Systemic medication and intraocular pressure in a British population: the EPIC-Norfolk Eye Study.
OBJECTIVE
To determine the association between systemic medication use and intraocular pressure (IOP) in a population of older British men and women.


METHODS
Population-based, cross-sectional study.


METHODS
We included 7093 participants from the European Prospective Investigation into Cancer-Norfolk Eye Study. Exclusion criteria were a history of glaucoma therapy (medical, laser, or surgical), IOP asymmetry between eyes of >5 mmHg, and missing data for any covariables. The mean age of participants was 68 years (range, 48-92) and 56% were women.


METHODS
We measured IOP using the Ocular Response Analyzer. Three readings were taken per eye and the best signal value of the Goldmann-correlated IOP value considered. Participants were asked to bring all their medications and related documentation to the health examination, and these were recorded by the research nurse using an electronic case record form. The medication classes examined were angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, α-blockers, β-blockers, calcium channel blockers, diuretics, nitrates, statins, insulin, biguanides, sulfonylureas, aspirin, and other nonsteroidal anti-inflammatory drugs. We examined associations between medication use and IOP using multivariable linear regression models adjusted for age, sex, and body mass index. Models containing diabetic medication were further adjusted for glycosylated hemoglobin levels.


METHODS
Mean IOP of the right and left eyes.


RESULTS
Use of systemic β-blockers (-0.92 mmHg; 95% CI, -1.19, -0.65; P<0.001) and nitrates (-0.63 mmHg; 95% CI, -1.12, -0.14; P = 0.011) were independently associated with lower IOP. The observed associations between statin or aspirin use with IOP were no longer significant after adjustment for β-blocker use.


CONCLUSIONS
This is the first population-based study to demonstrate and quantify clinically significant differences in IOP among participants using systemic β-blockers or nitrates. Lower IOP observed in participants using statins or aspirin was explained by concurrent systemic β-blocker use. The study findings may have implications for the management of glaucoma patients with comorbidity, and may provide insight into the pathophysiologic processes underlying IOP.
Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK. Electronic address: anthony.khawaja@gmail.com.
Anthony P
AP
Khawaja
Division of Genetics and Epidemiology, UCL Institute of Ophthalmology, London, UK.
Michelle P Y
MP
Chan
Department of Ophthalmology, Norfolk & Norwich University Hospital, Norwich, UK.
David C
DC
Broadway
NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
David F
DF
Garway-Heath
Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK.
Robert
R
Luben
Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK.
Jennifer L Y
JL
Yip
Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK.
Shabina
S
Hayat
MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK.
Nicholas J
NJ
Wareham
Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK.
Kay-Tee
KT
Khaw
Division of Genetics and Epidemiology, UCL Institute of Ophthalmology, London, UK; NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
Paul J
PJ
Foster
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000627:therapeutic use*; D001645:Biguanides / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007429:Intraocular Pressure / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D009566:Nitrates / Q000627:therapeutic use*; D009798:Ocular Hypertension / Q000139:chemically induced / Q000517:prevention & control; D011446:Prospective Studies; D013453:Sulfonylurea Compounds / Q000009:adverse effects; D014065:Tonometry, Ocular; D006113:United Kingdom
D000319:Adrenergic beta-Antagonists; D001241:Aspirin; D001645:Biguanides; D006442:Glycated Hemoglobin; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D009566:Nitrates; D013453:Sulfonylurea Compounds