1.29-17.01). The lowest tertile of carotid distensibility compared with the highest had an OR for htOAG of 2.84 (95% CI, 0.99-8.10; P = .05).

Conclusions  We found that htOAG was associated with high pulse pressure, possibly with increased carotid arterial stiffness, and, only in persons treated for systemic hypertension, with low diastolic perfusion pressure. In these persons, ntOAG was associated with high diastolic BP, whereas the association between ntOAG and low diastolic perfusion pressure was inverted.

Author Affiliations: The Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, and Department of Ophthalmology, Academic Medical Center, Amsterdam (Drs Hulsman and de Jong), and Departments of Epidemiology and Biostatistics (Drs Hulsman, Vingerling, Hofman, Witteman, and de Jong) and Ophthalmology (Dr Vingerling), Erasmus Medical Center, Rotterdam, the Netherlands.

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