Antihypertensives use tied to thinner average retinal nerve fibre layer

Use of two or more antihypertensive medications, angiotensin-converting enzyme inhibitor (ACEI), and diuretics appears to induce a loss of structural markers of retinal ganglion cell health in a multiethnic Asian population, suggests a study.

A total of 9,144 eyes for retinal nerve fibre layer (RNFL) analysis (2,668 Malays, 3,554 Indians, and 2,922 Chinese) and 8,549 eyes for ganglion cell-inner plexiform layer (GC-IPL) analysis (2,460 Malays, 3,230 Indians, and 2,859 Chinese) aged 44 to 86 years were included in this population-based cross-sectional study. Participants underwent standardized systemic and ocular examinations, as well as interviewer-administered questionnaires, for the collection of data on medication and other variables.

The investigators obtained intraocular pressure (IOP) readings, using Goldmann applanation tonometry before pupil dilation for fundoscopy and optical coherence tomography (OCT) imaging, and measured blood pressure (BP) with an automatic BP monitor. Mean arterial pressure (MAP) was defined as diastolic BP plus 1/3 (systolic BP – diastolic BP). Finally, they evaluated the association of antihypertensive medication with OCT measurements of RNFL and GC-IPL using regression models.

After adjusting for age, gender, ethnicity, MAP, IOP, body mass index, and presence of diabetes, participants taking any antihypertensive drug (β, –0.83, 95 percent confidence interval [CI], –1.46 to –0.02; p=0.01), particularly ACEIs (β, –1.66, 95 percent CI, –2.57 to –0.75; p<0.001) or diuretics (β, –1.38, 95 percent CI, –2.59 to –0.17; p<0.05), had thinner average RNFL relative to those not taking any antihypertensive medication.

Moreover, use of a greater number of antihypertensive agents significantly correlated with thinner average RNFL (p_trend=0.001). This association was most pronounced in the inferior RNFL quadrant in participants on ACEIs (β, –2.44, 95 percent CI, –3.99 to –0.89; p=0.002) or diuretics (β, –2.76, 95 percent CI, –4.76 to –0.76; p=0.007). A similar trend was seen in the analysis of macular GC-IPL thickness.