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Relationship Between Daytime Variability of Blood Pressure or Ocular Perfusion Pressure and Glaucomatous Visual Field Progression

      Purpose

      To study daytime or nighttime variability of mean arterial pressure and ocular perfusion pressure in untreated normal-tension glaucoma (NTG) patients and determine whether increased short-term mean arterial pressure and/or ocular perfusion pressure variability are associated with greater risk of visual field (VF) progression.

      Design

      Longitudinal, retrospective, observational study.

      Methods

      This study enrolled 237 eyes of 237 untreated NTG patients who underwent 24-hour intraocular pressure and ambulatory blood pressure monitoring in the habitual position, and had ≥5 reliable VF tests during follow-up. Kaplan-Meier analyses were performed to compare outcomes with reference to the level of short-term mean arterial pressure and ocular perfusion pressure standard deviation for VF deterioration. Hazard ratios for the association between clinical factors, including short-term mean arterial pressure and ocular perfusion pressure standard deviation, and VF progression were obtained using Cox proportional hazards models.

      Results

      Over-dipper NTG patients showed significantly larger daytime and nighttime mean arterial pressure and ocular perfusion pressure standard deviation than non-dippers or dippers. Both increased daytime and nighttime mean arterial pressure or ocular perfusion pressure standard deviation were associated with greater VF progression probabilities. Increased daytime mean arterial pressure or ocular perfusion pressure standard deviation was a significant predictor of subsequent VF progression (P = .023 and P < .001, respectively).

      Conclusions

      Over-dipper NTG eyes showed significantly higher daytime or nighttime mean arterial pressure and ocular perfusion pressure variabilities than non-dipper and dipper NTG eyes. Increased daytime mean arterial pressure and ocular perfusion pressure standard deviation at baseline were significant predictors of future VF progression in NTG.
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      References

