Antihypertensive medications reduce the thickness of both the retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GC-IPL), according to new research.

The use of any class of antihypertensive medication is associated with thinner average RNFL after adjusting for age, gender, ethnicity, intraocular pressure (IOP), body mass index (BMI), mean arterial pressure, and diabetes, according to a Singapore-based analysis. The researchers evaluated close to 4700 participants between 44 and 86 years old. Specifically, ACE inhibitors and diuretics were significantly associated with thinner RNFL.

Researchers discovered a similar trend with macular ganglion cells — ACE inhibitor and diuretic medications also had the most impact on average GC-IPL thickness. In addition, participants who took two or more types of antihypertensives exhibited a thinner average measurement in either data category; RNFL or GC-IPL.

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ACE inhibitors and diuretics may have greater impact because they affect “the ocular microvasculature structurally and/or functionally in terms of diurnal BP regulation, in comparison with other classes of antihypertensive drugs,” the report explains.

“Our study has important implications for the use of antihypertensive medications in glaucoma patients, who already possess structurally impaired retinal ganglion cells as a result of their disease,” the authors wrote.

Since any of the five classes of these medications can be prescribed to manage blood pressure, “the use of certain types of antihypertensive medication, particularly ACE inhibitors as first-line therapy, may need to be carefully considered in patients with vulnerable optic nerves.” Optic nerves at risk include those affected by glaucoma and other optic neuropathies.

The researchers recommend additional directions to explore, including genetic variances in ocular response to antihypertensives, and the time of day blood pressure medications are taken in relation to a nocturnal dip in blood pressure. They add that a multi-visit longitudinal study is the next step “to evaluate the sequential relationships between medication intake status, hypertension control status, and RNFL or GC-IPL profiles.”


Chong R, Chee M, Tham Y, Association of Antihypertensive Medication with Retinal Nerve Fiber Layer and Ganglion Cell-Inner Plexiform Layer Thickness. Ophthalmology. 2020. doi: