Amlodipine increases risk of primary open angle glaucoma

Abstract

Abstract Background The use of calcium channel blockers (CCBs), especially cardioselective medicines, is associated with primary open angle glaucoma (POAG) in a statistically meaningful but minor way. In general, those who had received CCB medication were at a 23% increased risk of developing glaucoma in comparison to those who had never taken the antihypertensive drugs. Methods We used MedWatch and UK Biobank (UKBB) data to evaluate the effects of amlodipine on POAG and intra ocular pressure (IOP). We analyzed 3 POAG associated SNPs: rs9913911, an intron variant in Growth arrest-specific 7 (GAS7), one of the genes that influences IOP; rs944801, an intron variant within CDKN2B-AS1, and rs2093210, an intron variant within SIX6, known to be associated with vertical cup-disc ratio (VCDR), an important optic nerve head parameter that is often used to define or diagnose glaucoma. Results Amlodipine use in MedWatch doubled the prevalence of POAG, from 0.0805–0.177%, a small but significant increase. Multivariate analysis by logistic regression of UKBB data revealed that POAG risk was significantly increased with age, male sex, and major alleles of rs9913911 (GAS7) and rs944801 (CDKN2B-AS1), minor allele of rs2093210 (SIX6). Amlodipine increased POAG risk by 16.1% (p = 0.032). Conclusion Amlodipine, a frequently prescribed drug and first line treatment for hypertension, has a potentially hazardous relationship with POAG. Knowledge of this link can guide the prescribing of alternate drugs for hypertensive individuals who have glaucoma or are at risk for it. Diuretics and beta blockers are not associated with POAG or increased IOP and could be substituted for amlodipine in hypertensive patients with POAG. If the physician feels that amlodipine treatment is necessary, hypertensive patients with a family history of glaucoma should have at least an eye examination and regular follow-up scheduled before amlodipine is initiated.