Diurnal Blood Pressure Variation in the Retinal Vein Occlusion

Sung Jin Park; Sang Woo Moon; Sung Hyup Lim; Il Han Yoon; Kyu Nam Choi; Ho Young Lee

doi:10.3341/jkos.2013.54.9.1371

Journal List > J Korean Ophthalmol Soc > v.54(9) > 1009476

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Park, Moon, Lim, Yoon, Choi, and Lee: Diurnal Blood Pressure Variation in the Retinal Vein Occlusion

Original Article

J Korean Ophthalmol Soc 2013;54(9):1371-1378.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.9.1371

Diurnal Blood Pressure Variation in the Retinal Vein Occlusion

Sung Jin Park, MD¹, Sang Woo Moon, MD¹, Sung Hyup Lim, MD^1,², Il Han Yoon, MD¹, Kyu Nam Choi, MD³, Ho Young Lee, MD^1,²

¹Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

²Therapeutics Center for Ocular Neovascular Disease, Busan, Korea

³Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

Address reprint requests to Ho Young Lee, MD Department of Ophthalmology, Inje University Busan Paik Hospital, #75 Bokji-ro, Busanjin-gu, Busan 614-735, Korea Tel: 82-51-890-6016, Fax: 82-51-890-6329 E-mail: happytriad@gmail.com

∗ This study was presented as a narration at the 109th Annual Meeting of the Korean Ophthalmological Society 2013.

Received 26 January 201320 June 2013 Accepted 10 August 2013

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

The purpose of this study was to determine the diurnal blood pressure variation with retinal vein occlusion (RVO) using 24-hour ambulatory blood pressure monitoring (24-hour ABPM).

Methods

The subjects in this study visited the department of ophthalmology from May 2012 to December 2012 and were diagnosed with RVO but had no history of hypertension (HTN). Non-dipper was defined as a nocturnal systolic blood pres-sure (SBP) decrease less than 10%. These values were used to compare the 24-hour ABPM values of the RVO and the control groups.

Results

The 24-hour ABPM values, with the exception of the mean nightly SBP, were statistically different whne the RVO group was compared with the control group. The odds of an RVO patient being a non-dipper compared to dipper were 1.81 times greater than in the control. Additionally, the clinical SBP and DBP in the RVO group were not significantly different when the HTN group and the non-HTN group were compared. In contrast, the mean 24-hour SBP and the mean DBP were significantly different in regard to HTN.

Conclusions

Patients with RVO have a tendency to maintain high BP throughout the day and also during the night. A patient with non-dipper status can be at risk for RVO, even if the patient does not have HTN. Therefore, 24-hour ABPM is an effective management approach for HTN in addition to strict BP control in patients with RVO.

Keywords: Non-dipper, Retinal vein occlusion, Target organ damage, 24-hour ambulatory blood pressure monitoring

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Table 1.

The comparison of clinical manifestation between the RVO and control

	RVO (n = 26)	Control (n = 25)	p-value
Sex (M:F)	11:15	12:13
Age (years)	58.96 ± 9.01	59.32 ± 13.86	0.472
DM (person)	7	6
BMI (kg/m²)	23.96 ± 2.14	23.39 ± 2.74	0.759
LDL-c (mg/dL)	125.77 ± 29.24	126.35 ± 29.23	0.638
IOP (mm Hg)	16.9 ± 4.28	15.25 ± 3.57	0.265

Values are presented as mean ± SD; p-value is based on Mann-Whitney U-test.

RVO = retinal vein occlusion; DM = diabetic mellitus; BMI = body mass index; LDL-C = low density lipoprotein-cholesterol; IOP = intraocular pressure, measured by Goldmann applanation tonometer.

Table 2.

The comparison of hypertension ratio between the RVO and control

	RVO (n = 26)	Control (n = 25)
Hypertension (n = 24)	19	5
Non-hypertension (n = 27)	7	20

RVO = retinal vein occlusion.

Table 3.

The comparison of mean blood pressure between the RVO and control

	RVO (n = 26)	Control (n = 25)	p-value
SBP (mm Hg)	137.68 ± 16.07	127.04 ± 13.53	0.007
DBP (mm Hg)	84.90 ± 10.35	75.67 ± 8.91	0.001
Day SBP (mm Hg)	139.27 ± 16.00	128.44 ± 12.93	0.008
Day DBP (mm Hg)	85.45 ± 10.67	76.56 ± 8.64	0.001
Night SBP (mm Hg)	127.56 ± 20.40	122.11 ± 17.36	0.262
Night DBP (mm Hg)	78.96 ± 11.63	72.59 ± 11.13	0.013

Values are presented as mean ± SD; p-value is based on Mann-Whitney U-test.

