Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

24-h blood pressure monitoring in normal tension glaucoma: night-time blood pressure variability

Abstract

Systemic arterial hypotension, hypertension and altered ocular blood flow are known risk factors in glaucoma. In this study, 24-h ambulatory blood pressure monitoring was performed in patients with normal tension glaucoma (NTG) and controls to evaluate blood pressure variability. In all, 51 patients with NTG and 28 age-matched controls were included in this prospective study. A 24-h ambulatory blood pressure monitoring (SpaceLabs Medical Inc., Redmond, USA) was performed and systolic, diastolic and mean arterial blood pressures were measured every 30 min during daytime (0800–2000) and night time (0000–0600). To evaluate blood pressure variability a variability index was defined as the s.d. of blood pressure measurements. Night-time blood pressure depression (‘dip’) was calculated (in percent of the daytime blood pressures). Patients with NTG exhibited higher night-time diastolic (P=0.01) and mean arterial blood pressure values (P=0.02) compared to controls, whereas systolic blood pressure data were not significantly different. The variability indices of night-time systolic, diastolic and mean arterial blood pressure measurements were significantly increased in patients with NTG compared to controls (P<0.05). The night-time blood pressure depression of systolic (P=0.47), diastolic (P=0.11) and mean arterial blood pressures (P=0.28) was not significantly different between patients with NTG and controls. In conclusion, patients with NTG showed increased variability of night-time blood pressure measurements compared to controls. Increased fluctuation of blood pressure may lead to ocular perfusion pressure fluctuation and may cause ischaemic episodes at the optic nerve head.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Arend O, Remky A, Cantor LB, Harris A . Altitudinal visual field asymmetry is coupled with altered retinal circulation in patients with normal pressure glaucoma. Br J Ophthalmol 2000; 84: 1008–1012.

    Article  CAS  Google Scholar 

  2. Arend O, Remky A, Redbrake C, Arend S, Wenzel M, Harris A . Retinale Hämodynamik bei Patienten mit Normaldruckglaukom. Ophthalmologe 1999; 96: 24–29.

    Article  CAS  Google Scholar 

  3. Flammer J, Orgül S . Optic nerve blood-flow abnormalities in glaucoma. Progr Ret Eye Res 1998; 17: 267–289.

    Article  CAS  Google Scholar 

  4. Hayreh SS . The optic nerve circulation in health and disease. Exp Eye Res 1995; 61: 259–272.

    Article  CAS  Google Scholar 

  5. Plange N, Remky A, Arend O . Papilläre Füllungsdefekte in Fdluoreszein-Angiographien bei Glaukom – eine retrospektive klinische Studie. Klein Monatsbl Augenheilkd 2001; 218: 214–221.

    Article  CAS  Google Scholar 

  6. Béchetoille A, Bresson-Dumont H . Diurnal and nocturnal blood pressure drops in patients with focal ischemic glaucoma. Graefe's Arch Clin Exp Ophthalmol 1994; 232: 675–679.

    Article  Google Scholar 

  7. Chumbley LC, Brubaker RF . Low-tension glaucoma. Am J Ophthalmol 1976; 81: 761–767.

    Article  CAS  Google Scholar 

  8. Dielemans I, Vingerling JR, Algra D, Hofman A, Grobbee DE, de Jong PTVM . Primary open-angle glaucoma intraocular pressure, and systemic blood pressure in the general elderly population. Ophthalmology 1995; 102: 54–60.

    Article  CAS  Google Scholar 

  9. Drance SM, Wheeler C, Pattullo M . Uniocular open-angle glaucoma. Am J Ophthalmol 1968; 65: 891–902.

    Article  CAS  Google Scholar 

  10. Francois J, Neetens A . The deterioration of the visual field in glaucoma and the blood pressure. Doc Ophthalmol 1970; 28: 70–109.

    Article  CAS  Google Scholar 

  11. Geijssen HC . Studies on Normal Pressure Glaucoma, Chapter 6: Systemic Vascular Risc Factors. Kugler Publications: New York, Amsterdam, Milano, 1991, pp. 61–82.

    Google Scholar 

  12. Hayreh SS, Podhajsky P, Zimmermann MB . Role of nocturnal arterial hypotension in optic nerve head ischemic disorders. Ophthalmologica 1999; 213: 76–96.

    Article  CAS  Google Scholar 

  13. Jampol LM, Board RJ, Maumenee AE . Systemic hypotension and glaucomatous changes. Am J Ophthalmol 1978; 85: 154–159.

    Article  CAS  Google Scholar 

  14. Duke-Elder S . The phasic variations in the ocular tension in primary glaucoma. Am J Ophthalmol 1952; 35: 1–21.

    Article  CAS  Google Scholar 

  15. Coca A . Circadian rhythm and blood pressure control: physiological and pathophysiologica factors. J Hypertens 1994; 12 (Suppl 5): S13–S21.

