Normal-tension glaucomatous optic neuropathy is related to blood pressure variability in the Maracaibo Aging Study

Melgarejo, Jesús D.; Maestre, Gladys E.; Mena, Luis J.; Lee, Joseph H.; Petitto, Michele; Chávez, Carlos; Calmon, Gustavo; Silva, Eglé; Thijs, Lutgarde; Al-Aswad, Lama A.; Terwilliger, Joseph D.; Moraes, Carlos Gustavo De; Wei, Fang‐Fei; Vanassche, Thomas; Verhamme, Peter; Staessen, Jan A; Zhang, Zhenyu

doi:10.1038/s41440-021-00687-1

Cited by 10 publications

(9 citation statements)

References 30 publications

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“…Furthermore, critically ill patients with COVID-19 who required transfer to other hospitals for further treatment, were admitted to the intensive care unit or died had greater systolic and diastolic BPV than patients with severe COVID-19 who recovered and were discharged from hospital (despite similar use of antihypertensive medication and similar mean BP levels) 83 . Furthermore, even in patients without hypertension, BPV has been associated with glaucomatous optic neuropathy, most probably via hypoperfusion of the optic nerve 84 .…”

Section: Clinical Relevance Of Bpvmentioning

confidence: 99%

Blood pressure and its variability: classic and novel measurement techniques

2022

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Current hypertension guidelines recommend using the average values of several blood pressure (BP) readings obtained both in and out of the office for the diagnosis and management of hypertension. In-office BP measurement using an upper-arm cuff constitutes the evidence-based reference method for current BP classification and treatment targets. However, out-of-office BP evaluation using 24 h ambulatory or home BP monitoring is recommended by all major medical associations for obtaining further insights into the BP profile of an individual and how it relates to their daily activities. Importantly, the highly variable nature of office and out-of-office BP readings has been widely acknowledged, including the association of BP variability with cardiovascular outcomes. However, to date, the implications of BP variability on cardiovascular outcomes have largely been ignored, with limited application in clinical practice. Novel cuffless wearable technologies might provide a detailed assessment of the 24 h BP profile and behaviour over weeks or months. These devices offer many advantages for researchers and patients compared with traditional BP monitors, but their accuracy and utility remain uncertain. In this Review, we outline and compare conventional and novel methods and techniques for assessing average BP levels and BP variability, and reflect on the utility and potential of these methods for improving the treatment and management of patients with hypertension.

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Section: Clinical Relevance Of Bpvmentioning

confidence: 99%

Blood pressure and its variability: classic and novel measurement techniques

2022

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“…Hypotension and hypertension have been identified as risk factors for glaucoma [6,[18][19][20][21][22][23]. These conflicting findings result in a complex link between blood pressure and glaucoma [24].…”

Section: Discussionmentioning

confidence: 99%

“…permits the study of reading-to-reading MAP variability [5,6]. This opens the possibility to investigate two potential unexplored mechanisms in open-angle glaucoma that can lead to reduced OPP in the presence of normal or high MAP.…”

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confidence: 99%

Effect of 24-h blood pressure dysregulations and reduced ocular perfusion pressure in open-angle glaucoma progression

Melgarejo,

Van Eijgen,

Wei

et al. 2023

Journal of Hypertension

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Background: Low ocular perfusion pressure (OPP), which depends on the mean arterial pressure (MAP) and intraocular pressure (IOP), is associated with glaucoma. We studied 24-h MAP dysregulations and OPP in relation to the progression of glaucoma damage. Methods: We retrospectively analyzed 155 normal-tension glaucoma (NTG) and 110 primary open-angle glaucoma (POAG) patients aged 18 years old followed at the University Hospital Leuven with repeated visual field tests (n = 7000 measures, including both eyes) who underwent 24-h ambulatory blood pressure monitoring. Twenty-four-hour MAP dysregulations were variability independent of the mean (VIM), and the five lowest dips in MAP readings over 24 h. OPP was the difference between 2/3 of the MAP and IOP. Glaucoma progression was the deterioration of the visual field, expressed as decibel (dB) changes in mean deviation analyzed by applying multivariable linear mixed regression models. Results: The mean age was 68 years (53% were women). High 24-h VIMmap was associated with glaucoma progression in POAG (P < 0.001) independently of the 24-h MAP level. The estimated changes in mean deviation in relation to dip MAP measures ranged from −2.84 dB [95% confidence interval (CI) −4.12 to −1.57] to −2.16 dB (95% CI −3.46 to −0.85) in POAG. Reduced OPP along with high variability and dips in MAP resulted in worse mean deviation deterioration. Conclusion: The progression of glaucoma damage associates with repetitive and extreme dips in MAP caused by high variability in MAP throughout 24 h. This progression exacerbates if 24-h MAP dysregulations occur along with reduced OPP.

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“…IOP tends to be higher at night due to decreased aqueous humor drainage via the trabecular meshwork and uveoscleral pathway ( 80 ). Similarly, diurnal variation in BP and nocturnal dipping may contribute to glaucoma pathogenesis as well ( 81 , 82 ). Nocturnal BP reduction is attributed to a fall in sympathetic tone with reduced circulating levels of catecholamines ( 83 ).…”

Section: Cav-1 and Disruption Of Circadian Rhythmsmentioning

confidence: 99%

Caveolin-1 in vascular health and glaucoma: A critical vascular regulator and potential therapeutic target

2023

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Caveolin-1 (Cav-1) is an integral scaffolding membrane protein found in most cell types. Cav-1 has been found to contribute significantly to ocular function, with mutations of Cav-1 being associated with a genetic risk of glaucoma development. Raised intraocular pressure (IOP) is a major modifiable risk factor for glaucoma. Cav-1 may be involved in both IOP-dependent and independent mechanisms involving vascular dysregulation. Systemic vascular diseases including hypertension, diabetes and hyperlipidaemia, have been shown to be associated with glaucoma development. Cav-1 is closely interlinked with endothelial nitric oxide synthase pathways that mediate vascular function and prevent cardiovascular diseases. Endothelial nitric oxide synthase and endothelin-1 are key vasoactive molecules expressed in retinal blood vessels that function to autoregulate ocular blood flow (OBF). Disruptions in the homeostasis of OBF have led to a growing concept of impaired neurovascular coupling in glaucoma. The imbalance between perfusion and neuronal stimulation arising from Cav-1 depletion may result in relative ischemia of the optic nerve head and glaucomatous injury. OBF is also governed by circadian variation in IOP and systemic blood pressure (BP). Cav-1 has been shown to influence central BP variability and other circadian rhythms such as the diurnal phagolysosomal digestion of photoreceptor fragments and toxic substrates to maintain ocular health. Overall, the vast implications of Cav-1 on various ocular mechanisms leading to glaucoma suggest a potential for new therapeutics to enhance Cav-1 expression, which has seen success in other neurodegenerative diseases.

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Normal-tension glaucomatous optic neuropathy is related to blood pressure variability in the Maracaibo Aging Study

Cited by 10 publications

References 30 publications

Blood pressure and its variability: classic and novel measurement techniques

Blood pressure and its variability: classic and novel measurement techniques

Effect of 24-h blood pressure dysregulations and reduced ocular perfusion pressure in open-angle glaucoma progression

Caveolin-1 in vascular health and glaucoma: A critical vascular regulator and potential therapeutic target

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