Difference in 24-Hour Ambulatory Blood Pressure in Normal Tension Glaucoma and Primary Open-Angle Glaucoma

Chang Jun Park; Nam Ho Lee; Chang Sik Kim

doi:10.3341/jkos.2007.48.11.1512

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Park, Lee, and Kim: Difference in 24-Hour Ambulatory Blood Pressure in Normal Tension Glaucoma and Primary Open-Angle Glaucoma

Original Article

J Korean Ophthalmol Soc 2007;48(11):1512-1521.

Published online: 28 August 2007

DOI: https://doi.org/10.3341/jkos.2007.48.11.1512

Difference in 24-Hour Ambulatory Blood Pressure in Normal Tension Glaucoma and Primary Open-Angle Glaucoma

Chang Jun Park, M.D., Nam Ho Lee, M.D., Chang Sik Kim, M.D.

Department of Ophthalmology, College of Medicine, Chungnam National University, Daejeon, Korea

Address reprint requests to Chang Sik Kim, M.D., Department of Ophthalmology, Chungnam National University Hospital, #640 Daesa-dong, Jung-gu, Daejeon 301-721, Korea, Tel: 82-42-280-7606, Fax: 82-42-255-3745, E-mail: kcs61@cnu.ac.kr

Received 3 April 2006 Accepted 4 September 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the variation of 24-hours blood pressure in patients with normal tension glaucoma (NTG) and primary open-angle glaucoma (POAG).

Methods

Thirty patients with NTG, 30 patients with POAG, and 30 normal controls were enrolled in this study. Each subjects underwent 24-hours ambulatory blood pressure monitoring. The variation of each parameter and difference among NTG, POAG, and control groups were compared.

Results

The lowest diastolic blood pressure (DBP) and the lowest mean arterial blood pressure (MAP) were significantly lower in the NTG group(51.9±11.3 mmHg and 66.9± 13.1 mmHg) than in the POAG group(60.0±11.4 mmHg and 77.8±16.8 mmHg, p=0.048 and 0.024) and the control group(60.1±10.5 mmHg and 77.4±13.3 mmHg, p=0.047 and 0.031) during nighttime. More patients showed a lowest MAP less than 60 mmHg in the NTG group(8 patients, 27%) than in the POAG group(2 patients, 7%) and the control group(2 subjects, 7%, p=0.038 each). In addition, a decrease of more than 15% in DBP was more frequent in NTG group(17 patients, 57%) than in the POAG group(9 patients, 30%) and the control group(9 subjects, 30%, p=0.037 each).

Conclusions

Nocturnal reduction in blood pressure may play an important role in the pathogenesis of NTG in some patients. Therefore, nighttime blood pressure should be considered as an important reference factor in diagnosis and treatment of NTG.

Keywords: 24-Hour ambulatory blood pressure monitoring, Lowest mean arterial blood pressure, Nocturnal dip, Normal tension glaucoma, Primary open-angle glaucoma

References

1. Armaly MF. Ocular pressure and visual fields. A ten-year follow-up study. Arch Ophthalmol. 1969; 81:25–40.

2. Levens RZ. Low tension glaucoma. a critical review and new material. Surv Ophthalmol. 1980; 24:621–64.

3. Perkins ES. The Bedford glaucoma survey. I . Long-term follow-up of boarderline cases. Br J Ophthalmol. 1973; 57:179–85.

4. Van Buskirk EM, Cioffi GA. Glaucomatous optic neuropathy. Am J Ophthalmol. 1992; 113:447–52.

5. Brubaker RF. Delayed functional loss in glaucoma. LII Edward Jackson Memorial Lecture. Am J Ophthalmol. 1996; 121:473–83.

6. Becker B. Diabetes mellitus and primary open-angle glaucoma. Am J Ophthalmol. 1971; 71:1–16.

7. Mcleod SD, West SK, Quigley HA, Fozard JL. A longitudinal study of the relationship between intraocular and blood pressures. Invest Ophthalmol Vis Sci. 1990; 31:2361–6.

