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Patients with glaucoma at risk for increased nighttime BP
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The presence of glaucoma was significantly associated with increased nighttime BP, according to a study published in JAMA Ophthalmology.
“Nighttime blood pressure and the presence of a non-dipper pattern are associated with aging, obesity and diabetes. However, little is known about whether glaucoma is associated with nighttime blood pressure and its circadian variations,” Tadanobu Yoshikawa, MD, PhD, department of ophthalmology, Nara Medical University School of Medicine, Nara, Japan, and colleagues wrote.
Researchers conducted an observational, cross-sectional study in which they assessed 109 glaucoma patients and 708 control patients without glaucoma. All patients underwent ophthalmic examinations. Each patient’s ambulatory blood pressure (BP) was measured every 30 minutes for a period of 48 hours. The patients’ sleep diary entities defined the daytime and nighttime periods as periods of being out of bed and in bed. A non-dipper pattern was evident if there was a decrease in the mean nighttime systolic BP by less than 10% of the mean daytime systolic BP.
The results showed that nighttime systolic BP was significantly higher by 4.1 mm Hg (95% CI, 1.0-7.2; P = 0.01) for patients in the glaucoma group than for controls. The non-dipper pattern was significantly prevalent in the glaucoma group (45%) than in the control group (27.5%; P < 0.001). Additionally, multivariable logistic regression analyses showed a higher odds ratio in regard to the non-dipper pattern in the glaucoma group than in the control group (odds ratio, 1.96; 95% CI, 1.26-3.05; P = 0.003).
“In conclusion, our cross-sectional analysis of the circadian blood pressure variability determined by ambulatory blood pressure monitoring in glaucoma patients and healthy participants without glaucoma showed a significant association between glaucoma and increased nighttime systolic blood pressure independent of known risk factors such as age, obesity and diabetes,” Yoshikawa and colleagues wrote. “Further longitudinal studies involving larger numbers of glaucoma patients are needed to show whether the severity and progression of glaucoma are associated with circadian blood pressure variability.” – by Alexandria Brooks
Disclosures: Yoshikawa receives financial support from Novartis Pharma and Alcon Japan Ltd. Please see the full study for the other authors’ relevant financial disclosures.
Perspective
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Carl H. Jacobsen, OD, FAAO
The relationship between blood pressure and eye pressure/glaucoma is a complex one. There appears to be a strong association between normotensive glaucoma (NTG) and low blood pressure. Many practitioners, myself included, will recommend steps to increase vascular perfusion (aspirin or ginkgo, for example) for NTG patients who progress despite lowering IOP. Interestingly, elevated blood pressure (HTN) also has a glaucoma association. HTN is associated with elevated IOP, which increases the risk of open angle glaucoma (OAG). Yoshikawa and colleague’s paper supports this association. They found that the presence of glaucoma is positively associated with high nighttime BP and the non-dipper BP pattern.
So, let’s review. Low BP is fairly strongly associated with NTG. High BP has a weaker association with OAG. How do we use this information in clinic? First, don’t confuse the two glaucoma types. You may be doing this if you advise your OAG patients to avoid taking HTN meds at night for fear of reducing ocular perfusion pressure. Second, remember to treat the individual. We ultimately determine the best treatment empirically. Consider addressing concerns specific to your patient. Finally, please carry on lowering IOP. The BP-glaucoma literature is too muddled to start making BP recommendations in your glaucoma clinic.
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Yoshikawa T, et al. JAMA Ophthalmology. 2019;doi:10.1016/j.ophtha.2019.05.019.
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