        • Hietanen E.
        • Wendelin-Saarenhovi M.
        Ambulatory blood pressure reproducibility and application of the method in a healthy Finnish cohort.
        Scand J Clin Lab Invest. 1996; 56: 471-480
        • Mancia G.
        • Grassi G.
        Mechanisms and clinical implications of blood pressure variability.
        J Cardiovasc Pharmacol. 2000; 35: S15-S19
        • Kapa S.
        • Venkatachalam K.L.
        • Asirvatham S.J.
        The autonomic nervous system in cardiac electrophysiology: an elegant interaction and emerging concepts.
        Cardiol Rev. 2010; 18: 275-284
        • Palatini P.
        • Penzo M.
        • Racioppa A.
        • et al.
        Clinical relevance of nighttime blood pressure and of daytime blood pressure variability.
        Arch Intern Med. 1992; 152: 1855-1860
        • Rothwell P.M.
        Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension.
        Lancet. 2010; 375: 938-948
        • Verdecchia P.
        • Angeli F.
        • Gattobigio R.
        • Rapicetta C.
        • Reboldi G.
        Impact of blood pressure variability on cardiac and cerebrovascular complications in hypertension.
        Am J Hypertens. 2007; 20: 154-161
        • Pringle E.
        • Phillips C.
        • Thijs L.
        • et al.
        Systolic blood pressure variability as a risk factor for stroke and cardiovascular mortality in the elderly hypertensive population.
        J Hypertens. 2003; 21: 2251-2257
        • Meyer J.H.
        • Brandi-Dohrn J.
        • Funk J.
        Twenty four hour blood pressure monitoring in normal tension glaucoma.
        Br J Ophthalmol. 1996; 80: 864-867
        • Bisantis C.
        Glaucoma: decision making in therapy.
        in: Bucci M.G. Ocular Blood Flow and its Autoregulation. Springer Verlag, Milan1996: 37-40
        • Graham S.L.
        • Drance S.M.
        Nocturnal hypotension: role in glaucoma progression.
        Surv Ophthalmol. 1999; 43: S10-S16
        • Kario K.
        • Motai K.
        • Mitsuhashi T.
        • et al.
        Autonomic nervous system dysfunction in elderly hypertensive patients with abnormal diurnal blood pressure variation: relation to silent cerebrovascular disease.
        Hypertension. 1997; 30: 1504-1510
        • Hayreh S.S.
        • Podhajsky P.
        • Zimmerman M.B.
        Role of nocturnal arterial hypotension in optic nerve head ischemic disorders.
        Ophthalmologica. 1999; 213: 76-96
        • Feldman F.
        • Sweeney V.P.
        • Drance S.M.
        Cerebro-vascular studies in chronic simple glaucoma.
        Can J Ophthalmol. 1969; 4: 358-364
        • Kaiser H.J.
        • Flammer J.
        • Burckhardt D.
        Silent myocardial ischemia in glaucoma patients.
        Ophthalmologica. 1993; 207: 6-7
        • Phelps C.D.
        • Corbett J.J.
        Migraine and low-tension glaucoma. A case-control study.
        Invest Ophthalmol Vis Sci. 1985; 26: 1105-1108
        • Cursiefen C.
        • Wisse M.
        • Cursiefen S.
        • Junemann A.
        • Martus P.
        • Korth M.
        Migraine and tension headache in high-pressure and normal-pressure glaucoma.
        Am J Ophthalmol. 2000; 129: 102-104
        • Choi J.
        • Jeong J.
        • Cho H.S.
        • Kook M.S.
        Effect of nocturnal blood pressure reduction on circadian fluctuation of mean ocular perfusion pressure: a risk factor for normal tension glaucoma.
        Invest Ophthalmol Vis Sci. 2006; 47: 831-836
        • Choi J.
        • Kim K.H.
        • Jeong J.
        • Cho H.S.
        • Lee C.H.
        • Kook M.S.
        Circadian fluctuation of mean ocular perfusion pressure is a consistent risk factor for normal-tension glaucoma.
        Invest Ophthalmol Vis Sci. 2007; 48: 104-111
        • Sung K.R.
        • Lee S.
        • Park S.B.
        • et al.
        Twenty-four hour ocular perfusion pressure fluctuation and risk of normal-tension glaucoma progression.
        Invest Ophthalmol Vis Sci. 2009; 50: 5266-5274
        • Kikuya M.
        • Hozawa A.
        • Ohokubo T.
        • et al.
        Prognostic significance of blood pressure and heart rate variabilities: the Ohasama study.
        Hypertension. 2000; 36: 901-906
        • Ramdas W.D.
        • Wolfs R.C.
        • Hofman A.
        • de Jong P.T.
        • Vingerling J.R.
        • Jansonius N.M.
        Ocular perfusion pressure and the incidence of glaucoma: real effect or artifact? The Rotterdam Study.
        Invest Ophthalmol Vis Sci. 2011; 52: 6875-6881
        • Jeong da W.
        • Kook M.S.
        • Lee K.S.
        • Lee J.R.
        • Han S.
        Circadian pattern of intraocular pressure fluctuations in young myopic eyes with open-angle glaucoma.
        Invest Ophthalmol Vis Sci. 2014; 55: 2148-2156
        • Lee Y.R.
        • Kook M.S.
        • Joe S.G.
        • et al.
        Circadian (24-hour) pattern of intraocular pressure and visual field damage in eyes with normal-tension glaucoma.
