Progression of functional and structural glaucomatous damage in relation to diurnal and nocturnal dips in mean arterial pressure.

Autor:	Melgarejo JD; Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, Studies Coordinating Centre, Katholieke Universiteit Leuven, Leuven, Belgium.; Laboratory of Neurosciences, Faculty of Medicine, University of Zulia, Maracaibo, Venezuela., Eijgen JV; Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium.; Research Group of Ophthalmology, Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium., Wei D; Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, Studies Coordinating Centre, Katholieke Universiteit Leuven, Leuven, Belgium., Maestre GE; Laboratory of Neurosciences, Faculty of Medicine, University of Zulia, Maracaibo, Venezuela.; Rio Grande Valley Alzheimer's Disease Resource Center for Minority Aging Research (RGV AD-RCMAR), University of Texas Rio Grande Valley, Brownsville, TX, United States.; School of Medicine, Institute for Neuroscience, University of Texas Rio Grande Valley, Harlingen, TX, United States.; Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, United States., Al-Aswad LA; Department of Ophthalmology, New York University (NYU) Grossman School of Medicine, NYU Langone Health, New York, NY, United States., Liao CT; Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, Studies Coordinating Centre, Katholieke Universiteit Leuven, Leuven, Belgium., Mena LJ; Department of Informatics, Universidad Politécnica de Sinaloa, Mazatlán, Mexico., Vanassche T; KU Leuven Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology, Katholieke Universiteit Leuven, Leuven, Belgium., Janssens S; Division of Cardiology, Department of Internal Medicine, University Hospitals UZ Leuven, Leuven, Belgium., Verhamme P; KU Leuven Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology, Katholieke Universiteit Leuven, Leuven, Belgium., Keer KV; Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium.; Research Group of Ophthalmology, Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium., Stalmans I; Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium.; Research Group of Ophthalmology, Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium., Zhang ZY; Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, Studies Coordinating Centre, Katholieke Universiteit Leuven, Leuven, Belgium.
Jazyk:	angličtina
Zdroj:	Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2022 Nov 15; Vol. 9, pp. 1024044. Date of Electronic Publication: 2022 Nov 15 (Print Publication: 2022).
DOI:	10.3389/fcvm.2022.1024044
Abstrakt:	Background: Systemic hypoperfusion plays a pivotal role in the pathogenesis of primary open-angle glaucoma (POAG). Extreme dips in mean arterial pressure (MAP) due to high 24-h variability are associated with POAG, however, whether this is driven by diurnal or nocturnal dips remains undocumented. We aimed this study to investigate the association of POAG damage with variability and dips in the diurnal and nocturnal MAP. Methods: We conducted a retrospective longitudinal study that included 110 POAG patients who underwent 24-h ambulatory blood pressure monitoring. Our outcomes included (i) functional [visual field defects expressed as mean deviation (MD)] and (ii) structural (optic disc cupping obtained from cup-to-disc ratio) glaucoma damage. MAP variability independent of the mean (VIMmap) was computed for diurnal and nocturnal MAP. Dips were the five diurnal and three nocturnal lowest drops in MAP. We also calculated the night-to-day ratio. We applied mixed models to evaluate the progression of visual field defects and optic disc cupping in relation to diurnal and nocturnal MAP measures. Results: The mean age was 64.0 y (53% women). The median follow-up was 9 years. In adjusted mixed models, functional progression of glaucoma damage was associated with VIMmap (-2.57 dB change in MD per every 3 mmHg increase in VIMmap; P < 0.001) and diurnal MAP dips (changes in the MD ranged from -2.56 to -3.19 dB; P < 0.001). Every 5 mmHg decrease in the nocturnal MAP level was associated with -1.14 dB changes in MD [95% confidence interval (CI), -1.90 to -0.40] and 0.01 larger optic disc cupping (95% CI, 0.01-0.02). Lower night-to-day ratio was also related to both outcomes ( P ≤ 0.012). Functional glaucoma damage worsened if nocturnal hypotension was combined with high variability or extreme dips in the diurnal MAP ( P ≤ 0.022). Conclusion: Progression of glaucoma damage in POAG associates with high variability and extreme dips in the diurnal MAP. Structural glaucoma damage seems more vulnerable to nocturnal hypotension. Ambulatory blood pressure monitoring allows the assessment of sporadic diurnal and persistent nocturnal hypotension episodes. These phenotypes might offer an opportunity to improve the risk-stratification of open-angle glaucoma (OAG). Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Melgarejo, Eijgen, Wei, Maestre, Al-Aswad, Liao, Mena, Vanassche, Janssens, Verhamme, Keer, Stalmans and Zhang.)
Databáze:	MEDLINE
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