Risk Of Glaucoma Associated With Use Of Calcium Channel Blockers In Patients With Cardiovascular Disease

Calcium channel blockers (CCBs) are one of the most prescribed agents for cardiovascular disease (CVD) globally and are frequently used as first line agents in treating hypertension. Recent epidemiologic studies have shown an adverse relationship between CCBs use and the incidence of glaucoma, however the studies had significant methodological limitations. The purpose of this study was to conduct the largest epidemiologic study to date and re-examine the association between CCBs and glaucoma with more robust methodology that may have biased the results of previous studies.

Retrospective cohort study with a case control analysis from 2016-2023 using the IQVIA Ambulatory Database (USA).

Three cohorts of new users (CCBs, angiotensin receptor blockers [ARBs] and thiazide diuretics, with the latter two as controls), were created and followed until first diagnosis of glaucoma or end of follow up period (December 2023). Cases included all patients with newly diagnosed open angle glaucoma (OAG) or primary angle closure glaucoma (PACG) and had to have no previous glaucoma codes prior to date of first antihypertensive prescription. For each case, four controls were matched by age and calendar time. Regular use of a CCB was defined as use of at least one prescription every three months in the year prior to event date. A conditional logistic regression model was constructed to compute odds ratios (ORs) and adjust for confounders.

957, 758 patients with CVD were included in the study. 53.1% of the population were women and the mean age 59.4 years old ± SD 15.1. When compared to both thiazide and ARBs users, CCBs users did not have an increased risk for developing OAG (OR = 1.28, 95% confidence interval [CI] 1.06-1.53 and OR = 1.02, 95% CI 0.91-1.15 respectively). CCBs users did have an increased risk for PACG when compared to thiazide users (OR = 1.85, 95% CI 1.14-2.99), but not when compared to the ARBs group (OR = 0.94, 95% CI 0.72-1.24).

Our study found that patients with CVD who used CCBs were at a greater risk for PACG when compared to the thiazide group, but not the ARBs group. Contrary to previously published reports, our study did not find patients on CCBs to be at a higher risk for developing OAG when compared to either thiazides or ARBs, and previous studies that demonstrated a harmful association between CCBs and glaucoma may be attributed to confounding factors such as CVD that was not isolated.