Glaucomatous Optic Neuropathy Associated with Nocturnal Dip in Blood Pressure

Melgarejo, Jesús D.; Lee, Joseph H.; Petitto, Michele; Yépez, Juan B.; Murati, Felipe A.; Jin, Zhezhen; Chávez, Carlos; Pirela, Rosa V.; Calmon, Gustavo; Lee, Winston; Johnson, Matthew P.; Mena, Luis J.; Al-Aswad, Lama A.; Terwilliger, Joseph D.; Allikmets, Rando; Maestre, Gladys E.; Moraes, Carlos Gustavo De

doi:10.1016/j.ophtha.2017.11.029

Cited by 53 publications

(59 citation statements)

References 37 publications

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“…Another study also suggested that non-physiological nocturnal BP dipping and wider circadian fluctuations in ocular perfusion pressure were linked with the development and progression of glaucoma [8]. In the Maracaibo Aging Study, extreme decreases in nighttime systolic and diastolic BP (defined as a BP decrease greater than 20%, compared to daytime levels) were significant risk factors for glaucomatous damage (with the odds ratio 19.78 and 5.55, respectively) [68]. On the other hand, Yoshikawa et al found that individuals with glaucoma have higher nighttime systolic BP (by 4.1 mmHg) than the healthy controls [69].…”

Section: Systemic Hypertension and Hypotensionmentioning

confidence: 99%

Primary Open Angle Glaucoma and Vascular Risk Factors: A Review of Population Based Studies from 1990 to 2019

Grzybowski¹,

Och

Kanclerz

et al. 2020

JCM

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Glaucoma is one of the leading causes of blindness worldwide, and as the proportion of those over age 40 increases, so will the prevalence of glaucoma. The pathogenesis of primary open angle glaucoma (POAG) is unclear and multiple ocular risk factors have been proposed, including intraocular pressure, ocular perfusion pressure, ocular blood flow, myopia, central corneal thickness, and optic disc hemorrhages. The purpose of this review was to analyze the association between systemic vascular risk factors (including hypertension, diabetes, age, and migraine) and POAG, based on major epidemiological studies. Reports presenting the association between POAG and systemic vascular risk factors included a total of over 50,000 patients. Several epidemiological studies confirmed the importance of vascular risk factors, particularly hypertension and blood pressure dipping, in the pathogenesis and progression of glaucomatous optic neuropathy. We found that diabetes mellitus is associated with elevated intraocular pressure, but has no clear association with POAG. No significant correlation between migraine and POAG was found, however, the definition of migraine varied between studies.

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Section: Systemic Hypertension and Hypotensionmentioning

confidence: 99%

Primary Open Angle Glaucoma and Vascular Risk Factors: A Review of Population Based Studies from 1990 to 2019

Grzybowski¹,

Och

Kanclerz

et al. 2020

JCM

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“…In contrast, more recent reports, as Maracaibo Aging Study, suggest that it is not the physiological nocturnal hypotension that triggers optic nerve damage, but rather the non-physiological overdipping pattern of more than 20% [14]. Similar findings were presented by Pillunat et al [23], who suggested that normotensive (but not hypertensive) patients with an over-dipping pattern of ABP have an increased risk of glaucoma progression.…”

Section: Low Blood Pressure and Glaucomamentioning

confidence: 60%

“…Interestingly, some research contradicts studies claiming harmful effects of hypertension on the optic nerve. Recent analysis of the Maracaibo Aging Study showed that patients with hypertension have a lower risk of developing glaucoma [14]. What is more, it is hypothesized that a low ABP might accelerate progression of optic nerve neuropathy.…”

Section: Low Blood Pressure and Glaucomamentioning

confidence: 99%

Blood pressure and glaucoma: At the crossroads between cardiology and ophthalmology

et al. 2019

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Glaucoma is an optic nerve neuropathy of undetermined cause. Although many mechanisms are thought to be involved in the development and progression of the disease, only an increased intraocular pressure has been established as a clinically significant modifiable risk factor. Nevertheless, up to 40% of patients develop glaucoma without evidence of increased intraocular pressure. Ample evidence suggests that alterations in the control of arterial blood might negatively affect optic nerve function. However, evidence-based guidelines on the management of arterial blood pressure in glaucoma patients are lacking. Regrettably, intraocular pressure is generally not included as a secondary end-point in clinical trials on arterial hypertension. Considering the relative simplicity of intraocular pressure measurements and large number of patients included in hypertension studies, the benefits of including intraocular pressure as a secondary end-point could be of a great value for improving care for glaucoma patients. Therefore, closer collaboration between cardiologists and ophthalmologists is needed.

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“… 23 Also, nocturnal arterial hypotension was found to play a critical role in the pathogenesis of glaucomatous optic neuropathy. 24 – 28 Most healthy people have a dip of 10% to 20% in nocturnal BP compared to daytime BP; however, others present extreme dipping (>20% dipping of nocturnal BP compared to daytime BP) or reverse dipping of BP. 29 – 31 In the Maracaibo Aging Study, extreme nighttime dipping of systolic pressure or diastolic pressure was a significant risk factor (odds ratios 19.78 and 5.55, respectively) for glaucomatous damage.…”

Section: Discussionmentioning

confidence: 99%

Systemic Alpha1-Adrenoceptor Antagonists and Increased Risk of Open-Angle Glaucoma: A Nationwide Population-Based Cohort Study

Lin

Hsieh

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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Glaucomatous Optic Neuropathy Associated with Nocturnal Dip in Blood Pressure

Abstract: In this population, the link between nocturnal BP and GON is determined by extreme dipping effects rather than low nocturnal BP levels alone. Further studies considering extreme decreases in nocturnal BP in individuals at high risk of glaucoma are warranted.

Cited by 53 publications

References 37 publications

Primary Open Angle Glaucoma and Vascular Risk Factors: A Review of Population Based Studies from 1990 to 2019

Primary Open Angle Glaucoma and Vascular Risk Factors: A Review of Population Based Studies from 1990 to 2019

Blood pressure and glaucoma: At the crossroads between cardiology and ophthalmology

Systemic Alpha1-Adrenoceptor Antagonists and Increased Risk of Open-Angle Glaucoma: A Nationwide Population-Based Cohort Study

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