Relationship Between Daytime Variability of Blood Pressure or Ocular Perfusion Pressure and Glaucomatous Visual Field Progression

Lee, Jin Young; Choi, Jaewan; Jeong, Dawoon; Kim, Soa; Kook, Michael S.

doi:10.1016/j.ajo.2015.05.034

Cited by 41 publications

(34 citation statements)

References 38 publications

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“…Ocular blood flow could be influenced and compromised by various systemic factors such as vascular endothelial dysfunction [25–27], blood pressure behavior [28,29], and autonomic dysfunction [30] in patients with glaucoma. Of those, vascular endothelial dysfunction in glaucoma was demonstrated by reduced brachial artery flow-mediated vasodilation [25,27] or exaggerated vasoconstriction of arteries dissected from gluteal fat biopsies in response to 5-hydroxytryptamine and endothelin-1 [26].…”

Section: Discussionmentioning

confidence: 99%

Albuminuria Is Associated with Open-Angle Glaucoma in Nondiabetic Korean Subjects: A Cross-Sectional Study

Kim

Park

et al. 2016

PLoS ONE

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ObjectiveSystemic vascular dysfunction has been suggested to contribute to glaucomatous damage. Albuminuria is a surrogate marker of endothelial injury, including vessels. However, their relationship is not well understood. This study aimed to investigate the association between albuminuria and the prevalence of open-angle glaucoma (OAG) in nondiabetic subjects.MethodsWe conducted a cross-sectional study of 4186 nondiabetic participants aged 19 years or older from the 2011–2012 Korea National Health and Nutrition Examination Survey. OAG was defined based on the criteria of the International Society for Geographic and Epidemiologic Ophthalmology. Urinary albumin excretion was assessed by the urinary albumin-to-creatinine ratio (UACR). A multivariate logistic regression analysis was performed to evaluate the relationship between albuminuria and OAG.ResultsAmong the subjects, 124 had OAG. The weighted prevalences of microalbuminuria (UACR of 30–299 mg/g creatinine [Cr]) and macroalbuminuria (UACR ≥ 300 mg/g Cr) were 3.2 ± 0.3% and 0.4 ± 0.1%, respectively. The percentages of OAG increased in accordance with increasing UACR tertiles. Compared with subjects in the lower UACR tertile, those in the upper tertile showed an increased prevalence of OAG (odds ratio, 1.963; 95% confidence interval 1.072–3.595, P = 0.029) after adjusting for demographic factors, laboratory parameters, kidney function, and intraocular pressure. Furthermore, even after excluding 155 subjects with microalbuminuria and 19 subjects with macroalbuminuria, a positive association persisted between the upper UACR tertile (low-grade albuminuria) and an increased prevalence of OAG (odds ratio, 2.170; 95% confidence interval, 1.174–4.010, P = 0.014).ConclusionAlbuminuria, even low-grade, was significantly associated with OAG in nondiabetic subjects. This result implies the role of vascular endothelial dysfunction in the pathogenic mechanism of OAG and suggests that careful monitoring of OAG is required in nondiabetic subjects with albuminuria.

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Section: Discussionmentioning

confidence: 99%

Albuminuria Is Associated with Open-Angle Glaucoma in Nondiabetic Korean Subjects: A Cross-Sectional Study

Kim

Park

et al. 2016

PLoS ONE

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“…investigated the difference of BP fluctuation between glaucoma patients and controls using 24-h BP monitoring and Lee et al . evaluated relationship between daytime variability of BP or ocular perfusion pressure (OPP) and visual field progression3738. However, no population-based cohort study has yet evaluated the relationship between POAG and BP variability…”

Section: Discussionmentioning

confidence: 99%

Fluctuation in systolic blood pressure is a major systemic risk factor for development of primary open-angle glaucoma

