In the long-term, chronically high blood pressure increases one’s risk of stroke and heart failure; in some cases it can also lead to vision loss. However, certain blood pressure medications, such as beta-blockers, are known to have adverse ocular effects. Beta-blockers can cause dry eye, and one study found that beta-blockers may unfavorably disturb retinal microcirculation.1

Adding to the body of research on blood pressure medications’ effects on the eye, researchers investigated possible associations between anti-hypertensive medications with retinal nerve fiber layer (RNFL) thickness and ganglion cell-inner plexiform layer (GC-IPL) thickness in an Indian, Chinese and Malaysian population-based cross-sectional study. A total of 9,144 eyes for RNFL analysis and 8,549 eyes for GCIPL were included, with participants aged 44 to 86 years. None of the participants had glaucoma.

The researchers performed systemic and ocular examinations, administered questionnaires on medications and other variables, measured IOP and blood pressure, and performed funduscopy and OCT imaging.

Participants on any type of anti-hypertensive medication had thinner average RNFL compared with those who were not on anti-hypertensive treatment. ACE inhibitors and diuretics in particular caused RNFL thinning. The researchers also noticed a significant association between use of a greater number of anti-hypertensive medications and thinner average RNFL, most evident in the inferior RNFL quadrant in participants using ACE inhibitors or diuretics. Similar trends were observed with the macular GC-IPL thickness.

The researchers concluded that the use of two or more anti-hypertensive medications, particularly ACE inhibitors and diuretics, were associated with a loss of structural markers of retinal ganglion cell health in this particular population.

1. Madej A, Gierek-Ciaciura S, Haberka M, et al. Effects of bisoprolol and cilazapril on the central retinal artery blood flow in patients with essential hypertension—preliminary results. Upsala J Med Sci. 2010;115:249-52.

2. Chong RS, Chee M, Tham Y, et al. Association of anti-hypertensive medication with retinal nerve fiber layer and ganglion cell-inner plexiform layer thickness. Ophthalmology. July 30, 2020. [Epub ahead of print].