Correlation Between Nocturnal Dip and Progression of Glaucoma

Hong Ryung Seo; Won Yeol Ryu; Sae Heun Rho

doi:10.3341/jkos.2010.51.11.1471

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Seo, Ryu, and Rho: Correlation Between Nocturnal Dip and Progression of Glaucoma

Original Article

J Korean Ophthalmol Soc 2010;51(11):1471-1478.

Published online: 7 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.11.1471

Correlation Between Nocturnal Dip and Progression of Glaucoma

Hong Ryung Seo, MD, Won Yeol Ryu, MD, Sae Heun Rho, MD, PhD

Department of Ophthalmology, Dong-A University College of Medicine, Pusan, Korea

Address reprint requests to Sae Heun Rho, MD, PhD Department of Ophthalmology, Dong-A University Medical Center #3 Dongdaesin-dong, Seo-gu, Busan 602-715, Korea Tel: +82-51-240-5227, Fax: +82-51-254-1987, E-mail: shrho@donga.ac.kr

Received 9 March 2010 Accepted 25 August 2010

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 investigate the effect of nocturnal dip influence on the progression of glaucomatous visual field defect.

Methods

We performed 24hr ABPM and V/F tests on patients diagnosed with NTG (140 patients, 280 eyes) and POAG (84 patients, 168 eyes). Nocturnal dips below 10% were classified as non-dippers, and those above 10% were noted as dippers. The correlations among nocturnal dip, progression of glaucomatous visual field defect, and hypertension treatment were examined.

Results

In NTG, dippers in both systolic and diastolic blood pressure furthered glaucomatous visual field defects, with a relative risk of approximately three times that of non-dippers. Hypertension treatment was not influenced by the progression of glaucomatous visual field defect but was influenced by dips in the systolic and diastolic pressures in NTG and in diastolic pressure in POAG. Nocturnal dips were more frequent in the group with progression of the visual field compared to those in the group with non-progression of the visual field in NTG.

Conclusions

Dipper caused a progression of glaucomatous visual field defects in NTG and was influenced by hypertension treatment in NTG and POAG. Performing 24hr ABPM should be helpful for glaucoma patients with progression of a glaucomatous visual field defect even when the IOP is less than the target pressure. In addition, hypertension treatment should be considered an important factor in the treatment of glaucoma.

Keywords: Dipper, Hypertension treatment, Nocturnal dip, Progression of visual field defect, 24-hour blood pressure monitoring

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Table 1.

Demographics of patients in NTG and POAG

	NTG	POAG	p value
M: F (n)	114: 166	92: 76	0.479^*
Mean age (yrs)	56.17 ± 14.84	58.23 ± 13.89	0.676^†
Mean IOP (mmHg)	12.98 ± 2.47	14.31 ± 3.50	0.244^†
Mean deviation of visual field (dB)	−4.18 ± 5.25	−8.43 ± 8.74	0.128^†
Mean SBP (mmHg)	115.95 ± 11.02	120.63 ± 13.24	0.481^†
Mean DBP (mmHg)	72.94 ± 7.36	76.37 ± 10.22	0.278^†
Mean nocturnal dip of SBP (%)	7.98 ± 5.54	8.41 ± 6.17	0.118^†
Mean nocturnal dip of DBP (%)	8.89 ± 6.93	9.22 ± 7.16	0.180^†
Hypertension (n)	112	61	0.374^*
Mean period of hypertension medication (yrs)	7.33 ± 4.28	7.03 ± 3.47	0.614^†

NTG = normal tension glaucoma; POAG = priamry open angle glaucoma; SBP = systolic blood pressure; DBP = diastolic blood pressure.

^* Chi-square test

^† Student t-test.

Table 2.

Association of dipper and V/F progression in NTG and POAG

	V/F progression		Chi-square test
	Yes	No	p value^*	Odd ratio	Relative risk
SBP in NTG			<0.000		
Dipper	27	67		4.951	3.816
Non-dipper	14	172		(CI^†: 2.448∼10.015)	(CI^†: 2.103∼6.925)
DBP in NTG			0.002		
Dipper	30	112		3.093	2.650
Non-dipper	11	127		(CI^†: 1.481∼6.456)	(CI^†: 1.384∼5.077)
SBP in POAG			0.116		
Dipper	11	51		2.071	1.881
Non-dipper	10	96		(CI^†: 0.824∼5.202)	(CI^†: 0.848∼4.173)
DBP in POAG			0.128		
Dipper	13	65		2.050	1.875
Non-dipper	8	82		(CI^†: 0.802∼5.242)	(CI^†: 0.82∼4.287)

V/F = visual field; SBP = systolic blood pressure; NTG = normal tension glaucoma; DBP = diastolic blood pressure; POAG = priamry open angle glaucoma.

