24 HOUR BLOOD PRESSURE PROFILE IN YOUNG AND MIDDLE-AGED PATIENTS WITH RETINAL VEIN OCCLUSION

Abstract

Background. Absence of nocturnal decrease (non-dipper) or an extreme decrease of blood pressure (BP) (overdipper) may be a sign of vascular dysregulation. Non-dipper pattern is associated with increased risk of strokes and cardiovascular events. Over-dipper pattern increases the risk of non-arteritic anterior ischemic neuropathy and glaucoma progression. Daily BP profile in young and middle-aged adults with retinal vein occlusion (RVO) has not been previously examined. The target organ damage is determined by BP dynamics, regional microcirculation and associated perfusion pressure decrease, which verifies the relevance of our study. Objective. To evaluate the diurnal BP variation, the prevalence of arterial hypertension (HTN) and its character, ocular blood flow in RVO in young and middle-aged adults. Design and methods. The study included 30 patients with RVO. In all patients, routine ophthalmic examination was performed, as well as an additional ocular blood flow assessment (ophthalmoplethysmography, ophthalmorheography, ophthalmosphygmography, and fluorescein angiography). 24‑hour blood pressure monitoring (BPM) was performed to estimate systemic hemodynamics. Results. Statistically significant differences between eyes were noted in visual acuity (p = 0,001) and retinal thickness in macular area (p < 0,001). Patients with HTN showed lower visual acuity (р = 0,04), ocular blood flow parameters (p < 0,05) and retinal mean sensitivity (RMS) (р = 0,02) according to automated static perimetry. Fluorescein angiography showed zones of peripheral retinal ischemia with a mean area of 103 mm 2 (from 0 to 250 mm 2 ). 8 patients had masked HTN according to ambulatory BPM. Depending on the night decrease of BP 13 patients had an extreme decrease of BP (over-dipper), 12 had non-dipper pattern and 5 had dipper pattern. No relation between evaluated parameters was found. However, non-dippers showed a tendency towards lower hemodynamic and automated static perimetry parameters. Conclusions. The prevalence of HTN was 57%, while 47% demonstrated masked HTN. Lower ocular blood flow parameters and RMS according to automated static perimetry were associated with HTN. Vascular dysregulation is considered as a possible cause of RVO in young and middle-aged adults. Its manifestation is the equal frequency of non-dipper and over-dipper patterns. Ambulatory BPM in patients with RVO can be recommended for the detection of HTN, BP profiles, and indirectly, for the evaluation of ocular perfusion pressure, risk stratification and the selection of adequate and individualized antihypertensive therapy to reduce the risk of developing and progressing cardiovascular diseases and mortality.