Laboratory of Neurosciences, Faculty of Medicine at University of Zulia-Maracaibo, Zulia, Venezuela.
The Taub Institute for Research in Alzheimer's Disease and the Aging Brain and the G.H. Sergievsky Center at Columbia University, New York, New York; Department of Epidemiology, School of Public Health, Columbia University, New York, New York.
Ophthalmology. 2018 Jun;125(6):807-814. doi: 10.1016/j.ophtha.2017.11.029. Epub 2018 Jan 6.
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.
Observational cross-sectional study.
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.
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.
Glaucomatous optic neuropathy (GON) based on the presence of optic nerve damage and VF defects.
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).
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.
确定夜间血压（BP）参数（低值或极端杓型状态）与西班牙裔人群青光眼损害风险增加之间的关系。
观察性横断面研究。
符合研究入选标准的马拉开波衰老研究（MAS）参与者的一个亚组（n=93）被纳入研究。这些参与者年龄至少 40 岁，进行了光学断层相干测量、视野（VF）测试、24 小时 BP、诊室 BP 和眼压<22mmHg 的测量。
使用广义估计方程（GEE）框架下的单变量和多变量逻辑回归分析，研究了 BP 参数与青光眼损害之间的关系，特别关注夜间 BP 的下降。
基于视神经损伤和 VF 缺陷的青光眼性视神经病变（GON）。
平均年龄为 61.9 岁，87.1%为女性。在 185 只受评估的眼中，19 只（26.5%）有 GON 迹象。有 GON 的个体 24 小时和夜间舒张压水平明显低于无 GON 的个体。然而，多变量 GEE 模型的结果表明，青光眼损害与 24 小时、白天或夜间测量的平均收缩压或舒张压水平无关。相比之下，夜间收缩压和舒张压的极端下降（与白天 BP 相比下降超过 20%）是青光眼损害的显著危险因素（比值比分别为 19.78 和 5.55）。
在该人群中，夜间 BP 与 GON 之间的联系是由极端杓型效应决定的，而不仅仅是夜间 BP 水平低。需要进一步研究考虑高危青光眼个体夜间 BP 的极端下降。
