Circadian Blood Pressure and Intraocular Pressure Patterns in Normal Tension Glaucoma Patients with Undisturbed Sleep

Abstract

PurposeTo investigate and compare the circadian pattern of blood pressure (BP), intraocular pressure (IOP) and mean ocular perfusion pressure (MOPP) while experiencing undisturbed sleep in normal-tension glaucoma (NTG) and non-glaucoma control patient groups.MethodsTwenty-four eyes from 24 patients diagnosed with NTG and 22 eyes from 22 control group patients were enrolled. Systolic BP, diastolic BP and IOP were measured every two hours except for the period of time from 1 AM to 7 AM in the NTG group and from 11 PM to 7 AM in the control group over a one-day period. IOP and hemodynamic parameters were then compared between the two groups. NTG patients were subdivided according to the degree of morning BP dip and IOP, and hemodynamic parameters and visual field indices (mean deviation and pattern standard deviation) were also compared among these subgroups.ResultsThere were no significant differences in mean systolic BP, mean diastolic BP and mean arterial pressure (MAP) between the NTG and the control groups. The NTG group showed a significantly large morning BP dip compared to the control group (7.1±4.2% vs. 3.8±3.4%, p=0.022). However, there were no significant differences in mean or fluctuation of MOPP between the two groups. Morning over-dippers showed significantly large MAP and MOPP fluctuations compared to non-dippers and dippers, while there were no significant differences in visual field indices among the three subgroups.ConclusionsNTG patients showed significant morning BP dips compared to the control group. The marked morning BP dip was associated with significantly large MAP or MOPP fluctuations but was not associated with visual field indices.

Primary Open-Angle Glaucoma vs Normal-Tension Glaucoma

“…Evaluation of ambulatory BP in patients with glaucoma can provide insight into the presence of associated modifiable vascular risk factors and ischemic risk. In the current study and consistent with previous research, 7,32,41,42 no significant differences in the average diurnal and nocturnal BP variables or the nocturnal dipping status were found between the POAG, NTG, and control groups following 24-hour BP assessment. There is, however, a lack of consistency in results reported by various groups regarding the relationship between systemic BP and glaucoma, with other studies 40,[43][44][45][46][47][48][49][50][51][52][53][54][55] finding associations between abnormal systemic BP and the presence of GON, particularly with regard to hypotension and nocturnal BP dipping.…”

Intraocular pressure fluctuation and glaucoma progression: what do we know?

“…Further, Kim et al 41 noted that during waking hours, patients with NTG had a significantly greater degree of IOP fluctuation than controls.…”

Comparison of intraocular pressure fluctuation before and after cataract surgeries in normal-tension glaucoma patients

“…Using GAT, Kim et al 34 reported that the 24-h IOP fluctuation in NTG eyes was significantly larger than that in healthy eyes. Their method could not adequately account for the variations in IOP throughout the day, because their methods might overlook the IOP fluctuations at interval between IOP measurements.…”