        Invest Ophthalmol Vis Sci. 2012; 53: 881-887
        • Bill A.
        Glaucoma: conceptions of a disease: pathogenesis, diagnosis, therapy.
        in: Heilmann K. Richardson K.T. Physiological Aspects of the Circulation in the Optic Nerve. Saunders, Philadelphia1978: 97-103
        • Verdecchia P.
        • Schillaci G.
        • Porcellati C.
        Dippers versus non-dippers.
        J Hypertens Suppl. 1991; 9: S42-S44
        • Leske M.C.
        • Heijl A.
        • Hyman L.
        • Bengtsson B.
        Early Manifest Glaucoma Trial: design and baseline data.
        Ophthalmology. 1999; 106: 2144-2153
        • Sohn S.W.
        • Song J.S.
        • Kee C.
        Influence of the extent of myopia on the progression of normal-tension glaucoma.
        Am J Ophthalmol. 2010; 149: 831-838
        • Charlson M.E.
        • de Moraes C.G.
        • Link A.
        • et al.
        Nocturnal systemic hypotension increases the risk of glaucoma progression.
        Ophthalmology. 2014; 121: 2004-2012
        • Tokunaga T.
        • Kashiwagi K.
        • Tsumura T.
        • Taguchi K.
        • Tsukahara S.
        Association between nocturnal blood pressure reduction and progression of visual field defect in patients with primary open-angle glaucoma or normal-tension glaucoma.
        Jpn J Ophthalmol. 2004; 48: 380-385
        • Riccadonna M.
        • Covi G.
        • Pancera P.
        • et al.
        Autonomic system activity and 24-hour blood pressure variations in subjects with normal- and high-tension glaucoma.
        J Glaucoma. 2003; 12: 156-163
        • Yazici B.
        • Usta E.
        • Erturk H.
        • Dilek K.
        Comparison of ambulatory blood pressure values in patients with glaucoma and ocular hypertension.
        Eye (Lond). 2003; 17: 593-598
        • Skinhoj E.
        • Strandgaard S.
        Pathogenesis of hypertensive encephalopathy.
        Lancet. 1973; 1: 461-462
        • Liu J.H.
        • Gokhale P.A.
        • Loving R.T.
        • Kripke D.F.
        • Weinreb R.N.
        Laboratory assessment of diurnal and nocturnal ocular perfusion pressures in humans.
        J Ocul Pharmacol Ther. 2003; 19: 291-297
        • Lee T.E.
        • Yoo C.
        • Kim Y.Y.
        Effects of different sleeping postures on intraocular pressure and ocular perfusion pressure in healthy young subjects.
        Ophthalmology. 2013; 120: 1565-1570
        • Pierdomenico S.D.
        • Lapenna D.
        • Di Tommaso R.
        • et al.
        Blood pressure variability and cardiovascular risk in treated hypertensive patients.
        Am J Hypertens. 2006; 19: 991-997
        • Gulati V.
        • Fan S.
        • Zhao M.
        • Maslonka M.A.
        • Gangahar C.
        • Toris C.B.
        Diurnal and nocturnal variations in aqueous humor dynamics of patients with ocular hypertension undergoing medical therapy.
        Arch Ophthalmol. 2012; 130: 677-684
        • Krupin T.
        • Liebmann J.M.
        • Greenfield D.S.
        • Ritch R.
        • Gardiner S.
        Low-Pressure Glaucoma Study Group. A randomized trial of brimodine versus timolol in preserving visual function: results from the Low-Pressure Glaucoma Treatment Study.
        Am J Ophthalmol. 2011; 151: 671-681
        • Leske M.C.
        • Heijl A.
        • Hyman L.
        • Bengtsson B.
        • Dong L.
        • Yang Z.
        Predictors of long-term progression in the early manifest glaucoma trial.
        Ophthalmology. 2007; 114: 1965-1972
        • Heijl A.
        • Leske M.C.
        • Bengtsson B.
        • Hyman L.
        • Bengtsson B.
        • Hussein M.
        Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial.
        Arch Ophthalmol. 2002; 120: 1268-1279
        • Collaborative normal-tension glaucoma study group
        The effectiveness of intraocular pressure reduction in the treatment of normal-tension glaucoma. Collaborative Normal-Tension Glaucoma Study Group.
        Am J Ophthalmol. 1998; 126: 498-505
        • De Moraes C.G.
        • Liebmann J.M.
        • Greenfield D.S.
        • Gardiner S.K.
        • Ritch R.
        • Krupin T.
        Risk factors for visual field progression in the low-pressure glaucoma treatment study.
        Am J Ophthalmol. 2012; 154: 702-711
        • Sayegh F.N.
        • Weigelin E.
        Functional ophthalmodynamometry. Comparison between brachial and ophthalmic blood pressure in sitting and supine position.
        Angiology. 1983; 34: 176-182

      Biography

      Jinyoung Lee, MD, is a clinical fellow at the Asan Medical Center, Seoul, Korea. Dr Lee graduated from Ulsan University College of Medicine. She completed internship, residency, and glaucoma fellowship at the Asan Medical Center. Her current research interests include myopia and glaucoma, glaucoma imaging, and pathophysiology of glaucoma.

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