Risikofaktoren und Zielwerte in der kardiovaskulären Primär- und Sekundärprävention: Bedeutung für das Glaukom

Claudia Hacke; Carl Erb; Burkhard Weisser

doi:10.1055/s-0044-101260

Klinische Monatsblätter für Augenheilkunde, Table of Contents

Klin Monbl Augenheilkd 2018; 235(02): 151-156
DOI: 10.1055/s-0044-101260

Übersicht

Georg Thieme Verlag KG Stuttgart · New York

Risikofaktoren und Zielwerte in der kardiovaskulären Primär- und Sekundärprävention: Bedeutung für das Glaukom

Risk Factors and Therapeutic Goals for Primary and Secondary Cardiovascular Prevention: Significance for the Glaucoma Patient

Claudia Hacke

¹Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg

,

Carl Erb

²Augenklinik am Wittenbergplatz, Berlin

,

Burkhard Weisser

³Institut für Sportwissenschaft, Sportmedizin, Christian-Albrechts-Universität, Kiel

› Author Affiliations

Abstract

Zusammenfassung

Bluthochdruck, Diabetes mellitus und Fettstoffwechselstörungen gehören zu den wichtigsten kardiovaskulären Risikofaktoren. Gleichzeitig besteht auch ein Zusammenhang mit der Entwicklung und Progression des Glaukoms. In den letzten Jahren wurde eine intensive Diskussion über die optimalen Zielwerte für diese Risikofaktoren geführt. Vor kurzer Zeit haben die amerikanischen Fachgesellschaften 130/80 mmHg als neue Grenze zum Bluthochdruck definiert und auch europäische Richtlinien werden folgen. Die strengeren Grenzwerte erhöhen die Gefahr, dass unter Umständen ein zu starker Blutdruckabfall in der Nacht beim Glaukompatienten erfolgen könnte. Im Gegensatz dazu sollte das LDL-Cholesterin so niedrig wie möglich eingestellt werden („the lower the better“). Differenzierter sind die Zielbereiche beim Diabetes mellitus zu sehen. Für Ältere, also die Hauptgruppe der Glaukompatienten, wird inzwischen eine eher moderate Blutzuckereinstellung mit einem HbA_1c-Wert von über 7% empfohlen, um stärkere Unterzuckerungen zu vermeiden. In der vorliegenden Zusammenfassung werden die Bedeutung kardiovaskulärer Risikofaktoren und deren therapeutische Zielbereiche für die Ophthalmologie bei der Therapie von Glaukompatienten dargestellt.

Abstract

Hypertension, diabetes mellitus and dyslipidaemia are among the most important cardiovascular risk factors. In addition, there is an association with the development and progression of glaucoma. During the last years, there has been an intense discussion concerning optimal treatment goals for these risk factors. Recently, the American Heart Association has defined a blood pressure greater than 130/80 mmHg as hypertension and the European guidelines will follow this definition. These lower blood pressure limits increase the risk for a too strict blood pressure treatment with night values, which might be too low for glaucoma patients. In contrast, the treatment goals for LDL cholesterol should be as low as possible (“the lower the better”). There is a more differentiated picture concerning treatment goals for diabetes mellitus. For elderly patients, which is the main group of the glaucoma patients, a less intense blood sugar reduction is currently recommended with an HbA_1c value of above 7%. The present paper summarizes the significance of cardiovascular risk factors and the respective treatment goals for the therapy of patients with glaucoma.

Schlüsselwörter

Hypertonie - Diabetes mellitus - Fettstoffwechselstörungen - Glaukom

Key words

hypertension - diabetes mellitus - dyslipidaemia - glaucoma

Full Text

References

Literatur
1 Chen YY, Hu HY, Chu D. et al. Patients with primary open-angle glaucoma may develop ischemic heart disease more often than those without glaucoma: an 11-year population-based cohort study. PLoS One 2016; 11: e0163210
2 Erb C, Weisser B. The importance of systemic hypertension for eye diseases. Dtsch Med Wochenschr 2004; 129: 2486-2490
3 Erb C, Gast U, Schremmer D. German register for glaucoma patients with dry eye. I. Basic outcome with respect to dry eye. Graefes Arch Clin Exp Ophthalmol 2008; 246: 1593-1601
4 Lin HC, Chien CW, Hu CC. et al. Comparison of comorbid conditions between open-angle glaucoma patients and a control cohort: a case-control study. Ophthalmology 2010; 117: 2088-2095
5 Graham S, Drance S. Nocturnal hypotension: role in glaucoma progression. Surv Ophthalmol 1999; 43 (Suppl. 01) S10-S16
6 Hayreh S, Zimmerman M, Podhajsky P. et al. Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders. Am J Ophthalmol 1994; 117: 603-624
7 Charlson ME, de Moraes CG, Link A. et al. Nocturnal systemic hypotension increases the risk of glaucoma progression. Ophthalmology 2014; 121: 2004-2012
8 Collignon N, Dewe W, Guillaume S. et al. Ambulatory blood pressure monitoring in glaucoma patients. The nocturnal systolic dip and its relationship with disease progression. Int Ophthalmol 1998; 22: 19-25
9 Krasińska B, Karolczak-Kulesza M, Krasiński Z. et al. A marked fall in nocturnal blood pressure is associated with the stage of primary open-angle glaucoma in patients with arterial hypertension. Blood Press 2011; 20: 171-181
10 Pache M, Dubler B, Flammer J. Peripheral vasospasm and nocturnal blood pressure dipping – two distinct risk factors for glaucomatous damage?. Eur J Ophthalmol 2003; 13: 260-265
11 Perlman J, Delany C, Sothern R. et al. Relationships between 24 h observations in intraocular pressure vs. blood pressure, heart rate, nitric oxide and age in the medical chronobiology aging project. Clin Ter 2007; 158: 31-47
12 Parati G, Stergiou G, OʼBrien E. et al. European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring. J Hypertens 2014; 32: 1359-1366
13 Plange N, Kaup M, Daneljan L. et al. 24-h blood pressure monitoring in normal tension glaucoma: night-time blood pressure variability. J Hum Hypertens 2006; 20: 137-142
14 Kochkorov A, Gugleta K, Katamay R. et al. Short-term variability of systemic blood pressure and submacular choroidal blood flow in eyes of patients with primary open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol 2010; 248: 833-837
15 Wierzbowska J, Wierzbowski R, Stankiewicz A. et al. Cardiac autonomic dysfunction in patients with normal tension glaucoma: 24-h heart rate and blood pressure variability analysis. Br J Ophthalmol 2012; 96: 624-628
16 Bowe A, Grünig M, Schubert J. et al. Circadian variation in arterial blood pressure and glaucomatous optic neuropathy – a systematic review and meta-analysis. Am J Hypertens 2015; 28: 1077-1082
17 Tokunaga T, Kashiwagi K, Tsumura T. et al. Association between nocturnal blood pressure reduction and progression of visual field defect in patients with primary open-angle glaucoma or normal-tension glaucoma. Jpn J Ophthalmol 2004; 48: 380-385
18 Erb C, Predel H. Die Bedeutung der arteriellen Hypertonie für das primäre Offenwinkelglaukom. Klin Monatsbl Augenheilkd 2014; 231: 136-143
19 Weisser B, Erb C. Ambulatory 24-h blood pressure measurement in patients with glaucoma. Klin Monatsbl Augenheilkd 2015; 232: 169-173