Lee

Jung

Han

et al. 2017

Sci Rep

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We evaluated the risk of development of primary open-angle glaucoma (POAG) in terms of variability in BP using a nationwide, population-based, 11-year longitudinal study using the Korean National Health Insurance Research Database. We included patients who underwent health care examinations more than twice between January 2002 and December 2006. We divided all subjects by the quartiles of variability in systolic blood pressure (SBP), diastolic blood pressure (DBP), and the difference between SBP and DBP. Of the total of 80,021 included subjects, 910 were diagnosed with POAG between January 2007 and December 2013. Both the Kaplan-Meier survival curves and log-rank test data indicated that patients with higher-level BP variability developed POAG significantly more frequently than did patients with lower-level variability (P < 0.001). On multivariate Cox’s regression modeling including gender, age, sex, household income, smoking status, level of alcohol intake, extent of exercise, diabetes mellitus status, dyslipidemia status, SBP, and DBP; the hazard ratios among the highest and lowest quartiles of SD SBP and CV SBP were 1.256 and 1.238, respectively. Our findings suggest that subjects in the highest quartile of SBP variability were significantly more likely to develop POAG in our population-based sample of Korean adults.

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“…The ocular perfusion pressure (OPP) is an indirect measurement calculated with arterial BP and IOP. In NTG patients, significant dips in BP during sleep and OPP were the risk factors for the severe progression of VF damage (15) . The fluctuation of mean OPP also correlated with VF damage progression.…”

Section: Nocturnal Systemic Hypotensionmentioning

confidence: 96%

Normal-tension glaucoma: an update

Esporcatte¹,

Tavares²

2016

Arquivos Brasileiros De Oftalmologia

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However, several structural and functional differences support the fact that different mechanisms may have a stronger role in the pathogenesis of NTG versus high-pressure POAG. Also, a recent study reported genetic variants associated with different tendencies towards POAG with lower or higher IOP (6) . Furthermore, clinical impression and anecdotal evidence suggest that NTG with mean IOP in the high teens (>15 mmHg), in which circadian fluctuation and CCT could lead to a possible misdiagnosis of an IOP ≤21 mmHg, would differ from NTG with mean IOP in the low teens (≤15 mmHg), with different ABSTRACT Descritores: Glaucoma de ângulo aberto; Pressão in traocular; Doenças do nervo óptico; Anti-hipertensivos/uso terapêuticopathogenesis and progression patterns, harder to achieve target IOP, and higher incidence of disc hemorrhages. Nonetheless, a recent report does not support this assumption and underscores low-teens NTG as an important entity (7) . The proportion of NTG varies depending on different population studies. In Asian epidemiological protocols, NTG constituted the majority of open-angle glaucomas (52%-92%), depending on the country and study methodology (8) . Normal IOP was measured in 57.1% cases of POAG in a South African study (9) . In white populations, the proportion of NTG was lower than that observed in Asian and African populations. In studies conducted in the United States, Netherlands, and Italy, NTG presented proportions of 31. 7%, 38.9%, and 30%, respectively (10-12) . The etiology of NTG is most likely multifactorial and still not well defined. Moreover, several alternative treatments based on this different pathogenesis have been discussed. The objective of this study was to review the mechanisms involved in the onset and progression of NTG and the efficacy of established and alternative therapies for NTG treatment. PathogenesisThe pathogenesis of NTG is unclear, and perhaps the development of the disease is a consequence of a complex interaction of several systemic and ocular factors. Different studies have shown that the cardiovascular system and intracranial pressure may be involved in the main pathways of optic nerve damage. Nevertheless, the complex relationship between these mechanisms and glaucoma pro gression continues to be debated.

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Relationship Between Daytime Variability of Blood Pressure or Ocular Perfusion Pressure and Glaucomatous Visual Field Progression

Cited by 41 publications

References 38 publications

Albuminuria Is Associated with Open-Angle Glaucoma in Nondiabetic Korean Subjects: A Cross-Sectional Study

Albuminuria Is Associated with Open-Angle Glaucoma in Nondiabetic Korean Subjects: A Cross-Sectional Study

Fluctuation in systolic blood pressure is a major systemic risk factor for development of primary open-angle glaucoma

Normal-tension glaucoma: an update

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