Elsevier

Ophthalmology

Volume 126, Issue 10, October 2019, Pages 1366-1371
Ophthalmology

Original Article
Increased Nighttime Blood Pressure in Patients with Glaucoma: Cross-sectional Analysis of the LIGHT Study

https://doi.org/10.1016/j.ophtha.2019.05.019Get rights and content

Purpose

To determine whether the presence of glaucoma is associated significantly with nighttime blood pressure (BP) and dipping pattern.

Design

Observational, cross-sectional study.

Participants

We assessed 109 glaucoma patients (mean age, 71.0 years) from the Longitudinal Study of Biological Circadian Rhythms in Glaucoma Patients: Home Testing of Circadian Intraocular Pressure and Biological Parameters (LIGHT) study and 708 healthy control participants without glaucoma (mean age, 70.8 years) from a community-based cohort.

Methods

All of the glaucoma patients and healthy control participants underwent ophthalmic examinations. The ambulatory BP was measured every 30 minutes for 48 hours. The daytime and nighttime periods were based on the sleep diary entries. A nondipper pattern of BP was defined as a decrease in the mean nighttime systolic BP by less than 10% of the mean daytime systolic BP.

Main Outcome Measures

Nighttime BP and dipping pattern.

Results

After adjusting for potential confounders, multivariable linear regression analyses indicated that nighttime systolic BP was significantly higher by 4.1 mmHg (95% confidence interval [CI], 1.0–7.2; P = 0.01) in the glaucoma group than in the control group. The prevalence of the nondipper pattern was significantly higher in the glaucoma group (45.0%) than in the control group (27.5%; P < 0.001). Multivariable logistic regression analyses indicated a significantly higher odds ratio (OR) for the nondipper pattern in the glaucoma group than in the control group (OR, 1.96; 95% CI, 1.26–3.05; P = 0.003).

Conclusions

The presence of glaucoma was associated significantly with increased nighttime BP and the nondipper pattern of the BP independent of potential confounders such as aging, obesity, and diabetes. Further prospective studies are needed to determine whether the glaucoma severity and progression are associated with the nighttime BP.

Section snippets

Methods

The procedures were approved by the ethics committee of Nara Medical University and conformed to the tenets of the Declaration of Helsinki. Written informed consent was obtained from all patients and participants after an explanation of the procedures and possible complications. This study was registered with the University Hospital Medical Information Network Clinical Trials Registry (identifier, UMIN000027299).

Results

The mean age ± standard deviation age of the glaucoma patients was 71.0±11.2 years and that of those without glaucoma was 70.8±6.8 years. The number of men with glaucoma was 52 (47.7%) and the number of men without glaucoma was 339 (47.8%). Glaucoma was associated significantly with low eGFR, low BCVA in the worse eye, high myopia, and history of cataract surgery. A nondipper pattern was associated significantly with older age, use of antihypertensive drugs, low levels of eGFR, and low BCVA (

Discussion

The results showed that the nighttime systolic BP, the lowest systolic BP, and the prevalence of the nondipper pattern were significantly higher in the glaucoma group than the control group. The strength of our study is the large sample size with 109 in the glaucoma group and 708 in the healthy control group without glaucoma.

An earlier observational study of 51 glaucoma patients and 28 healthy controls showed that there is no significant difference in the nighttime systolic BP in the 2 groups

Acknowledgments

The authors thank Michiru Higuchi, Etsuko Inoue, Tomoko Moriguchi, and Yumiko Sakata for their help and data collection.

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    Financial Disclosure(s): The author(s) have made the following disclosure(s): T.Y.: Financial support – Novartis Pharma (Tokyo, Japan), Alcon (Tokyo, Japan).

    K.O.: Financial support – YKK AP, Inc (Tokyo, Japan), Ushio, Inc (Tokyo, Japan), Tokyo Electric Power Company (Tokyo, Japan), EnviroLife Research Institute Co, Ltd (Tokyo, Japan), Sekisui Chemical Co, Ltd (Osaka, Japan), LIXIL Corp (Tokyo, Japan), KYOCERA Corp (Kyoto, Japan).

    K.S.: Financial support – YKK AP, Inc (Tokyo, Japan), Ushio, Inc (Tokyo, Japan), Tokyo Electric Power Company (Tokyo, Japan), EnviroLife Research Institute Co, Ltd (Tokyo, Japan), Sekisui Chemical Co, Ltd (Osaka, Japan), LIXIL Corp (Tokyo, Japan), KYOCERA Corp (Kyoto, Japan).

    The LIGHT (Longitudinal Study of Biological Circadian Rhythms in Glaucoma Patients: Home Testing of Circadian Intraocular Pressure and Biological Parameters) study was supported by the Mitsui Sumitomo Insurance Welfare Foundation (Tokyo, Japan); Osaka Gas Group Welfare Foundation (Osaka, Japan); and Nara Medical University Grant-in-Aid for Young Scientists (Nara, Japan). The HEIJO-KYO study was supported by the Department of Indoor Environmental Medicine, Nara Medical University (Nara, Japan); JSPS KAKENHI (grant nos.: 24790774, 22790567, 25860447, 25461393, 15H04776, and 10124877); Mitsui Sumitomo Insurance Welfare Foundation (Tokyo, Japan); Meiji Yasuda Life Foundation of Health and Welfare (Tokyo, Japan); Osaka Gas Group Welfare Foundation (Osaka, Japan); Japan Diabetes Foundation (Tokyo, Japan); Daiwa Securities Health Foundation (Tokyo, Japan); Japan Science and Technology Agency (Saitama, Japan); Nara Prefecture Health Promotion Foundation (Nara, Japan); and Nara Medical University Grant-in-Aid for Collaborative Research Projects (Nara, Japan). The sponsor or funding organization had no role in the design or conduct of this research.

    HUMAN SUBJECTS: Human subjects were included in this study. The human ethics committees at Nara Medical University approved the study. All research adhered to the tenets of the Declaration of Helsinki. All participants provided informed consent.

    No animal subjects were included in this study.

    Author Contributions:

    Conception and design: Yoshikawa, Obayashi, Miyata, Saeki

    Analysis and interpretation: Yoshikawa, Obayashi

    Data collection: Yoshikawa, Obayashi, Miyata, Saeki

    Obtained funding: Yoshikawa, Obayashi, Saeki

    Overall responsibility: Yoshikawa, Obayashi, Ogata

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