24-Hour Blood Pressure Monitoring in Patients With Anterior Ischemic Optic Neuropathy

Landau, Klara; Winterkorn, Jacqueline M.S.; Mailloux, Lionel U.; Vetter, W; Napolitano, Barbara

doi:10.1001/archopht.1996.01100130562012

Cited by 88 publications

(48 citation statements)

References 33 publications

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“…17 Although the conclusions drawn by the authors of the study point to a major difference between groups in early morning BP (lower BP was seen in the AION patients), there were only two time points (in either systolic or diastolic BP averages during the 24-h period) when the controls had higher BP than the AION patients. This observation is at least consistent with the hypothesis that AION may be related to relative hypotension, especially at night and on arising.…”

Section: Adverse Ophthalmic Consequences Of Nocturnal Ischemiamentioning

confidence: 80%

Circadian variation in blood pressureImplications for the elderly patient

Elliott

1999

American Journal of Hypertension

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In most people, blood pressure (BP) displays a characteristic diurnal pattern, with a decline during sleep and a sharp increase around the time of awakening. The early morning surge in BP is synchronous with an increase in the risk of catastrophic cardiovascular events, including acute myocardial infarction, sudden cardiac death, and stroke. Although most clinical investigations have centered on modulating or even preventing the morning surge, emerging data suggest that it may be important to avoid nocturnal hypotension, especially in elderly patients and in those with established atherosclerotic disease. Considerable evidence has been accumulated to suggest that excessive lowering of BP at night (whether naturally or through the use of antihypertensive medications) can result in untoward ischemic phenomena, including silent cerebral damage (Binswanger's disease) or ophthalmologic symptoms (eg, anterior ischemic optic neuropathy). Controlled-onset extended-release verapamil, through its unique delivery system, tends to diminish the morning BP surge, whereas it preserves a normal nocturnal BP decline; its effect on preventing early morning cardiovascular catastrophes (while preserving relatively normal nocturnal BP) is currently being tested in a large, international clinical trial. Am J Hypertens 1999; 12:43S-49S

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Section: Adverse Ophthalmic Consequences Of Nocturnal Ischemiamentioning

confidence: 80%

Circadian variation in blood pressureImplications for the elderly patient

Elliott

1999

American Journal of Hypertension

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“…Most data come from the adult literature and indicate that hypoperfusion of the posterior ciliary arteries, which perfuse the head of the optic nerve, is the principal culprit of this condition (14,15). In general, funduscopy performed immediately after the acute symptoms shows swelling of the optic disk and flame hemorrhages (6,7,16).…”

Section: Discussionmentioning

confidence: 99%

Anterior Ischemic Optical Neuropathy in Children on Chronic Peritoneal Dialysis: Report of 7 Cases

et al. 2015

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ORIGINAL ARTICLES♦ Background: Anterior ischemic optic neuropathy (AION) is characterized by infarction of the optic nerve head due to hypoperfusion of the posterior ciliary arteries and causes sudden blindness in adults on chronic dialysis, but has rarely been described in children. Unlike adults, children do not have comorbidities related to aging. ♦ Methods: We retrospectively analyzed data of 7 children on nocturnal continuous cycling peritoneal dialysis (CCPD) who developed AION identified within the Italian Registry of Pediatric Chronic Dialysis. We also summarized data from 10 cases reported in the literature. ♦ Results: Our 7 patients suffered from acute onset bilateral blindness. Their mean age was 3.2 years and chronic hypotension had been observed prior the AION in 3 of the 7 children. Low systolic blood pressure (SBP) was associated with higher risk of developing AION according to statistical analysis. None recovered completely. In total, 11 out of 16 experienced a partial recovery and no clear evidence emerged favoring specific treatments.

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“…(a) Detection of transient, short-term fall of BP and its importance in ONH ischemic disorders: Our experience of recording 24-hour ambulatory BP has shown that the definition frequently used for nocturnal arterial hypotension (by cardiologists, internists and those interested in only evaluating the therapeutic effects of the various arterial hypotensive drugs) is the difference between daytime and nighttime mean arterial BPs; but that is totally inappropriate for a study dealing with the role of nocturnal arterial hypotension in ONH ischemic disorders [92,93]. This is because a transient fall of BP below the critical autoregulatory range of blood flow in the ONH may be enough to precipitate an ischemic episode in a vulnerable ONH ( fig.…”

Section: Confounding Factors In Ambulatory Bp Monitoring In Patients mentioning

confidence: 99%

Role of Nocturnal Arterial Hypotension in Optic Nerve Head Ischemic Disorders

Hayreh

Podhajsky²,

Zimmerman³

1999

Ophthalmologica

287

193

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Objective: To investigate the role of nocturnal arterial hypotension, intraocular pressure (IOP) and heart rate in optic nerve head (ONH) ischemic disorders, and the effects of systemic factors and topical β-blocker eye-drops on nocturnal arterial hypotension and heart rate. Methods: We investigated prospectively, by 24-hour ambulatory blood pressure (BP) monitoring and diurnal curve of the IOP, 275 white patients with anterior ischemic optic neuropathy (AION – 114), normal tension glaucoma (NTG – 131) and primary open angle glaucoma (POAG – 30). Results: Hourly average BP data analyses showed a significantly greater drop in mean diastolic BP (p < 0.009) at night in NTG than AION. Cases with visual field deterioration had significantly (p = 0.05) lower minimum nighttime diastolic BP. Arterial hypertensives on oral hypotensive therapy showed a significantly lower mean nighttime systolic BP (p = 0.006) and larger mean percentage drop in systolic (p < 0.0001), diastolic (p = 0.0009) and mean (p < 0.0001) BPs. Normotensives and hypertensives without therapy had no such difference. IOP showed no significant correlation with visual field deterioration in any of these conditions. Patients using β-blocker eyedrops, compared with those not using them, had greater percentage drop in diastolic BP (p = 0.028), lower minimum nighttime diastolic BP (p = 0.072) and lower minimum nighttime heart rate (p = 0.002). Conclusions: Findings of our study suggest that nocturnal hypotension, by reducing the ONH blood flow below a crucial level during sleep in a vulnerable ONH, may play a role in the pathogenesis of AION and glaucomatous optic neuropathy (GON) and progression of visual loss in them. Thus, nocturnal hypotension may be the final insult in a multifactorial situation.

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24-Hour Blood Pressure Monitoring in Patients With Anterior Ischemic Optic Neuropathy

Cited by 88 publications

References 33 publications

Circadian variation in blood pressureImplications for the elderly patient

Circadian variation in blood pressureImplications for the elderly patient

Anterior Ischemic Optical Neuropathy in Children on Chronic Peritoneal Dialysis: Report of 7 Cases

Role of Nocturnal Arterial Hypotension in Optic Nerve Head Ischemic Disorders

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