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Abstract

The comments by Dr Hayreh include some important points with regard to discrepancies between our findings and those in previous studies. Our study revealed a significant increase in the nighttime systolic blood pressure (BP) in patients with glaucoma (n = 109) compared with a large number of control participants without glaucoma (n = 708). Although most of the earlier studies suggested a decrease in the nighttime BP in patients with glaucoma, our findings were the opposite. Cuff inflation during the nighttime along with ambulatory BP (ABP) monitoring may disturb sleep quality, as suggested by Dr Hayreh, possibly resulting in the increased nighttime BP in patients with glaucoma. However, in our study, the ABP monitoring was performed in both groups of patients with glaucoma and control participants using the same device and protocol. In addition, earlier studies on the effects of the cuff inflation during nighttime on objective sleep quality and quantity have been conflicting. One study suggested that ABP monitoring impaired subjective sleep quality in 70 individuals, but no significant association was observed between ABP monitoring and objective sleep quality evaluated by actigraphy.1Tropeano A.-I. Roudot-Thoraval F. Badoual T. et al.Different effects of ambulatory blood pressure monitoring on subjective and objective sleep quality.Blood Press Monit. 2006; 11: 315-320Crossref PubMed Scopus (16) Google Scholar Another study suggested that ABP monitoring did not adversely affect the actigraphic-determined sleep quality in 121 participants with untreated hypertension.2Sherwood A. Hill L.K. Blumenthal J.A. et al.The effects of ambulatory blood pressure monitoring on sleep quality in men and women with hypertension: dipper vs. nondipper and race differences.Am J Hypertens. 2019; 32: 54-60Crossref PubMed Scopus (14) Google Scholar We agree with the important findings of decreased diastolic nighttime BP for glaucoma progression. However, little is known about nighttime systolic and diastolic BP in patients with glaucoma compared with control participants without glaucoma. One study reported a significant decrease in the nighttime diastolic BP in patients with glaucoma (n = 26) compared with control participants (n = 67).3Melgarejo J.D. Lee J.H. Petitto M. et al.Glaucomatous optic neuropathy associated with nocturnal dip in blood pressure. Findings from the Maracaibo Aging Study.Ophthalmology. 2018; 125: 807-814Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar Another study reported an increase in the nighttime diastolic BP in patients with normal tension glaucoma (n = 51) compared with control participants (n = 28).4Plange N. Kaup M. Daneljan L. et al.24-h blood pressure monitoring in normal tension glaucoma: night-time blood pressure variability.J Hum Hypertens. 2006; 20: 137-142Crossref PubMed Scopus (56) Google Scholar Our study showed a significant increase of nighttime systolic BP in patients with glaucoma compared with control participants without glaucoma. To the best of our knowledge, our study may have the largest sample size. Further studies with large random samples and prospective studies investigating nighttime BP in individuals with and without glaucoma are needed. Finally, antihypertensive drug use may be associated with a decrease in the nighttime BP based on Dr Hayreh’s study (ref 3 in their letter). Our results suggested an association between antihypertensive drug use and higher prevalence of the nondipper pattern of BP. This finding was consistent with the results of a large-scale population study of approximately 40 000 hypertensive patients.5De La Sierra A. Redon J. Banegas J.R. et al.Prevalence and factors associated with circadian blood pressure patterns in hypertensive patients.Hypertension. 2009; 53: 466-472Crossref PubMed Scopus (277) Google Scholar Hypertensive patients were more likely to have advanced target organ damage, such as chronic kidney disease. This may be the reason for association between antihypertensive drug use and higher prevalence of the nondipper pattern of BP. Re: Yoshikawa et al.: Increased nighttime blood pressure in patients with glaucoma: cross-sectional analysis of the LIGHT study (Ophthalmology. 2019;126:1366-1371)OphthalmologyVol. 127Issue 5PreviewYoshikawa et al1 reported ambulatory blood pressure (BP) monitoring (ABPM) in 109 patients with high intraocular pressure glaucoma and 708 healthy controls. They concluded that there was “a significant association between glaucoma and increased nighttime systolic BP.” Full-Text PDF