Ambulatory blood pressure monitoring in glaucoma patients. The nocturnal systolic dip and its relationship with disease progression
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Purpose : This study was designed to uncover a new sensitive and specific factor for predicting the progression of glaucoma. Methods : The 24-hour ambulatory blood pressure and diurnal curve of intra-ocular pressure were recorded in seventy patients: 51 primary open angle glaucoma (POAG) and 19 normal tension glaucoma (NTG). The mean systolic, diastolic and average arterial blood pressure were calculated, along with the nocturnal dip of systolic pressure and diastolic blood pressure. Two-year disease progression was assessed for all patients by means of retrospective analysis of visual fields defects on repeated perimetries. Results : Abnormal (absence or increased) nocturnal dip of systolic blood pressure was found to be correlated with disease progression in POAG and NTG patients with a sensitivity of 86% and a specificity of 85%, whereas no significant correlation was found for the other risks factors envisaged. Furthermore, a significant relationship between stable visual field defects and the use of diuretics/laser procedure was evidenced. Conclusion : The nocturnal dip of systolic blood pressure should be considered as a predictive factor of disease progression in NTG and POAG. Further prospective studies are needed to ascertain whether dip normalization could help slow down the visual field loss in these patients.
- Hayreh SS. Vascular factors in the pathogenesis of the glaucomatous optic neuropathy. In: Drance SM (ed) International Symposium on Glaucoma. Blood flow and drug treatment. Williams and Wilkins, Baltimore, pp. 33-44, 1992.
- Hayreh SS, Zimmerman MB, Podhajsky P, Alward WLM. Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders. Am J Ophthalmol 1994; 117: 603-24.
- Verdecchia P, Schillaci G, Procellati S. Dippers versus non dippers. J Hypertension 1991; 9(8): S 42–4.
- Verdecchia P, Schillaci G, Guerrieri M et al. Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension. Circulation 1990; 81: 528-36.
- Shimada K, Kawamoto A, Matsubayashi K, Nishinaga M et al. Diurnal blood pressure variations and silent cerebrovascular damage in elderly patients with hypertension. J Hypertension 1992; 10: 875-8.
- Floras JS. Antihypertensive treatment, myocardial infartion and nocturnal ischemia. Lancet 1988; 2: 994-6. CrossRef
- Kleiman N, Schechteman K, Young P et al. Diltiazem reinfarction study. Lack of diurnal variation in the occurrence of non-Q wave infarction. Circulation 1990;81: 548-55.
- Berglund G. Goals of antihypertensive therapy. Is there a point beyond which pressure reduction is dangerous? Am J Hypertension 1989; 2: 586-93.
- Farnett L, Mulrow CD, Linn WD et al. The J-curve phenomenon and the treatment of hypertension: Is there a point beyond which pressure reduction is dangerous? Jama 1991; 265: 489-95.
- Graham SL, Drance SM, Wijsman K, Douglas GR, Mikelberg FS. Ambulatory blood pressure monitoring in glaucoma: The nocturnal dip. Ophthalmology 1995;.102: 61-9.
- O’Brien E, Murphy J, Tyndall A et al. Twenty-four hours ambulatory blood pressure in men and women aged 17 to 80 years: the Allied Irish Bank Study. J Hypertens.1991; 9:355-60.
- Kaiser HJ, Flammer J, Graf T, Stumpfig S. Systemic blood pressure in glaucoma patients. Graefes Arch Clin Exp Ophthalmol. 1993; 231: 677-80.
- Reeves RA, Shapiro AP, Thompson MS, Johnsen AM. Loss of nocturnal decline in blood pressure after cardiac transplantation. Circulation 1986; 73: 401-8.
- Munakata M, Imai Y, Abe K et al. Involvement of the hypothalamo-pituitary adrenal axis in the control of circadian blood pressure rhythm. J Hypertension 1988; 6(4): S 44-46.
- Grunwald JE, Riva CE, Stone RA et al.Retinal autoregulation in open-angle glaucoma. Ophthalmology 1984; 91: 1690-4.
- Ulrich WD, Ulrich C, Bohne BD. Deficient autoregulation and lengthening of diffusion distance in the anterior optic nerve circulation in glaucoma: an electroencephalodynamo-graphic investigation. Ophthalmic Res 1986; 18: 253-9.
- Pillumat LE, Stodtmeister R, Wilmanns I. Pressure compliance of the optic nerve head in low tension glaucoma. Br J Ophthalmol 1987; 71: 181-7.
- Ambulatory blood pressure monitoring in glaucoma patients. The nocturnal systolic dip and its relationship with disease progression
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