ImportanceLong-term variability of blood pressure may be associated with visual field (VF) progression in patients with glaucoma.ObjectivesTo investigate the association between blood pressure parameters and VF progression over time in patients with glaucoma.Design, Setting, and ParticipantsThis retrospective cohort study of longitudinal data included patients with suspected or confirmed glaucoma who were selected from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. Patients underwent blood pressure and VF testing from November 2000 to December 2022, and data were analyzed in October 2023.ExposureSuspected or confirmed glaucoma.Main Outcomes and MeasuresMean and SD values of blood pressure variables were calculated for systolic and diastolic arterial pressures. These parameters were incorporated into multivariable mixed-effect models to investigate the association between blood pressure parameters and mean intraocular pressure with rates of VF mean deviation loss. Interaction terms between blood pressure parameters and mean intraocular pressure were also included in the models.ResultsA total of 1674 eyes from 985 patients were assessed (mean [SD] age, 61.2 [0.4] years; 563 female [57.2%]). The mean rate of VF mean deviation change was −0.13 (95% CI, −0.16 to −0.10) dB/y over a mean follow-up of 8.0 (95% CI, 7.7-8.2) years. The interaction terms of higher mean blood pressure and higher SD of blood pressure were associated with faster annual mean deviation changes for both mean arterial pressure (0.02 [95% CI, 0.01-0.04] dB/y per 1-mm Hg higher; P = .001) and diastolic arterial pressure (0.02 [95% CI, 0.01-0.03] dB/y per 1-mm Hg higher; P < .001). The interaction term of higher SD of blood pressure and higher mean intraocular pressure was associated with faster annual mean deviation changes for both mean arterial pressure (0.01 [95% CI, 0.00-0.02] μm per 1-mm Hg higher; P = .003) and diastolic arterial pressure (0.01 [95% CI, 0.00-0.01] μm per 1-mm Hg higher; P = .001).Conclusions and RelevanceIn this cohort study, higher mean blood pressure and higher SD of blood pressure were associated with faster VF progression. These findings suggest that long-term variability of blood pressure may be a modifier of the association between intraocular pressure and VF progression in glaucoma.

中文翻译：

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青光眼的长期血压变异性和视野进展


重要性血压的长期变异可能与青光眼患者的视野 （VF） 进展有关。目的探讨青光眼患者血压参数与 VF 进展随时间推移的相关性。设计、设置和参与者这项纵向数据的回顾性队列研究包括从青光眼诊断创新研究和非洲血统和青光眼评估研究中选出的疑似或确诊青光眼患者。患者于 2000 年 11 月至 2022 年 12 月接受了血压和 VF 测试，并于 2023 年 10 月对数据进行了分析。主要结局和测量 计算收缩压和舒张动脉压血压变量的平均值和 SD 值。这些参数被纳入多变量混合效应模型中，以研究血压参数和平均眼压与 VF 平均偏差损失率之间的关联。模型中还包括血压参数和平均眼压之间的交互项。结果共评估了 985 例患者的 1674 只眼睛 （平均 [SD] 年龄，61.2 [0.4] 岁;563 名女性 [57.2%]）。VF 平均偏差变化的平均率为 -0.13 （95% CI，-0.16 至 -0.10） dB/y，平均随访时间为 8.0 （95% CI，7.7-8.2） 年。较高的平均血压和较高的血压 SD 的交互项与平均动脉压的更快年平均偏差变化相关（每升高 1 毫米汞柱 0.02 [95% CI，0.01-0.04] dB/y;P = .001）和舒张动脉压（每升高 1 毫米汞柱，0.02 [95% CI，0.01-0.03] dB/y;P < .001）。 血压 SD 较高和平均眼压较高 （0.01% CI，0.00-0.02] μm 的年平均偏差变化与平均动脉压的更快相关（每升高 1 毫米汞柱;P = .003）和舒张动脉压（每升高 1 毫米汞柱，0.01 [95% CI，0.00-0.01] μm;P = .001）。结论和相关性在这项队列研究中，较高的平均血压和较高的血压 SD 与更快的 VF 进展相关。这些发现表明，血压的长期变化可能是青光眼眼压与 VF 进展之间关联的调节因子。