Korean J Ophthalmol.  2009 Mar;23(1):32-39. 10.3341/kjo.2009.23.1.32.

Twenty-Four Hour Blood Pressure Pattern in Patients With Normal Tension Glaucoma in the Habitual Position

• Joe SG
• Choi J
• Sung KR
• Park SB
• Kook MS

• KMID: 1115649
• DOI: http://doi.org/10.3341/kjo.2009.23.1.32

Abstract

PURPOSE
To investigate the relationship between blood pressure (BP) parameters in the habitual position and glaucomatous damage at initial presentation in patients with untreated normal tension glaucoma (NTG).
METHODS
Fifty-four eyes from 54 subjects diagnosed with NTG were consecutively enrolled. BP was measured with an automated ambulatory monitoring device in the habitual position during 24-hour in-hospitalization. Patients were classified into three groups: non-dippers, dippers, and over-dippers. corresponded to the degree of reduction in their nocturnal mean arterial pressure (MAP) compared with their diurnal MAP. Regression models were used to evaluate potential risk factors, including: age, pre-admission office intraocular pressure (IOP), central corneal thickness (CCT), and BP parameters. Functional outcome variables for glaucomatous damage included mean deviation (MD) and pattern standard deviation (PSD) on a Humphrey field analyzer (HFA). Anatomic outcome variables were TSNIT score (temporal, superior, nasal, inferior, and temporal) average, superior average, inferior average, and nerve fiber indicator (NFI) score on scanning laser polarimetry with variable corneal compensation (SLP-VCC; GDx-VCC).
RESULTS
Marked systolic blood pressure (SBP), diastolic blood pressure (DBP), and MAP fluctuation were noted in the over-dipper group (p<0.05). A linear regression analysis model revealed that nocturnal trough DBP and MAP, average nocturnal SBP, and MAP were all significantly associated with a decreased average TSNIT score and an increased NFI score.
CONCLUSIONS
Nocturnal BP reduction estimated in the habitual position was associated with structural damage in eyes with NTG. This finding may suggest systemic vascular etiology of NTG development associated with nocturnal BP reduction.

Keyword

Blood pressure; Habitual position; Normal tension glaucoma; 24-hour

MeSH Terms

Adult
Aged
Aged, 80 and over
Blood Pressure/*physiology
Blood Pressure Monitoring, Ambulatory/*methods
Circadian Rhythm/*physiology
Disease Progression
Female
Follow-Up Studies
Glaucoma, Open-Angle/diagnosis/*physiopathology
Humans
Intraocular Pressure/physiology
Male
Middle Aged
Nerve Fibers/pathology
Posture/*physiology
Prognosis
Prospective Studies
Retina/pathology
Risk Factors
Visual Fields

Figure

• 

  Fig. 1 Nocturnal mean MAP comparison among dippers, over-dippers, and non-dippers (95% confidence interval). p<0.001, one-way ANOVA. MAP=mean arterial pressure; ANOVA=analysis of variance.

• 

  Fig. 2 Twenty-four hour variation of MAP (95% confidence interval). MAP=mean arterial pressure.

• 

  Fig. 3 Time of DBP trough. DBP=diastolic blood pressure.

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