RVO = retinal vein occlusion; 24-hour SBP = 24-hour mean systolic blood pressure; 24-hour DBP = 24-hour mean diastolic blood pressure; Day SBP = daytime mean systolic blood pressure; Day DBP = daytime mean diastolic blood pressure; Night SBP = nighttime mean systolic blood pressure; Night DBP = nighttime mean diastolic blood pressure.

Table 4.

The comparison of nocturnal systolic blood pressure fall between RVO and control

	RVO (n = 26)	Control (n = 25)
Dipper (n = 17)	7	10
Non-dipper (n = 34)	19	15

RVO = retinal vein occlusion.

Table 5.

The comparison of n on-dipper ratio based o n the presence or absenc e of hypertension between RVO and control

	RVO (n = 26)		Control (n = 25)
	Hypertension (n = 19) N	Non-hypertension (n = 7)	Hypertension (n = 5)	Non-hypertension (n = 20)
Dipper (n = 17)	5	2	2	8
Non-dipper (n = 34)	14	5	3	12

RVO = retinal vein occlusion.

Table 6.

The outcome of 24-hour ABPM based on the presence or absence of hypertension in the RVO (I)

	24-hour mSBP (mm Hg)	24-hour mDBP (mm Hg)
Hypertension (n = 19)	143.88 ± 14.29	87.65 ± 10.57
Non-hypertension (n = 7)	120.86 ± 3.53	77.43 ± 4.69
p-value	0.000	0.006

Values are presented as mean ± SD; p-value is based on Mann-Whitney U-test.

RVO = retinal vein occlusion; SBP = systolic blood pressure; DBP = diastolic blood pressure.

Table 7.

The outcome of mean 24-hour ABPM based on the presence or absence of hypertension in the RVO (II)

	Hypertension (n = 19)	Non-h ypertension (n = 7)	p-value
Day SBP (mm Hg)	144.95 ± 14.83	123.86 ± 5.18	0.000
Night SBP (mm Hg)	133.34 ± 20.85	111.86 ± 6.07	0.006
Day DBP (mm Hg)	87.93 ± 10.96	78.71 ± 6.42	0.048
Night DBP (mm Hg)	81.42 ± 12.54	72.29 ± 4.57	0.022

Values are presented as mean ± SD; p-value is based on Mann-Whitney U-test.

RVO = retinal vein occlusion; SBP = systolic blood pressure; DBP = diastolic blood pressure.

Table 8.

The outcome of 24-hour ABPM based on the extent of nocturnal SBP fall in the RVO

	Dippers (n = 7)	Non-dippers (n = 19)	p-value
Day mSBP (mm Hg)	136.71 ± 8.24	140.22 ± 18.14	0.910
Night mSBP (mm Hg)	110.57 ± 11.31	133.82 ± 19.54	0.004
p-value	0.001	0.223
Nocturnal SBP fall (%)	17.92 ± 3.62	4.64 ± 4.37

Values are presented as mean ± SD; p-value is based on Mann-Whitney U-test; Nocturnal SBP fall, nocturnal systolic blood pressure fall = {(Day mSBP-Night mSBP)/Day mSBP} × 100 (%).

RVO = retinal vein occlusion; SBP = systolic blood pressure.

Table 9.

The Comparison of clinical BP with 24-hour ABPM based on the presence or absence of hypertension in the RVO

	Hypertension (n = 19)	Non-h ypertension (n = 7)	p-value
Clinical SBP (mm Hg)	135.37 ± 17.72	127.86 ± 10.25	0.306
24-hour mSBP (mm Hg)	143.88 ± 14.29	120.86 ± 3.53	0.000
Clinical DBP (mm Hg)	80.63 ± 10.32	81.71 ± 6.34	0.651
24-hour mDBP (mm Hg)	87.65 ± 10.57	77.43 ± 4.69	0.006

Values are presented as mean ± SD; p-value is based on Mann-Whitney U-test.

RVO = retinal vein occlusion; SBP = systolic blood pressure; DBP = diastolic blood pressure.

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