What are the treatment options for patients with ocular hypertension (high blood pressure)?

Updated: Feb 22, 2019
  • Author: Matthew R Alexander, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Treatment of ocular hypertension varies. Depending on the severity of the ocular hypertension, management may include observation or initiation of antihypertensive therapy. In general, pharmacologic treatment is initiated in patients who have an increased risk of developing glaucoma.

Blood pressure control may result in regression of signs of hypertensive retinopathy, but spontaneous resolution may also be possible. [54] Among the issues that still need to be clarified are the following:

  • Whether antihypertensive agents with potential direct beneficial microvascular effects (eg, angiotensin-converting enzyme inhibitors [ACEIs]) would reduce the damage of retinopathy beyond the reduction caused by lowered blood pressure

  • Whether the specific reduction of hypertensive retinopathy also leads to reduction in cardiovascular disease morbidity and mortality

  • Whether established risk-reducing interventions in targeted persons with hypertensive retinopathy would lead to additional advantages, as compared to the use of strategies without regard to retinal findings

In the presence of hypertensive optic neuropathy, a rapid reduction of BP may pose a risk of worsening ischemic damage to the optic nerve. The optic nerve demonstrates autoregulation, so there is an adjustment in perfusion based on BP. A precipitous reduction in BP will reduce perfusion to the optic nerve and central nervous system as a result of their autoregulatory changes, resulting in infarction of the optic nerve head and, potentially, acute ischemic neurologic lesions of the CNS.

For further information, see the Medscape Drugs & Diseases article Ocular Hypertension.

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