    CAS  Google Scholar 

  16. O'Brien EO, Sheridan J, O'Malley K . Dippers and non-dippers. Lancet 1988; 2 (8607): 397.

    Article  CAS  Google Scholar 

  17. Roman MJ, Pickering TG, Schwartz JE, Cavallini MC, Pini R, Devereux RB . Is the absence of a nocturnal fall in blood pressure (nondipping) associated with cardiovascular target organ damage? J Hypertens 1997; 15: 969–978.

    Article  CAS  Google Scholar 

  18. European Glaucoma Society. Terminology and Guidelines for Glaucoma 1998. Editrice DOGMA S.r.l. Savona, Italy, 1998, pp. 43–48.

  19. The Scientific Committee. Consensus document on non-invasive ambulatory blood pressure measurement. J Hypertens 1990; 8 (Suppl 6): 135–140.

  20. Butkevich A, Phillps RA, Sheinart KF, Tuhrim S . The effects of various definitions of dipping and daytime and night-time on the characterization of 24 h profiles of blood pressure. Blood Press Monit 2000; 5: 19–22.

    Article  CAS  Google Scholar 

  21. Coats AJS, Clark SJ, Conway J . Analysis of ambulatory blood pressure data. J Hypertens 1991; 9 (Suppl 8): S19–S21.

    CAS  Google Scholar 

  22. Parati G . Blood presssure reduction at night: sleep and beyond. J Hypertens 2000; 18: 1725–1729.

    Article  CAS  Google Scholar 

  23. Verdecchia P, Schillaci G, Porcellati C . Dippers versus non-dippers. J Hypertens 1991; 9 (Suppl 8): S42–S44.

    CAS  Google Scholar 

  24. Kashiwagi K, Hosaka O, Kashiwagi F, Taguchi K, Mochizuki J, Ishii H et al. Systemic circulatory parameters: comparison between patients with normal tension glaucoma and normal subjects using ambulatory monitoring. Jpn J Ophthalmol 2001; 45: 388–396.

    Article  CAS  Google Scholar 

  25. Sommer A . Glaucoma risk factors observed in the Baltimore Eye Survey. Curr Opin Ophthalmol 1996; 7: 93–98.

    Article  CAS  Google Scholar 

  26. Wilson MR, Mertzmark E, Walker AM, Childs-Shaw K, Epstein DL . A case–control study of risk factors in open angle glaucoma. Arch Ophthalmol 1987; 105: 1066–1071.

    Article  CAS  Google Scholar 

  27. Leske MC, Podgor MJ . Intraocular pressure, cardiovascular risk variables, and visual field defects. Am J Epidemiol 1983; 118: 280–287.

    Article  CAS  Google Scholar 

  28. Follmann P, Palotás C, Süveges I, Petrovits A . Nocturnal blood pressure and intraocular pressure measurement in glaucoma patients and healthy controls. Int Ophthalmol 1997; 20: 83–87.

    Article  CAS  Google Scholar 

  29. Graham SL, Drance SM, Wijsman K, Douglas GR, Mikelberg FS . Ambulatory blood pressure monitoring in glaucoma – The Nocturnal Dip. Ophthalmology 1995; 102: 61–69.

    Article  CAS  Google Scholar 

  30. Gramer E, Tausch M . The risk profile of the glaucomatous patient. Curr Opin Ophthalmol 1995; 6: 78–88.

    Article  CAS  Google Scholar 

  31. Hollwich F . Augendruck und Blutdruck beim Glaukom. Münch med Wschr 1974; 116: 1813–1820.

    CAS  Google Scholar 

  32. Richler M, Werner EB, Thomas D . Risk factors for progression of visual field defects in medically treated patients with glaucoma. Can J Ophthalmol 1982; 17: 245–248.

    CAS  PubMed  Google Scholar 

  33. Leske MC, Connell ANS, Wu S-Y, Hyman LG, Schachat AP, the Barbados Eye Study Group. Risk factors for open-angle glaucoma. Arch Ophthalmol 1995; 113: 918–924.

    Article  CAS  Google Scholar 

  34. Demailly P, Cambien F, Plouin PF, Baron P, Chevallier B . Do patients with low tension glaucoma have particular cardiovascular characteristics? Ophthalmologica 1984; 188: 65–75.

    Article  CAS  Google Scholar 

  35. Gareis O, Baumert S, Lang GK . 24-hour-blood-pressure-monitoring and primary open-angle glaucoma. Invest Opthalmol Vis Sci 1996; 37: S32.

    Google Scholar 

  36. Pannarale G, Pannarale L, Arrico L, De Gregorio F, Pannarale MR . Ambulatory blood pressure in patients with glaucoma. Invest Ophthalmol Vis Sci 1996; 37: S30.

