Br J Ophthalmol 93:1276-1282 doi:10.1136/bjo.2008.149047
  • Review

Blood pressure and glaucoma

  1. V P Costa1,2,
  2. E S Arcieri1,3,
  3. A Harris4
  1. 1
    Department of Ophthalmology, University of Campinas, Campinas, Brazil
  2. 2
    Department of Ophthalmology, University of São Paulo, São Paulo, Brazil
  3. 3
    Department of Ophthalmology, Federal University of Uberlândia, Uberlândia, Brazil
  4. 4
    Department of Ophthalmology, Indiana University, Indianapolis, USA
  1. Correspondence to Dr V P Costa, Glaucoma Service, University of Campinas, Rua Bahia 1087 apto 21, São Paulo SP 01244-001 Brazil; vp.costa{at}
  • Accepted 15 February 2009
  • Published Online First 30 March 2009


Although intraocular pressure (IOP) is considered the main risk factor for the development of glaucoma and the only parameter subject to treatment, there is sufficient evidence to suggest that glaucoma may continue to progress despite lowering patients’ IOP to targeted levels. Several studies have implicated vascular risk factors in the pathogenesis of glaucoma. Among them, blood pressure (BP) and ocular perfusion pressure have become increasingly important. Although clinicians cannot currently visualise ocular blood flow directly, they can easily measure glaucoma patients’ BP and IOP to calculate their ocular perfusion pressure and quantify the vascular changes. The purpose of this review article is to discuss the relationship between BP and IOP, BP and glaucoma, and perfusion pressure and glaucoma. We discuss the importance of autoregulation to maintain the adequate perfusion of the optic nerve head, and suggest that ocular perfusion pressure and its fluctuation may be parameters that need to be measured in glaucoma patients.


  • Funding The participation of AH is supported in part by an unrestricted research grant from Research to Prevent Blindness, New York.

  • Competing interests None.

  • Provenance and Peer review Not commissioned; externally peer reviewed.