TY - JOUR
T1 - Glaucomatous Optic Neuropathy Associated with Nocturnal Dip in Blood Pressure
T2 - Findings from the Maracaibo Aging Study
AU - Melgarejo, Jesús D.
AU - Lee, Joseph H.
AU - Petitto, Michele
AU - Yépez, Juan B.
AU - Murati, Felipe A.
AU - Jin, Zhezhen
AU - Chávez, Carlos A.
AU - Pirela, Rosa V.
AU - Calmón, Gustavo E.
AU - Lee, Winston
AU - Johnson, Matthew P.
AU - Mena, Luis J.
AU - Al-Aswad, Lama A.
AU - Terwilliger, Joseph D.
AU - Allikmets, Rando
AU - Maestre, Gladys E.
AU - De Moraes, C. Gustavo
N1 - Funding Information:
The authors thank the participants and assessment team of the MAS in both Santa Lucía and Santa Rosa. We also acknowledge the fellows Drs. Federico Flores, Rubén Torrealba, Roxana Chacón, and David Santana, who collected the ophthalmological information, and support from Dr. Doris Molina. We acknowledge the technical English writing and editing of the article provided by Dr. Val Gerard, PhD, and ServingMed. We thank Edvin Jaimes for creating the illustrated figure. This report is supported by the Gene-Environment Interaction in Cognition in Venezuela Families project founded by the National Institute on Aging–National Institutes of Health under Award Number R01AG036469 and 1 R03 AG054186-01 (G.E.M., J.D.T., W.L.). We also acknowledge the South Texas Diabetes and Obesity Institute for support in preparation of this report.
PY - 2018/6
Y1 - 2018/6
N2 - Purpose: To determine which nocturnal blood pressure (BP) parameters (low levels or extreme dipper status) are associated with an increased risk of glaucomatous damage in Hispanics. Design: Observational cross-sectional study. Participants: A subset (n = 93) of the participants from the Maracaibo Aging Study (MAS) who met the study eligibility criteria were included. These participants, who were at least 40 years of age, had measurements for optical tomography coherence, visual field (VF) tests, 24-hour BP, office BP, and intraocular pressure <22 mmHg. Methods: Univariate and multivariate logistic regression analyses under the generalized estimating equations (GEE) framework were used to examine the relationships between glaucomatous damage and BP parameters, with particular attention to decreases in nocturnal BP. Main Outcome Measures: Glaucomatous optic neuropathy (GON) based on the presence of optic nerve damage and VF defects. Results: The mean age was 61.9 years, and 87.1% were women. Of 185 eyes evaluated, 19 (26.5%) had signs of GON. Individuals with GON had significantly lower 24-hour and nighttime diastolic BP levels than those without. However, results of the multivariate GEE models indicated that the glaucomatous damage was not related to the average systolic or diastolic BP levels measured over 24 hours, daytime, or nighttime. In contrast, extreme decreases in nighttime systolic and diastolic BP (>20% compared with daytime BP) were significant risk factors for glaucomatous damage (odds ratio, 19.78 and 5.55, respectively). Conclusions: In this population, the link between nocturnal BP and GON is determined by extreme dipping effects rather than low nocturnal BP levels alone. Further studies considering extreme decreases in nocturnal BP in individuals at high risk of glaucoma are warranted.
AB - Purpose: To determine which nocturnal blood pressure (BP) parameters (low levels or extreme dipper status) are associated with an increased risk of glaucomatous damage in Hispanics. Design: Observational cross-sectional study. Participants: A subset (n = 93) of the participants from the Maracaibo Aging Study (MAS) who met the study eligibility criteria were included. These participants, who were at least 40 years of age, had measurements for optical tomography coherence, visual field (VF) tests, 24-hour BP, office BP, and intraocular pressure <22 mmHg. Methods: Univariate and multivariate logistic regression analyses under the generalized estimating equations (GEE) framework were used to examine the relationships between glaucomatous damage and BP parameters, with particular attention to decreases in nocturnal BP. Main Outcome Measures: Glaucomatous optic neuropathy (GON) based on the presence of optic nerve damage and VF defects. Results: The mean age was 61.9 years, and 87.1% were women. Of 185 eyes evaluated, 19 (26.5%) had signs of GON. Individuals with GON had significantly lower 24-hour and nighttime diastolic BP levels than those without. However, results of the multivariate GEE models indicated that the glaucomatous damage was not related to the average systolic or diastolic BP levels measured over 24 hours, daytime, or nighttime. In contrast, extreme decreases in nighttime systolic and diastolic BP (>20% compared with daytime BP) were significant risk factors for glaucomatous damage (odds ratio, 19.78 and 5.55, respectively). Conclusions: In this population, the link between nocturnal BP and GON is determined by extreme dipping effects rather than low nocturnal BP levels alone. Further studies considering extreme decreases in nocturnal BP in individuals at high risk of glaucoma are warranted.
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U2 - 10.1016/j.ophtha.2017.11.029
DO - 10.1016/j.ophtha.2017.11.029
M3 - Article
AN - SCOPUS:85040009145
VL - 125
SP - 807
EP - 814
JO - Ophthalmology
JF - Ophthalmology
SN - 0161-6420
IS - 6
ER -