8. Armstrong JR, Daily RK, Dobson HL, Girard LJ. The incidence of glaucoma in diabetes mellitus. A comparison with the incidence of glaucoma in the general population. Am J Ophthalmol. 1960; 50:55–63.

9. Mitchell P, Lee AJ, Rochtchina E, Wang JJ. Open-angle glaucoma and systemic hypertension: the blue mountains eye study. J Glaucoma. 2004; 13:319–26.

10. Pradalier A, Hamard P, Sellem E, Bringer L. Migraine and glaucoma: an epidemiologic survey of French ophthalmologists. Cephalalgia. 1998; 18:74–6.

11. Broadway DC, Drance SM. Glaucoma and vasospasm. Br J Ophthalmol. 1998; 82:862–70.

12. Harris A, Rechtman E, Siesky B, et al. The role of optic nerve blood flow in the pathogenesis of glaucoma. Ophthalmol Clin North Am. 2005; 18:345–53.

13. Hayreh SS. Progress in the understanding of the vascular etiology of glaucoma. Curr Opin Ophthalmol. 1994; 5:26–35.

14. Hayreh SS. The blood supply of the optic nerve head and the evaluation of it: myth and reality. Prog Retin Eye Res. 2001; 20:563–93.

15. Gherghel D, Orgul S, Gugleta K, et al. Relationship between ocular perfusion pressure and retrobulbar blood flow in patients with glaucoma with progressive damage. Am J Ophthalmol. 2000; 130:597–605.

16. Sehi M, Flanagan JG, Zeng L, et al. Relative change in diurnal mean ocular perfusion pressure: a risk factor for the diagnosis of primary open-angle glaucoma. Invest Ophthalmol Vis Sci. 2005; 46:561–7.

17. Hayreh SS. Duke-elder Lecture. Systemic arterial blood pressure and the eye. Eye. 1996; 10:5–28.

18. Millar-Craig MW, Bishop CN, Raftery EB. Circadian variation of blood pressure. Lancet. 1978; 1:795–7.

19. Pickering T. Recommendations for the use of home (self) and ambulatory blood-pressure monitoring. Am J Hypertens. 1996; 9:1–11.

20. Hayreh SS, Zimmerman MB, Podhajsky P, Alward WL. Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders. Am J Ophthalmol. 1994; (15):117:603–24.

21. Bechetoille A, Bresson-Dumont H. Diurnal and nocturnal blood pressure drops in patients with focal ischemic glaucoma. Graefes Arch Clin Exp Ophthalmol. 1994; 11:675–9.

22. Plange 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; 20:137–42.

23. Graham SL, Drance SM, Wijsman K, et al. Ambulatory blood pressure monitoring in glaucoma. The nocturnal dip. Ophthalmology. 1995; 102:61–9.

24. Carenini AB, Sibour G, Boles Carenini B. Differences in the longterm effect of timolol and betaxolol on the pulsatile ocular blood flow. Surv Ophthalmol. 1994; 38:S118–24.

25. Arend O, Harris A, Arend S, et al. The acute effect of topical beta-adrenoreceptor blocking agents on retinal and optic nerve head circulation. Acta Ophthalmol Scand. 1998; 76:43–9.

26. Hayreh SS, Podhajsky P, Zimmerman MB. Beta-blocker eyedrops and nocturnal arterial hypotension. Am J Ophthalmol. 1999; 128:301–9.

Table 1.

