TY - JOUR
T1 - Normal-tension glaucomatous optic neuropathy is related to blood pressure variability in the Maracaibo Aging Study
AU - Melgarejo, J.D.
AU - Maestre, G.E.
AU - Mena, L.J.
AU - Lee, J.H.
AU - Petitto, M.
AU - Chavez, C.A.
AU - Calmon, G.
AU - Silva, E.
AU - Thijs, L.
AU - Al-Aswad, L.A.
AU - Terwilliger, J.D.
AU - De Moraes, C.G.
AU - Wei, F.F.
AU - Vanassche, T.
AU - Verhamme, P.
AU - Staessen, J.A.
AU - Zhang, Z.Y.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - Hypoperfusion of the optic nerve might be involved in the pathogenesis of normal-tension glaucomatous optic neuropathy (GON). Mean arterial pressure (MAP) drives ocular perfusion, but no previous studies have addressed the risk of GON in relation to blood pressure (BP) variability, independent of BP level. In a cross-sectional study, 93 residents of Maracaibo, Venezuela, underwent optical coherence tomography, visual field assessments and 24-h ambulatory BP monitoring between 2011 and 2016. We investigated the association of normal-tension GON with or without visual field defects with reading-to reading variability of 24-h MAP, as captured by variability independent of the MAP level (VIMmap). Odds ratios (ORs) were adjusted for 24-h MAP level and for a propensity score of up to five risk factors. Among the 93 participants (87.1% women; mean age, 61.9 years), 26 had open-angle normal-tension GON at both eyes; 14 had visual field defects; and 19 did not have visual field defects. The OR ratios for normal-tension GON, expressed per 1-SD increment in VIMmap (2 mm Hg), were 2.17 (95% confidence interval, 1.33-3.53) unadjusted; 2.20 (1.35-3.61) adjusted for 24-h MAP level only; 1.93 (1.10-3.41) with additional adjustment for age, educational attainment, high-density lipoprotein (HDL) cholesterol and office hypertension; and 1.95 (1.10-3.45) in models including intraocular pressure. We confirmed our a priori hypothesis that BP variability, most likely operating via hypoperfusion of the optic nerve, is associated with normal-tension GON. 24-H ambulatory BP monitoring might therefore help stratify the risk of normal-tension GON.
AB - Hypoperfusion of the optic nerve might be involved in the pathogenesis of normal-tension glaucomatous optic neuropathy (GON). Mean arterial pressure (MAP) drives ocular perfusion, but no previous studies have addressed the risk of GON in relation to blood pressure (BP) variability, independent of BP level. In a cross-sectional study, 93 residents of Maracaibo, Venezuela, underwent optical coherence tomography, visual field assessments and 24-h ambulatory BP monitoring between 2011 and 2016. We investigated the association of normal-tension GON with or without visual field defects with reading-to reading variability of 24-h MAP, as captured by variability independent of the MAP level (VIMmap). Odds ratios (ORs) were adjusted for 24-h MAP level and for a propensity score of up to five risk factors. Among the 93 participants (87.1% women; mean age, 61.9 years), 26 had open-angle normal-tension GON at both eyes; 14 had visual field defects; and 19 did not have visual field defects. The OR ratios for normal-tension GON, expressed per 1-SD increment in VIMmap (2 mm Hg), were 2.17 (95% confidence interval, 1.33-3.53) unadjusted; 2.20 (1.35-3.61) adjusted for 24-h MAP level only; 1.93 (1.10-3.41) with additional adjustment for age, educational attainment, high-density lipoprotein (HDL) cholesterol and office hypertension; and 1.95 (1.10-3.45) in models including intraocular pressure. We confirmed our a priori hypothesis that BP variability, most likely operating via hypoperfusion of the optic nerve, is associated with normal-tension GON. 24-H ambulatory BP monitoring might therefore help stratify the risk of normal-tension GON.
KW - EVENTS
KW - HYPERTENSION
KW - OCULAR PERFUSION-PRESSURE
KW - PROGNOSTIC-SIGNIFICANCE
KW - ambulatory blood pressure monitoring
KW - blood pressure variability
KW - normal-tension glaucoma visual
KW - population science
KW - visual field defects
KW - ASSOCIATION
U2 - 10.1038/s41440-021-00687-1
DO - 10.1038/s41440-021-00687-1
M3 - Article
C2 - 34253881
SN - 0916-9636
VL - 44
SP - 1105
EP - 1112
JO - Hypertension Research
JF - Hypertension Research
IS - 9
ER -