INTRODUCTION:
Studies have hinted at the possible
association of systemic calcium channel blockers (CCB) with the development of
glaucoma. In order to analyze this hypothesis a large study was performed using
data from the UK Biobank records. The data was analyzed in January 2023 and
published in JAMA Ophthalmology.
In a cross-sectional study of 427480 adult
UK Biobank participants, the study found CCB use was adversely associated with
glaucoma prevalence and optical coherence tomography–derived inner retinal thicknesses but not IOP.
Therefore, these drugs may represent an
important modifiable risk factor for glaucoma, potentially through an IOP-independent
mechanism.
METHODS:
The primary outcome measures included
glaucoma status, corneal-compensated IOP, and two OCT-derived inner retinal
thickness parameters (macular retinal nerve fiber layer [mRNFL] and macular
ganglion cell–inner plexiform layer [mGCIPL] thicknesses). Logistic regression
and linear regression analyses were performed to test for associations with
glaucoma status and IOP and OCT-derived inner retinal thickness parameters,
respectively.
RESULTS:
The median age of participants was 58 (IQR,
50-63) years, and more than half (54.1%) were women.
There were 33 175 CCB users (7.8%).
After adjustment for key sociodemographic,
medical, anthropometric, and lifestyle factors, the use of CCBs (but not other
antihypertensive agents) was associated with greater odds of glaucoma (odds
ratio [OR], 1.39 [95% CI, 1.14 to 1.69]; P = .001).
Calcium channel blocker use was also
associated with thinner mGCIPL (−0.34
μm [95% CI, −0.54 to −0.15
μm]; P = .001) and mRNFL (−0.16 μm
[95% CI, −0.30 to −0.02 μm];
P = .03) thicknesses but not IOP (−0.01 mm Hg [95% CI, −0.09 to 0.07 mm Hg]; P = .84).
CONCLUSIONS AND RELEVANCE:
In this study, an adverse association
between CCB use and glaucoma was observed, with CCB users having, on average,
39% higher odds of glaucoma. Calcium channel blocker use was also associated
with thinner mGCIPL and mRNFL thicknesses, providing a structural basis that
supports the association with glaucoma. The lack of association of CCB use with
IOP suggests that an IOP-independent mechanism of glaucomatous
neurodegeneration may be involved.
Although a causal relationship has not been
established, CCB replacement or withdrawal may be considered should glaucoma
progress despite optimal care.
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