Open-Angle Glaucomatous Optic Neuropathy Is Related to Dips Rather Than Increases in the Mean Arterial Pressure Over 24-H. (26th February 2022)

• Record Type: Journal Article
• Authors: Melgarejo, Jesus D; Eijgen, Jan V; Maestre, Gladys E; Al-Aswad, Lama A; Thijs, Lutgarde; Mena, Luis J; Lee, Joseph H; Terwilliger, Joseph D; Petitto, Michele; Chávez, Carlos A; Brito, Miguel; Calmon, Gustavo; Silva, Egle; Wei, Dong-Mei; Cutsforth, Ella; Keer, Karel V; Gustavo De Moraes, C; Vanassche, Thomas; Janssens, Stefan; Stalmans, Ingeborg; Verhamme, Peter; Staessen, Jan A; Zhang, Zhen-Yu
• Is Part Of: American journal of hypertension. Volume 35:Number 8(2022)
• Page Start: 703
• Page End: 714
• Publication Date: 2022-02-26
• Subjects: ambulatory blood pressure monitoring -- blood pressure -- blood pressure variability -- dips -- glaucomatous optic neuropathy -- hypertension -- open -- angle glaucoma -- population science; Hypertension -- Periodicals; 616.132005
• DOI: 10.1093/ajh/hpac028
• Languages: English
• ISSNs: 0895-7061

Abstract

Abstract: BACKGROUND: Mean arterial pressure (MAP) drives ocular perfusion. Excessive 24-h MAP variability relates to glaucoma, however, whether this is due to dips or increases in the blood pressure (BP) is undocumented. We investigated the association of open-angle glaucoma (OAG) in relation to the 5 largest MAP dips/increases over 24-h, henceforth called dips/blips. METHODS: In the Maracaibo Aging Study (MAS), 93 participants aged ≥40 y (women, 87.1%; mean age, 61.9 y) underwent baseline ophthalmological and 24-h ambulatory BP monitoring assessments. OAG was the presence of optic nerve damage and visual field defects. Statistical methods included logistic regression and the generalized R 2 statistic. For replication, 48 OAG cases at the Leuven Glaucoma Clinic were matched with 48 controls recruited from Flemish population. RESULTS: In the MAS, 26 participants had OAG. OAG compared to non-OAG participants experienced longer and deeper dips (116.5 vs. 102.7 minutes; to 60.3 vs. 66.6 mm Hg; −21.0 vs. −18.0 mm Hg absolute or 0.79 vs. 0.81 relative dip compared to the preceding reading). The adjusted odds ratios associated with dip measures ranged from 2.25 (95% confidence interval [CI], 1.31–4.85; P = 0.009) to 3.39 (95% CI, 1.36–8.46; P = 0.008). On top of covariables and 24-MAP level/variability, the dip measures increased the model performance ( P ≤ 0.025). Blips did not associate with OAG. The case–control study replicated the MAS observations. CONCLUSIONS: Dips rather than increases in the 24-h MAP level were associated with increased risk for OAG. An ophthalmological examination combined with 24-h BP monitoring might be precautious steps required in normotensive and hypertensive patients at risk of OAG. Graphical Abstract: