Ambulatory blood pressure monitoring in glaucoma patients. The nocturnal systolic dip and its relationship with disease progression
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.
Unable to display preview. Download preview PDF.
- 1.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.Google Scholar
- 3.Verdecchia P, Schillaci G, Procellati S. Dippers versus non dippers. J Hypertension 1991; 9(8): S 42–4.Google Scholar
- 5.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.Google Scholar
- 8.Berglund G. Goals of antihypertensive therapy. Is there a point beyond which pressure reduction is dangerous? Am J Hypertension 1989; 2: 586-93.Google Scholar
- 11.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.Google Scholar
- 14.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.Google Scholar