    Google Scholar 

  37. Tielsch JM, Katz J, Sommer A, Quigley HA, Javitt JC . Hypertension, perfusion pressure, and primary open-angle glaucoma. A population-based assessment. Arch Ophthalmol 1995; 113: 216–221.

    Article  CAS  Google Scholar 

  38. Berglund G . Goals of antihypertensive therapy, is there a point beyond which pressure reduction is dangerous? Am J Hypertension 1989; 2: 586–593.

    Article  CAS  Google Scholar 

  39. Criuckshank JM, Thorp JM, Zacharias FJ . Benefits and potential harm of lowering high blood pressure. Lancet 1987; 1 (8533): 581–583.

    Article  Google Scholar 

  40. Farnett L, Mulrow CD, Linn WD, Lucey CR, Tuley MR . The J-curve phenomenon and the treatment of hypertension, is there a point beyond which pressure reduction is dangerous? JAMA 1991; 265: 489–495.

    Article  CAS  Google Scholar 

  41. Meyer JH, Brandi-Dohrn J, Funk J . Twenty four hour blood pressure monitoring in normal tension glaucoma. Br J Ophthalmol 1996; 80: 864–867.

    Article  CAS  Google Scholar 

  42. Rouhiainen HJ, Teräsvirta ME . Hemodynamic variables in progressive and non-progressive low tension glaucoma. Acta Ophthalmol 1990; 68: 34–36.

    Article  CAS  Google Scholar 

  43. Graham SL, Drance SM . Nocturnal hypotension: role in glaucoma progression. Surv Ophthalmol 1999; 43 (Suppl 1): S10–S16.

    Article  Google Scholar 

  44. Detry M, Boschi A, Ellinghaus G, De Plaen JF . Simultanous 24-hour monitoring of intraocular pressure and arterial blood pressure in patients with progressive and non-progressive primary open-angle glaucoma. Eur J Ophthalmol 1996; 6: 273–278.

    Article  CAS  Google Scholar 

  45. O'Brien EO, Murphy J, Tyndall A, Atkins N, Mee F, McCarthy G et al. Twenty-four-hour ambulatory blood pressure in men and women aged 17 to 80 years: the Allied Irish Bank Study. J Hypertens 1991; 9: 335–360.

    Google Scholar 

  46. Staessen JA, Fagard RH, Lijnen PJ, Thijs L, Van Hoof R, Amery AK . Mean and range of the ambulatory pressure in normotensive subjects from a meta-analysis of 23 studies. Am J Cardiol 1991; 67: 723–727.

    Article  CAS  Google Scholar 

  47. Kaiser HJ, Flammer J, Graf T, Stümpfig D . Systemic blood pressure in glaucoma patients. Graefe's Arch Clin Exp Ophthalmol 1993; 231: 677–680.

    Article  CAS  Google Scholar 

  48. Frattola A, Parati G, Cuspidi C, Albini F, Mancia G . Prognostic value of 24-hour blood pressure variability. J Hypertens 1993; 11: 1133–1137.

    Article  CAS  Google Scholar 

  49. Mancia G, Fattola A, Gropelli A, Omboni S, Parati G, Ulian L et al. Blood pressure reduction and end-organ damage in hypertension. J Hypertens 1994; 12 (Suppl 8): S35–S42.

    CAS  Google Scholar 

  50. Drance SM . Diurnal variation of intraocular pressure in treated glaucoma. Arch Ophthalmol 1963; 70: 302–311.

    Article  CAS  Google Scholar 

  51. Konstas AGP, Mantziris DA, Stewart WC . Diurnal intraocular pressure in untreated exfoliation and primary open-angle glaucoma. Arch Ophthalmol 1997; 115: 182–185.

    Article  CAS  Google Scholar 

  52. Liu JHK, Zhang X, Kripke DF, Weinreb RN . Twenty-four hour intraocular pressure pattern associated with early glaucomatous changes. Invest Ophthalmol Vis Sci 2003; 44: 1586–1590.

    Article  Google Scholar 

  53. Sacca SC, Rolando M, Marletta A, Macri A, Cerqueti P, Ciurlo G . Fluctuations of intraocular pressure during the day in open-angle glaucoma, normal-tension glaucoma and norma lsubjects. Ophthalmologica 1998; 212: 115–119.

    Article  CAS  Google Scholar 

  54. Nouri-Mahdavi K, Hoffman D, Coleman AL, Liu G, Li G, Gaasterland D et al. Predictive factors for glaucomatous visual field progression in the Advanced Glaucoma Intervention Study. Ophthalmology 2004; 111: 1627–1635.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to N Plange.

Additional information

Property interests: None.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Plange, N., Kaup, M., Daneljan, L. et al. 24-h blood pressure monitoring in normal tension glaucoma: night-time blood pressure variability. J Hum Hypertens 20, 137–142 (2006). https://doi.org/10.1038/sj.jhh.1001959

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jhh.1001959

Keywords

This article is cited by

Search

Quick links