Phenotypes of orthostatic blood pressure behaviour and association with visual acuity
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Manifestations of neurocardiovascular instability (NCVI), including orthostatic hypotension (OH) orthostatic hypertension (OHTN) and impaired blood pressure variability (BPV), have been associated with cardiovascular (CV) events. The eye is highly vascular and we propose an ideal target end organ to investigate pathological implications of NCVI.
To identify and define clinically applicable phenotypes of orthostatic blood pressure (BP) behaviour, analogous to OH, OHTN, and orthostatic BPV and to investigate their relationship to vision.
Wave one data from the Irish Longitudinal Study on Ageing (TILDA) were used. Orthostatic BP (OBP) phenotypes were identified and defined from beat-to-beat BP data, measured by digital photoplethysmography during an active stand (AS) lasting 110 s (s). Visual acuity (VA) was assessed using the Early Treatment Diabetic Retinopathy Study (EDTRS) LogMAR chart. The relationship between OBP phenotypes and VA in 4355 adults aged ≥50 years was investigated through multivariate linear regression models.
There was a wide fluctuation in the prevalence of OH and OHTN up to 20 s after standing. After 30 s, four distinct OBP phenotypes were identified: in 70 % BP stabilised to within 20/10 mmHg of baseline BP, 4 % had persistent OH, 2 % had persistent OHTN and 25 % had exaggerated orthostatic blood pressure variability BPV. Systolic BPV was associated with worse VA (P = 0.02) as was diastolic BPV (P = 0.03), following adjustment for demographics, health behaviours, self-report eye diseases and diabetes, uncorrected refractive error, objective hypertension and antihypertensives.
The hypothesis that NCVI may independently modulate CV risk is supported the independent association of exaggerated BPV and worse VA.
KeywordsEye Visual acuity Orthostatic hypotension Orthostatic hypertension Blood pressure variability End-organ damage
The authors would like to thank all the participants in the study, the TILDA research, the team of interviewers and the study nurses and administrators. Funding is by The Atlantic. Philanthropies (research grant to TILDA), Irish Life plc, the Irish Government (research grant to TILDA), the health Research Board, The National Institutes of Health (NIH) /National Institute of Aging (NIA) and the European Union Horizon 2020. Dr Peto is funded by the NIHR BMRC at Moorfields Eye Hospital Foundation Trust and the UCL Institute of Ophthalmology.
Compliance with ethical standards
Conflict of interest
The authors report no conflicts of interest.
Informed consent was obtained for all participants, and all protocols and procedures were approved by the institutional review board.
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