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Association of the Optic Disc Structure With the Use of Antihypertensive Medications: The Thessaloniki Eye Study

Harris, Alon, PhD, MS, FARVO*; Topouzis, Fotis, MD, PhD; Wilson, M., Roy, MD, MS; Founti, Panayiota, MD; Kheradiya, Nisha, Shah, MD*; Anastasopoulos, Eleftherios, MD; Gong, Gordon, MD§; Yu, Fei, PhD; Jonescu-Cuypers, Christian, P., MD; Pappas, Theofanis, MD; Koskosas, Archimidis, MD; Coleman, Anne, L., MD, PhD

doi: 10.1097/IJG.0b013e31824d1e12
Original Studies

Purpose: To investigate the association of antihypertensive medications with optic disc structure by blood pressure (BP) level, in nonglaucoma subjects.

Design: Cross-sectional, population-based study.

Methods: A subset of Thessaloniki Eye Study participants was included in this study. Subjects were interviewed for medical history and underwent extensive ophthalmic examination, BP measurement, and optic disc imaging with the Heidelberg retinal tomograph. Subjects treated for hypertension were grouped in the following groups: (1) angiotensin-converting enzyme inhibitors and/or angiotensin-receptor blockers; (2) beta blockers and/or calcium-channel blockers; (3) diuretics alone or combined with others; and (4) other combinations. Cup size and cup-to-disc (C/D) ratio in the above groups were compared with the untreated group, using regression models. Analyses were rerun for subjects with systolic BP (SBP)<140 mm Hg, SBP≥140 mm Hg, diastolic BP (DBP)<90 mm Hg, and DBP≥90 mm Hg.

Results: Among 232 subjects, 131 were receiving antihypertensive medications. In subjects with DBP<90 mm Hg, all medications groups were associated with larger cup size and higher C/D ratio compared with the untreated group. Results were similar in subjects with SBP<140 mm Hg, with the exception of the beta blockers and/or calcium-channel blockers group. None of the medications groups were associated with the Heidelberg retinal tomograph parameters in those with DBP≥90 mm Hg or SBP≥140 mm Hg.

Conclusions: All classes of antihypertensive medications were associated with larger cup size and higher C/D ratio in subjects with either DBP<90 mm Hg or SBP<140 mm Hg. These results suggest that there is no specific medication-related effect on optic disc structure, and the associations found are mediated through the hypotensive effect of antihypertensive medications.

*Department of Ophthalmology, Indiana University, School of Medicine, Indianapolis, IN

A Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece

University of Colorado, Denver, CO

§F. Marie Hall Institute for Rural and Community Health, Texas Tech University Health Sciences Center, Lubbock, TX

Center for Eye Epidemiology, Jules Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, CA

Department of Ophthalmology, Saarland University Hospital, Homburg/Saar, Germany

The Thessaloniki Eye Study is supported in part by: International Glaucoma Association, London, UK; UCLA Center for Eye Epidemiology, Los Angeles, CA; Health Future Foundation, Creighton University, Omaha, NE; Glaucoma Research and Education Foundation, Indianapolis, IN; Texas Tech University Health Sciences Center, Lubbock, TX; Pfizer, Inc., New York, NY; Merck and Co. Inc., Whitehouse Station, NJ; Pharmacia Hellas, Athens, Greece. All the grants were unrestricted.

Disclosure: The authors declare no conflict of interest.

Reprints: Fotis Topouzis, MD, PhD, A Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, General Hospital “AHEPA,” S. Kiriakidi 1, 54636 Thessaloniki, Greece. (e-mail:

Received April 14, 2011

Accepted January 9, 2012

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