Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
Institute of Neurosciences, School of Medicine, University of Rio Grande Valley, Harlingen.
J Hypertens. 2023 Nov 1;41(11):1785-1792. doi: 10.1097/HJH.0000000000003537. Epub 2023 Sep 11.
Low ocular perfusion pressure (OPP), which depends on the mean arterial pressure (MAP) and intraocular pressure (IOP), is associated with glaucoma. We studied 24-h MAP dysregulations and OPP in relation to the progression of glaucoma damage.
We retrospectively analyzed 155 normal-tension glaucoma (NTG) and 110 primary open-angle glaucoma (POAG) patients aged 18 years old followed at the University Hospital Leuven with repeated visual field tests ( n = 7000 measures, including both eyes) who underwent 24-h ambulatory blood pressure monitoring. Twenty-four-hour MAP dysregulations were variability independent of the mean (VIM), and the five lowest dips in MAP readings over 24 h. OPP was the difference between 2/3 of the MAP and IOP. Glaucoma progression was the deterioration of the visual field, expressed as decibel (dB) changes in mean deviation analyzed by applying multivariable linear mixed regression models.
The mean age was 68 years (53% were women). High 24-h VIMmap was associated with glaucoma progression in POAG ( P < 0.001) independently of the 24-h MAP level. The estimated changes in mean deviation in relation to dip MAP measures ranged from -2.84 dB [95% confidence interval (CI) -4.12 to -1.57] to -2.16 dB (95% CI -3.46 to -0.85) in POAG. Reduced OPP along with high variability and dips in MAP resulted in worse mean deviation deterioration.
The progression of glaucoma damage associates with repetitive and extreme dips in MAP caused by high variability in MAP throughout 24 h. This progression exacerbates if 24-h MAP dysregulations occur along with reduced OPP.
低眼灌注压（OPP）取决于平均动脉压（MAP）和眼内压（IOP），与青光眼有关。我们研究了 24 小时 MAP 失调与青光眼损害进展的关系。
我们回顾性分析了在鲁汶大学医院接受随访的 155 例正常眼压青光眼（NTG）和 110 例原发性开角型青光眼（POAG）患者，这些患者年龄在 18 岁以上，共进行了 7000 次重复视野检查（包括双眼），并进行了 24 小时动态血压监测。24 小时 MAP 失调是指独立于均值的变异性（VIM），以及 24 小时内 MAP 读数的五个最低下降。OPP 是 MAP 和 IOP 的 2/3 之间的差值。青光眼进展是指视野恶化，以平均偏差的分贝（dB）变化表示，通过应用多变量线性混合回归模型进行分析。
平均年龄为 68 岁（53%为女性）。POAG 中，高 24 小时 VIMmap 与青光眼进展相关（P < 0.001），独立于 24 小时 MAP 水平。与 dip MAP 测量值相关的平均偏差变化范围从-2.84dB（95%CI-4.12 至-1.57）到-2.16dB（95%CI-3.46 至-0.85）。OPP 降低以及 MAP 中的高变异性和下降导致平均偏差恶化更严重。
青光眼损害的进展与 24 小时内 MAP 反复且极端下降有关，这是由 MAP 变异性引起的。如果 24 小时 MAP 失调与降低的 OPP 同时发生，则会加重这种进展。