Clinical and demographic data of the patients with normal tension glaucoma (NTG), primary open-angle glaucoma (POAG), and control group

Parameter	NTG	POAG	Control	p-value
Parameter	NTG	POAG	Control	NTG vs POAG	NTG vs Control	POAG vs Control
Number	30	30	30
Sex (M/F)	18/12	16/14	15/15	0.602^*	0.436^*	0.796^*
Age (years)	56.4±10.1	58.4±12.4	56.0±10.3	0.562^†	0.823^†	0.573^†
IOP (mmHg)	12.9±2.0	17.16±7.7	14.2±3.3	0.061^†	0.127^†	0.179^†
No. of anti-glaucomatous medication	1.17	1.36	0	0.625^†	-	-
MD (dB)	-11.7±7.0	-7.9±6.8	-	0.148^†	-	-
PSD (dB)	10.8±4.3	6.9±3.7	-	0.101^†	-	-
C/D ratio	0.85±0.15	0.86±0.13	0.42±0.14	0.867^†	0.066^†	0.078^†
Diabetes mellitus	5	9	6	0.222^*	0.739^*	0.371^*
Hypertension	7	13	7	0.100^*	1.000^*	0.100^*

NTG = normal tension glaucoma; POAG = primary open-angle glaucoma; IOP = intraocular pressure; MD = mean deviation;

PSD = pattern standard deviation.

^* Chi-square test.

^† Paired t-test.

Table 2.

Blood pressure data of 24-hour ambulatory blood pressure measurement in patients with normal tension glaucoma (NTG), primary open-angle glaucoma (POAG), and control group during the daytime (mean±S.D.)

Parameter	NTG(n=30)	POAG(n=30)	Control(n=30)	p-value^*
Parameter	NTG(n=30)	POAG(n=30)	Control(n=30)	NTG vs POAG	NTG vs Control	POAG vs Control
Systolic blood pressure (SBP, mmHg)
highest SBP	172.1±28.7	169.5±19.0	165.0±18.4	0.741	0.162	0.420
lowest SBP	103.8±15.0	110.9±15.8	107.8±15.2	0.162	0.343	0.316
mean SBP	132.8±13.5	137.3±17.2	131.3±14.3	0.321	0.723	0.209
variability index of SBP	15.3±5.8	13.4±3.5	13.0±4.9	0.254	0.231	0.815
Diastolic blood pressure (DBP, mmHg)
highest DBP	124.5±22.8	114.7±20.0	112.4±19.5	0.113	0.078	0.497
lowest DBP	61.0±10.6	65.2±10.9	64.6±9.9	0.145	0.216	0.795
mean DBP	82.9±9.4	87.0±12.1	86.0±10.3	0.262	0.328	0.783
variability index of DBP	12.7±5.6	10.5±4.5	10.9±5.1	0.137	0.244	0.787
Heart rate (HR, rate/min)
highest HR	125.9±27.1	118.2±28.3	115.2±26.8	0.443	0.126	0.559
lowest HR	53.5±8.2	53.0±13.4	56.3±9.0	0.775	0.335	0.317
mean HR	72.8±7.5	73.5±12.0	74.2±8.7	0.721	0.376	0.711
variability index of HR	15.0±7.4	14.3±7.1	13.7±6.8	0.652	0.356	0.638
Mean arterial blood pressure (MAP, mmHg)
highest MAP	138.9±21.4	128.5±18.1	128.3±19.6	0.104	0.100	0.837
lowest MAP	74.7±11.3	80.1±11.4	80.2±11.2	0.233	0.224	0.879
mean MAP	99.5±10.0	103.8±14.8	101.1±11.7	0.271	0.725	0.559
variability index of MAP	13.0±5.8	10.9±3.5	10.5±4.2	0.095	0.087	0.773

NTG = normal tension glaucoma; POAG = primary open-angle glaucoma.

^* Paired t-test.

Table 3.

