Nocturnal Systemic Hypotension Increases the Risk of Glaucoma Progression

Abstract

Objective The objective of this prospective, longitudinal study of patients with normal-tension glaucoma (NTG) was to determine whether patients with nocturnal hypotension are at greater risk for visual field (VF) loss over 12 months than those without nocturnal hypotension. Design Prospective, longitudinal study. Participants Consecutive patients with NTG with at least 5 prior VF tests were screened for eligibility. Methods The baseline evaluation assessed demographic and clinical characteristics, covering systemic comorbid conditions, including systemic hypertension. All oral and ophthalmologic medications were recorded. A complete ophthalmological examination was performed at baseline and follow-up. Patients had their blood pressure (BP) monitored every 30 minutes for 48 hours with an ambulatory recording device at baseline and 6 and 12 months. Main Outcome Measures The primary outcome was based on the global rates of VF progression by linear regression of the mean VF threshold sensitivity over time (decibels/year). Results Eighty-five patients with NTG (166 eyes; mean age, 65 years; 67% were women) were included. Of the 85 patients, 29% had progressed in the 5 VFs collected before study enrollment. The nocturnal mean arterial pressure (MAP) was compared with the daytime MAP. Multivariate analysis showed that the total time that sleep MAP was 10 mmHg below the daytime MAP was a significant predictor of subsequent VF progression (P<0.02). Conclusions Cumulative nocturnal hypotension predicted VF loss in this cohort. Our data suggest that the duration and magnitude of decrease in nocturnal blood pressure below the daytime MAP, especially pressures that are 10 mmHg lower than daytime MAP, predict progression of NTG. Low nocturnal blood pressure, whether occurring spontaneously or as a result of medications, may lead to worsening of VF defects.

Factors Influencing Lamina Cribrosa Microcapillary Hemodynamics and Oxygen Concentrations

“…This result is reasonable, as the aforementioned changes in pressure will reduce the overall perfusion pressure of the LC. It has also been shown that both an increase in central venous pressure and a decrease in arterial pressure are risk factors for the development of OAG, [49][50][51][52] and our result suggests that changes in blood pressure can significantly impact LC hemodynamics and potentially contribute to OAG progression.…”

Blood flow mechanics and oxygen transport and delivery in the retinal microcirculation: multiscale mathematical modeling and numerical simulation

“…These results are supported by clinical observations. Low blood pressure (i.e., arterial hypotension) is associated with low perfusion of ocular tissues (Caprioli and Coleman 2010;Pournaras et al 2008) and is identified as a risk factor for many ocular diseases, including glaucoma (Charlson et al 2014;Costa et al 2014;Deokule and Weinreb 2008;He et al 2011) and nonarteritic anterior ischemic optic neuropathy (NAION) (Hayreh 2008;Kerr et al 2009). High blood pressure (i.e., arterial hypertension) is also an important clinical condition and has been identified as a risk factor for retinal artery and vein occlusion and macular edema (Bhargava et al 2012;Kida et al 2014;Kolar 2014;Martinez et al 2014), diabetic retinopathy (Bhargava et al 2012;Wong and Mitchell 2007) and NAION (Bawazir et al 2011).…”

OCT Angiography of the Peripapillary Retina in Primary Open-Angle Glaucoma

“…[3][4][5][6] Decreased retinal perfusion has also been demonstrated angiographically in glaucoma patients using fluorescein angiography. [7][8][9][10] These findings has raised the interest in the potential role of decreased ocular perfusion as an etiopathogenic factor for the glaucomatous optic neuropathy (GON), together with epidemiologic or clinical data that demonstrated the association of low blood pressure [11][12][13] or nocturnal blood pressure dips [14][15][16] with glaucoma. In contrast, Quigley et al 17 demonstrated that the density of capillaries remained constant across a wide range of neural tissue losses within the optic nerve head (ONH) in both experimental and human glaucoma eyes.…”