^* Statistical significance: p<0.05

^† CI: confidence interval, CI was calculated at 95 percentile.

Table 3.

Association of hypertension and V/F progression in NTG and POAG

	V/F progression		Chi-square test
	Yes	No	p value^*	Odd ratio	Relative risk
NTG			0.112		
HTN Treatment group	21	91		1.708	1.575
Normal BP group	20	148		(CI^†: 0.878∼3.323)	(CI^†: 0.896∼2.768)
POAG			0.249		
HTN Treatment group	10	51		1.711	1.595
Normal BP group	11	96		(CI^†: 0.681∼4.299)	(CI^†: 0.719∼3.537)

V/F = visual field; NTG = normal tension glaucoma; HTN = hypertension; POAG = priamry open angle glaucoma; BP = blood pressure.

^* statistical significance: p<0.05

^† CI: confidence interval, CI was calculated at 95 percentile.

Table 4.

Association of hypertension and dipper in NTG and POAG

	Dipper		Chi-square test
	Yes	No	p value^*	Odd ratio	Relative risk
SBP in NTG			0.001		
HTN treatment group	51	61		2.430	1.779
Normal BP group	43	125		(CI^†: 1.462∼4.040)	(CI^†: 1.282∼2.469)
DBP in NTG			<0.000		
HTN treatment group	80	32		10.625	3.750
Normal BP group	62	106		(CI^†: 6.054∼18.647)	(CI^†: 2.688∼5.232)
SBP in POAG			0.068		
HTN treatment group	28	33		1.822	1.445
Normal BP group	34	73		(CI^†: 0.953∼3.481)	(CI^†: 0.979∼2.131)
DBP in POAG			<0.000		
HTN treatment group	33	28		3.170	1.996
Normal BP group	45	62		(CI^†: 1.639∼6.132)	(CI^†: 1.355∼2.940)

SBP = systolic blood pressure; NTG = normal tension glaucoma; DBP = diastolic blood pressure; HTN = hypertension; POAG = priamry open angle glaucoma.

^* Statistical significance: p<0.05

^† CI: confidence interval, CI was calculated at 95 percentile.

Table 5.

The mean of nocturnal dip & 24 hours blood pressure in NTG & POAG

	The mean of nocturnal dip (%)			The mean of blood pressure (mmHg)
	V/F progression		p value_^*	V/F progression		p value^*
	Yes	No	p value_^*	Yes	No	p value^*
SBP in NTG			0.001			0.392
Dipper	15.66 ± 4.02	13.21 ± 2.70		118.27 ± 11.05	121.28 ± 10.77	
Non-dipper	3.63 ± 5.42	5.10 ± 3.55		115.28 ± 10.93	113.56 ± 10.38	
DBP in NTG			<0.000			0.245
Dipper	16.57 ± 4.23	14.07 ± 3.30		73.84 ± 8.11	74.40 ± 7.15	
Non-dipper	1.81 ± 3.54	3.11 ± 3.94		75.11 ± 8.69	71.25 ± 6.97	
SBP in POAG			0.144			0.175
Dipper	18.03 ± 5.23	13.93 ± 3.45		122.30 ± 8.51	123.15 ± 19.10	
Non-dipper	3.25 ± 3.06	4.91 ± 3.84		126.51 ± 11.88	118.49 ± 9.11	
DBP in POAG			0.104			0.139
Dipper	18.03 ± 5.48	14.90 ± 3.71		81.25 ± 3.16	79.55 ± 11.74	
Non-dipper	2.75 ± 3.24	3.95 ± 4.35		76.55 ± 10.44	73.07 ± 8.52	

SBP = systolic blood pressure; NTG = normal tension glaucoma; DBP = diastolic blood pressure; POAG = priamry open angle glaucoma.

^* Student t-test, statistical significance: p<0.05.

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