20 Nesher R, Kohen R, Shulman S. et al. Diastolic double-product: a new entity to consider in normal-tension glaucoma patients. Isr Med Assoc J 2012; 14: 240-243
21 Whelton PK, Carey RM, Aronow WS. et al. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2017;
22 SPRINT Research Group, Wright JT jr., Williamson JD, Whelton PK et al. A randomized trial of intensive versus standard blood-pressure Control. N Engl J Med 2015; 373: 2103-2116
23 Krämer BK, Hausberg M, Sanner B. et al. Blutdruckmessung und Zielblutdruck – Stellungnahme der Deutschen Hochdruckliga e.V. DHL^®/Deutschen Gesellschaft für Hypertonie und Prävention. Dtsch Med Wochenschr 2017; 142: 1446-1447
24 Krasińska B, Karolczak-Kulesza M, Krasiński Z. et al. Effects of the time of antihypertensive drugs administration on the stage of primary open-angle glaucoma in patients with arterial hypertension. Blood Press 2012; 21: 240-248
25 Jünemann AG, Huchzermeyer C, Rejdak R. et al. Dyslipidaemia and glaucoma. Klin Monatsbl Augenheilkd 2014; 231: 1203-1214
26 Helin-Toiviainen M, Rönkkö S, Kaarniranta K. et al. Oxidized low-density lipoprotein, lipid and calcium aggregates reveal oxidative stress and inflammation in the conjunctiva of glaucoma patients. Acta Ophthalmol 2017; 95: 378-385
27 Benoist dʼAzy C, Pereira B, Chiambaretta F. et al. Oxidative and anti-oxidative stress markers in chronic glaucoma: a systematic review and meta-analysis. PLoS One 2016; 11: e0166915
28 Wang S, Xu L, Jonas JB. et al. Dyslipidemia and eye diseases in the adult Chinese population: the Beijing eye study. PLoS One 2012; 7: e26871 doi:10.1371/journal.pone.0026871
29 Shoji T, Sakurai Y, Sato H. et al. Serum low-density lipoprotein cholesterol level is strong risk factor for acquired color vision impairment in young to middle-aged Japanese men: the Okubo Color Study Report 2. Atherosclerosis 2010; 210: 542-547
30 Catapano AL, Graham I, De Backer G. et al. 2016 ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J 2016; 37: 2999-3058
31 Whigham B, Oddone EZ, Woolson S. et al. The influence of oral statin medications on progression of glaucomatous visual field loss: A propensity score analysis. Ophthalmic Epidemiol 2017;
32 McCann P, Hogg RE, Fallis R. et al. The effect of statins on intraocular pressure and on the incidence and progression of glaucoma: a systematic review and meta-analysis. Invest Ophthalmol Vis Sci 2016; 57: 2729-2748
33 Stein JD, Newman-Casey PA, Talwar N. et al. The relationship between statin use and open-angle glaucoma. Ophthalmology 2012; 119: 2074-2081
34 De Castro DK, Punjabi OS, Bostrom AG. et al. Effect of statin drugs and aspirin on progression in open-angle glaucoma suspects using confocal scanning laser ophthalmoscopy. Clin Exp Ophthalmol 2007; 35: 506-513
35 Song BJ, Aiello LP, Pasquale LR. Presence and risk factors for glaucoma in patients with diabetes. Curr Diab Rep 2016; 16: 124
36 Zhou M, Wang W, Huang W. et al. Diabetes mellitus as a risk factor for open-angle glaucoma: a systematic review and meta-analysis. PLoS One 2014; 9: e102972 doi:10.1371/journal.pone.0102972
37 Gerber AL, Harris A, Siesky B. et al. Vascular dysfunction in diabetes and glaucoma: a complex relationship reviewed. J Glaucoma 2015; 24: 474-479
38 Brown A, Reynolds LR, Bruemmer D. Intensive glycemic control and cardiovascular disease: an update. Nat Rev Cardiol 2010; 7: 369-375
39 Zeyfang A, Bahrmann A, Wernecke J. Diabetes mellitus im Alter. Diabetologie 2016; 11 (Suppl. 02) S170-S176
40 Landgraf R, Kellerer M, Fach E. Praxisempfehlungen DDG/DGIM Therapie des Typ-2-Diabetes. Diabetologie 2013; 8 (Suppl. 02) S146-S158
41 Pelletier AL, Rojas-Roldan L, Coffin J. Vision loss in older adults. Am Fam Physician 2016; 94: 219-226