Increasing incidence of macular edema in excessive morning blood pressure surge in patients with retinal vein occlusion

Abstract

Morning blood pressure surge (MBPS) had been known to be associated with hypertensive target organ injury and vascular events. Retinal vein occlusion (RVO) is also known to be related with underlying cardiovascular risk factors. This study investigated the effect of MBPS on patients with RVO. In total, 76 patients with RVO who had undergone systemic cardiovascular examination including a 24-hour ambulatory blood pressure monitoring, carotid artery intima media thickness, and pulse wave velocity were evaluated between January 2015 and February 2019. The MBPS was calculated as follows: mean systolic blood pressure measured over two hours after awakening minus mean systolic blood pressure measured during the one hour that included the lowest sleep blood pressure. Macular edema was significantly more prevalent in the MBPS group compared with the non-MBPS group. After adjusting for confounding factors, multivariate regression analyses revealed that MBPS independently predicted macular edema in patients with RVO [Odds ratio 4.75, 95% confidence interval 1.136-16.6, p = 0.015]. In conclusion, evaluating blood pressure patterns, especially MBPS, using 24-hour ambulatory blood pressure monitoring may be useful for assessing and predicting ophthalmologic outcome and may facilitate better blood pressure control in patients with RVO. Retinal vein occlusion (RVO) is a common retinal vascular disease that leads to vision loss 1. RVO includes branch retinal vein occlusion (BRVO), which is caused by venous thrombosis at an arteriovenous crossing where an artery and vein share a vascular sheath or at the optic disc, and central retinal vein occlusion (CRVO), which results from thrombosis of the central retinal vein and a disturbance in the venous outflow, at the lamina cribrosa or posterior to it 1-3. The main complication of RVO is macular edema, which can lead visual impairment 4. Macular edema is the swelling or thickening of the macula due to leakage of fluid and blood components from blood vessels and is a major cause of RVO-associated blindness, angiogenesis, and retinal detachment. Therefore, it is associated with poor ophthalmologic outcomes 5. It has been demonstrated that many systemic cardiovascular risk factors such as hypertension, diabetes, dyslipidemia, and systemic inflammatory diseases are associated with RVO; hypertension is one of the most significant risk factors among them 5-7. In hypertensive patients, nocturnal blood pressure (BP) rise and morning BP surge (MBPS) have been known to be associated with an increased risk of target-organ damage and cardiovascular events 8-12. Interestingly, RVO has been shown to have circadian variation as well, with event onset time peaking in the early morning hours in previous studies 13,14. In this study, we evaluated the effect of morning blood pressure surge on patients with RVO.

Evaluation of Systemic Endothelial Dysfunction in Retinal Vein Occlusions.

“…In our study, we found that bilateral CIMT values in patients with RVO were significantly thicker, suggesting that patients with RVO should be evaluated using carotid Doppler ultrasound. In contrast to these studies, Kim et al reported that PWV and CIMT parameters were not associated with RVO ( 24 ).…”

Poor response to first intravitreal injection for predicting unfavorable outcomes of retinal vein occlusion related macular edema

“…According to literature reports, [1][2][3][4][5][6][7][8][9][10][11] retinal vein occlusion (RVO), including branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO), has the strongest correlation with hypertension, 1 followed by diabetes, hyperlipidemia, hospital-treated ischemic heart disease, obstructive sleep apnea, morning blood pressure surge, glaucoma, thrombophilia and hypercoagulation, systemic and inflammatory diseases, retinal vasculitis, pseudotumor cerebri, crowded optic disc, endothelin-1 and medications. The current first-line treatment for retinal vein occlusion related macular edema (RVO-ME) is intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF) medicine, 2,3,12,13 or dexamethasone (DEX) implant.…”