New research indicates a potential link between certain blood pressure medications, particularly calcium channel blockers (CCBs), and an increased risk of glaucoma. Studies suggest that CCBs may contribute to glaucoma development by thinning retinal layers, rather than affecting intraocular pressure. This discovery prompts a reevaluation of treatment strategies for hypertensive patients, especially those with existing glaucoma or a predisposition to the condition.
Blood Pressure Drugs And Glaucoma Risk
Recent studies have highlighted a concerning association between the use of calcium channel blockers (CCBs) and an elevated risk of glaucoma. A large meta-analysis involving over 143,000 individuals found that patients on CCBs had a 23% higher likelihood of developing glaucoma. This risk nearly doubled for those using single-agent cardioselective CCBs. Another study, analyzing data from the UK Biobank, reported a 39% greater odds of glaucoma among CCB users.
The Role Of Calcium Channel Blockers
CCBs, commonly prescribed for hypertension, appear to influence glaucoma risk through mechanisms independent of intraocular pressure (IOP). While IOP is a primary risk factor for glaucoma, research suggests that CCBs may directly affect the optic nerve and lead to thinning of the inner retinal layers. Specifically, studies have observed:
- A 39% increased odds of glaucoma with CCB use.
- Thinner inner retina and macular ganglion cell-inner plexiform layers in CCB users.
- No significant difference in eye pressure between CCB users and non-users.
This indicates that the impact of CCBs on glaucoma may stem from direct effects on the optic nerve rather than changes in eye pressure.
Other Antihypertensive Medications
In contrast to CCBs, other classes of antihypertensive medications have not shown a consistent association with an increased risk of glaucoma. For instance, studies found no significant link between glaucoma and the use of:
- Diuretics
- RAS inhibitors
- Systemic beta-blockers
Beta-blockers, in particular, have been associated with a modest reduction in intraocular pressure, which could potentially lower glaucoma risk.
Clinical Implications And Future Research
While the evidence suggests a correlation, a definitive causal relationship between CCBs and glaucoma has not yet been established. Experts advise that the risk is not severe enough to discontinue CCBs in patients with stable glaucoma or no existing condition. However, for patients experiencing worsening glaucoma despite optimal care, considering alternative antihypertensive medications may be warranted. Further research is crucial to fully understand the underlying mechanisms and to guide future treatment decisions for hypertensive patients at risk of glaucoma.
Sources
- Calcium Channel Blockers Again Linked to Glaucoma, MedPage Today.
- Effect of antihypertensive medications on the risk of open-angle glaucoma, Nature.
- Epic Research, Epic Research.
- (PDF) Amlodipine increases risk of primary open angle glaucoma, ResearchGate.
- New Evidence Links Calcium Channel Blockers to Increased Risk of Glaucoma, MedPage Today.