Nocturnal blood pressure dip and parapapillary choroidal microvasculature dropout in normal-tension glaucoma

Joong Won Shin,Hun Jae Won,Youn Hye Jo,Michael S Kook,Min Kyung Song

doi:10.1038/s41598-020-80705-3

Abstract

Choroidal microvasculature dropout (CMvD) implies compromised optic nerve head perfusion in glaucoma patients. However, there are conflicting findings whether office-hour systemic blood pressure (BP) is related to the presence of CMvD. The present study investigated which systemic BP parameters, derived from 24-h ambulatory BP monitoring (ABPM), are associated with CMvD as assessed by optical coherence tomography angiography (OCT-A) in normal-tension glaucoma (NTG). This study included 88 eyes of 88 NTG patients who underwent 24-h ABPM and OCT-A imaging. Various systemic BP parameters associated with the presence of CMvD were evaluated using logistic regression analyses. CMvD was detected in 38 NTG eyes (43.2%). NTG eyes with CMvD had nighttime diastolic BP (DBP) dip of greater magnitude and longer duration than eyes without CMvD. In multivariate logistic regression, worse VF mean deviation (MD) (odds ratio [OR] 0.786; P = 0.001), greater nighttime DBP dip “%” (OR 1.051; P = 0.034), and higher daytime peak IOP (OR 1.459; P = 0.013) were significantly associated with the presence of CMvD. Based on our findings that the eyes with CMvD are closely associated with having nighttime DBP dip, NTG patients with CMvD should be recommended to undergo 24-h ABPM.

Highlights

Choroidal microvasculature dropout (CMvD) implies compromised optic nerve head perfusion in glaucoma patients
While a few studies have reported that CMvD is associated with abnormal blood pressure (BP) parameters, such as low diastolic BP (DBP), ocular perfusion pressure (OPP), or mean arterial pressure (MAP)[13,15], other studies have not confirmed its association with systemic hypotension in glaucoma p atients[16,21]
The presence of CMvD has been reported to be associated with systemic vascular insufficiency, such as lower office-hour DBP, MAP, and O PP13,15, and may represent a regional filling defect of the parapapillary choroid in glaucoma patients[12]

Summary

Introduction

Choroidal microvasculature dropout (CMvD) implies compromised optic nerve head perfusion in glaucoma patients. Studies including our recent reports have shown that nocturnal hypotension, its duration and magnitude as determined by 24-h ambulatory BP monitoring (ABPM), significantly impacts on future visual field (VF) progression in patients with normal-tension glaucoma (NTG)[5,6,7,8,9,10,11]. While a few studies have reported that CMvD is associated with abnormal BP parameters, such as low diastolic BP (DBP), OPP, or mean arterial pressure (MAP)[13,15], other studies have not confirmed its association with systemic hypotension in glaucoma p atients[16,21] These conflicting findings may stem from the use of snapshot daytime BP measurements, which may not accurately reflect the true nature of the BP abnormality or its circadian rhythm as related to glaucoma pathogenesis.

Methods

Results

Conclusion