Parameter	NTG (n=30)	POAG(n=30)	Control(n=30)	p-value^*
Parameter	NTG (n=30)	POAG(n=30)	Control(n=30)	NTG vs POAG	NTG vs Control	POAG vs Control
Systolic blood pressure (SBP, mmHg)
highest SBP	172.1±28.7	169.5±19.0	165.0±18.4	0.741	0.162	0.420
lowest SBP	103.8±15.0	110.9±15.8	107.8±15.2	0.162	0.343	0.316
mean SBP	132.8±13.5	137.3±17.2	131.3±14.3	0.321	0.723	0.209
variability index of SBP	15.3±5.8	13.4±3.5	13.0±4.9	0.254	0.231	0.815
Diastolic blood pressure (DBP, mmHg)
highest DBP	124.5±22.8	114.7±20.0	112.4±19.5	0.113	0.078	0.497
lowest DBP	61.0± 10.6	65.2±10.9	64.6±9.9	0.145	0.216	0.795
mean DBP	82.9±9.4	87.0±12.1	86.0± 10.3	0.262	0.328	0.783
variability index of DBP	12.7±5.6	10.5±4.5	10.9±5.1	0.137	0.244	0.787
Heart rate (HR, rate/min)
highest HR	125.9±27.1	118.2±28.3	115.2±26.8	0.443	0.126	0.559
lowest HR	53.5±8.2	53.0±13.4	56.3±9.0	0.775	0.335	0.317
mean HR	72.8±7.5	73.5±12.0	74.2±8.7	0.721	0.376	0.711
variability index of HR	15.0±7.4	14.3±7.1	13.7±6.8	0.652	0.356	0.638
Mean arterial blood pressure (MAP, mmHg)
highest MAP	138.9±21.4	128.5±18.1	128.3±19.6	0.104	0.100	0.837
lowest MAP	74.7±11.3	80.1±11.4	80.2±11.2	0.233	0.224	0.879
mean MAP	99.5± 10.0	103.8±14.8	101.1±11.7	0.271	0.725	0.559
variability index of MAP	13.0±5.8	10.9±3.5	10.5±4.2	0.095	0.087	0.773

NTG = normal tension glaucoma; POAG = primary open-angle glaucoma.

^* Paired t-test.

Table 4.

Number of patients classified by lowest mean arterial blood pressure (MAP) in normal tension glaucoma (NTG), primary open-angle glaucoma (POAG), and control group

Parameter	NTG (n=30)	POAG (n=30)	Control (n=30)	p-value^*
Parameter	NTG (n=30)	POAG (n=30)	Control (n=30)	NTG vs POAG	NTG vs Control	POAG vs Control
Lowest MAP < 60 mmHg	8 (27%)	2 (7%)	2 (7%)	0.038	0.038	1.000
Lowest MAP < 65 mmHg	12 (40%)	6 (20%)	6 (20%)	0.091	0.091	1.000
Lowest MAP < 70 mmHg	17 (57%)	10 (33%)	11 (37%)	0.069	0.121	0.787

NTG = normal tension glaucoma; POAG = primary open-angle glaucoma; MAP = mean arterial blood pressure.

^* Chi-square test.

Table 5.

Average nighttime blood pressure depression in normal tension glaucoma (NTG), primary open-angle glaucoma (POAG), and control group

Parameter	NTG (n=30)	POAG (n=30)	Control (n=30)	p-value^*
Parameter	NTG (n=30)	POAG (n=30)	Control (n=30)	NTG vs POAG	NTG vs Control	POAG vs Control
Night time systolic dip (%)	13.0±5.3	11.1±7.8	8.0±5.7	0.259	0.053	0.219
Night time diastolic dip (%)	15.4±6.1	11.6±7.0	11.5±6.0	0.068	0.066	0.871
Night time MAP dip (%)	14.4±5.7	11.5±7.5	10.0±5.9	0.197	0.061	0.427

NTG = normal tension glaucoma; POAG = primary open-angle glaucoma; MAP = mean arterial blood pressure.

^* Paired t-test.

Table 6.

