The relevance of nocturnal dip of diastolic blood pressure and the perfusion pressure of the optic nerve to glaucomatous disease progression

Abstract

Abstract Purpose: Although age, genetics and intraocular pressure (IOP) help to define the risk of glaucoma progression, there also exists glaucoma in which the pathogenesis is mainly the results of vascular disorders. To investigate the combined IOP and arterial pressure fluctuations risk factors for the glaucoma disease progression. Methods: The 24‐hour ambulatory blood pressure and round‐the‐clock curve of the intraocular pressure were recorded in seventy patients : 51 primary open angle glaucoma (POAG) and 19 normal tension glaucoma (NTG). The mean systolic (SBP), diastolic blood pressure (DBP) and diastolic ocular perfusion pressure (DOPP ; DOPP=DBP‐IOP) were calculated along with the nocturnal dip of systolic pressure and diastolic blood pressure. Two‐years disease progression were assessed for all patients by means of retrospective analysis of visual fields defects on repeated perimetries. We performed statistical analyses on the readings to study the relative risk of the disease progression Results: Abnormal (absence or increased) nocturnal dip of the diastolic blood pressure, large IOP fluctuations, circadian DOPP fluctuations were significantly associated with disease progression in POAG and NTG patients whereas no significant correlation was found for the others risks factors envisaged (i.e.,myopia,heredity,vasospasm,..). Conclusions: Circadian DOPP fluctuations was the most significant clinical risk factor for the glaucoma disease progression. Our data are in line with several population‐based epidemiologic studies that will be presented during the talk.By monitoring this DOPP that does not require either sophisticated or invasive investigations, it would be wise to take this factor into account in the clinical evaluation of our glaucoma patients