Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, South Korea.
Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, South Korea.
Ophthalmology. 2019 Jul;126(7):967-979. doi: 10.1016/j.ophtha.2019.03.001. Epub 2019 Mar 8.
To investigate the impact of systolic and diastolic blood pressure (DBP) dip at baseline on subsequent visual field (VF) progression in eyes with normal-tension glaucoma (NTG).
Prospective cohort study.
This study included 119 eyes of 119 newly diagnosed NTG patients followed up for at least 2 years (average, 40.4±16.9 months).
All participants underwent baseline 24-hour ambulatory blood pressure (BP) monitoring and measurements of intraocular pressure (IOP) and at least 5 serial VF examinations. Participants were followed up as outpatients at 4- to 6-month intervals. Visual field progression was defined according to Early Manifest Glaucoma Trial criteria. The associations of VF progression with systolic BP (SBP) and DBP measured during the day and at night and other clinical variables were analyzed.
Factors associated with VF progression over time.
During follow-up, 41 eyes (34%) showed VF progression. In the multivariate Cox regression model, lower nighttime trough DBP (hazard ratio, 0.953; P = 0.023) and greater nighttime DBP dip area (time multiplied by nighttime DBP > 10 mmHg less than mean daytime DBP; hazard ratio, 1.017; P = 0.003) at baseline were significant predictors of subsequent VF progression. None of the SBP parameters was associated with VF progression. Nocturnal DBP dip showed a greater association with VF progression than SBP dip.
Nocturnal trough DBP and DBP dip area at baseline are significant predictors of subsequent VF progression in NTG. Nocturnal DBP dip may be more relevant to future VF progression than SBP dip in NTG eyes.
研究正常眼压性青光眼（NTG）患者基线时收缩压和舒张压（DBP）下降对随后视野（VF）进展的影响。
前瞻性队列研究。
本研究纳入了 119 名新诊断为 NTG 的患者的 119 只眼，这些患者至少随访了 2 年（平均 40.4±16.9 个月）。
所有参与者均进行了基线 24 小时动态血压（BP）监测、眼压（IOP）测量和至少 5 次连续 VF 检查。患者以 4 至 6 个月为间隔在门诊进行随访。根据早期表现性青光眼试验标准定义 VF 进展。分析了 VF 进展与日间和夜间测量的 SBP 和 DBP 以及其他临床变量的相关性。
与随时间推移的 VF 进展相关的因素。
在随访期间，41 只眼（34%）出现 VF 进展。在多变量 Cox 回归模型中，夜间低谷 DBP（风险比，0.953；P=0.023）和夜间 DBP 下降面积较大（夜间时间乘以 DBP 下降值大于 10mmHg 时减去日间平均 DBP；风险比，1.017；P=0.003）是随后 VF 进展的显著预测因子。SBP 参数均与 VF 进展无关。夜间 DBP 下降与 VF 进展的相关性大于 SBP 下降。
NTG 患者基线时夜间低谷 DBP 和 DBP 下降面积是随后 VF 进展的显著预测因子。夜间 DBP 下降可能比 NTG 眼中的 SBP 下降更与未来 VF 进展相关。