Number of dipper group in normal tension glaucoma (NTG), primary open-angle glaucoma (POAG), and control group

Parameter	NTG (n=30)	POAG (n=30)	Control (n=30)	p-value^*
Parameter	NTG (n=30)	POAG (n=30)	Control (n=30)	NTG vs POAG	NTG vs Control	POAG vs Control
SBP dipper group	11 (37%)	8 (27%)	9 (30%)	0.405	0.584	0.774
DBP dipper group	17 (57%)	9 (30%)	9 (30%)	0.037	0.037	1.000
MAP dipper group	13 (43%)	9 (30%)	9 (30%)	0.284	0.284	1.000

NTG = normal tension glaucoma; POAG = primary open angle glaucoma; SBP = systolic blood pressure; DBP = diastolic blood pressure; MAP = mean arterial blood pressure.

^* Chi-square test.

Table 7.

Blood pressure data of 24-hour ambulatory blood pressure measurement in primary open-angle glaucoma (POAG) with or without topical beta-blocker during the daytime (mean±S.D.)

Parameter	With beta-blocker (n=16)	Without beta-blocker (n=14)	p-value^*
Systolic blood pressure (SBP, mmHg)
highest SBP	167.7±19.2	171.3±18.8	0.665
lowest SBP	111.8±16.2	110.0±15.4	0.821
mean SBP	137.0±17.6	137.6±16.8	0.892
variability index of SBP	13.6±3.4	13.2±3.6	0.764
Diastolic blood pressure (DBP, mmHg)
highest DBP	115.9±20.9	113.5±19.1	0.712
lowest DBP	63.3± 10.7	67.1± 11.1	0.214
mean DBP	88.3± 12.0	85.7±12.2	0.727
variability index of DBP	10.4±4.5	10.6±4.5	0.924
Heart rate (HR, rate/min)
highest HR	115.7±27.2	120.7±29.4	0.287
lowest HR	52.2±13.1	53.8±13.7	0.746
mean HR	71.9±13.4	75.1±10.6	0.508
variability index of HR	14.7±8.0	13.9±6.2	0.776
Mean arterial blood pressure (MAP, mmHg)
highest MAP	130.0±18.8	127.0±17.4	0.693
lowest MAP	79.5±11.7	80.7± 11.1	0.885
mean MAP	104.5±14.2	103.0±15.4	0.852
variability index of MAP	10.1±3.6	11.7±3.4	0.749

^* Mann-Whitney U test.

Table 8.

Blood pressure data of 24-hour ambulatory blood pressure measurement in primary open-angle glaucoma (POAG) with or without topical beta-blocker during the nighttime (mean±S.D.)

Parameter	With beta-blocker (n=16)	Without beta-blocker (n=14)	p-value^*
Systolic blood pressure (SBP, mmHg)
highest SBP	139.7±19.5	137.5±18.3	0.789
lowest SBP	104.5±15.5	104.9±16.5	0.908
mean SBP	120.8±16.7	123.2±17.1	0.761
variability index of SBP	11.5±5.7	10.9±5.3	0.852
Diastolic blood pressure (DBP, mmHg)
highest DBP	91.5±18.0	91.9±18.2	0.911
lowest DBP	58.7±11.9	61.3±10.9	0.645
mean DBP	76.0±11.8	77.8±11.6	0.823
variability index of DBP	9.7±4.5	9.3±4.3	0.891
Heart rate (HR, rate/min)
highest HR	77.9±19.3	81.1±19.9	0.671
lowest HR	50.2±11.2	51.0±10.8	0.919
mean HR	61.1±11.5	62.3±12.3	0.874
variability index of HR	8.6±4.0	8.8±3.8	0.892
Mean arterial blood pressure (MAP, mmHg)
highest MAP	105.5±18.5	106.7±18.3	0.884
lowest MAP	76.9±15.9	78.7± 17.7	0.827
mean MAP	90.9±12.5	92.9±11.9	0.766
variability index of MAP	9.8±4.2	9.6±3.8	0.878

^* Mann-Whitney U test.

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