Association Between Chronic Oral Nitrate Use and the Risk of Ocular Hypertension and Open-Angle Glaucoma.

PURPOSE

To evaluate the association between the use of oral nitrates and the risk of developing ocular hypertension (OHT) and open-angle glaucoma (OAG) in patients with chronic ischemic heart disease (IHD).

DESIGN

Retrospective clinical cohort study.

SUBJECTS

Patients aged ≥40 with a diagnosis of chronic IHD identified in the TriNetX U.S. Collaborative Network from January 1, 2005, to January 1, 2023

METHODS

This study utilized deidentified patient data from the TriNetX database. Patients aged ≥40 years with a diagnosis of chronic IHD were categorized into two cohorts: those prescribed oral nitrates (≥4 renewal prescriptions) (index event) and those without nitrate prescriptions. Exclusion criteria included a prior diagnosis of glaucoma or OHT or those who had nitrates for indications other than IHD. Propensity score matching (PSM) (1:1 nearest neighbor, caliper 0.1) was performed to balance demographic, clinical, and socioeconomic factors. We performed Cox proportional hazards model to calculate the adjusted hazards ratio (aHR) and 95% confidence intervals (CIs).The primary endpoints were the risks of developing OAG, primary open-angle glaucoma (POAG), OHT, and the initiation of first-line glaucoma treatments over 1-, 3-, and 5-year follow-up periods from the index event.

MAIN OUTCOME MEASURES

OAG, POAG, OHT, and the initiation of first-line glaucoma treatments.

RESULTS

After PSM, each cohort included 30,937 patients. Nitrate use was associated with a significantly lower risk of OAG at 3 years (aHR, 0.82; 95% CI, 0.71-0.95) and 5 years (aHR, 0.68; 95% CI, 0.58-0.79). Similarly, the risk of POAG was reduced at 3 years (aHR, 0.78; 95% CI, 0.67-0.92) and 5 years (aHR, 0.67; 95% CI, 0.57-0.79). However, no significant association was observed between nitrate use and OHT at any time point. Patients in the nitrate group were also less likely to require first-line glaucoma therapy at 1 year (aHR, 0.72; 95% CI, 0.63-0.81), 3 years (aHR, 0.78; 95% CI, 0.71-0.85), and 5 years (aHR, 0.83; 95% CI, 0.75-0.91).

CONCLUSIONS

The use of oral nitrates was associated with a reduced risk of OAG and POAG over long-term follow-up, while no effect was observed on OHT development.