Objective: To study the correlation between the 24-hour blood pressure parameters and optic nerve damage in primary open-angle glaucoma (POAG). Methods: In this case control study, 60 patients with POAG were assigned to POAG group, and 55 normal subjects were assigned to control group. Synchronous monitoring of 24-hour intraocular pressure (IOP) and blood pressure was conducted in both groups. Blood pressure parameters, optic perfusion pressure, and intraocular pressure for the two groups were compared. We also evaluated the connections among the blood pressure parameters, optic perfusion pressure, and IOP with visual function. Inter-group comparisons were made by independent samples t-tests and multiple linear regression. Results: ①The average IOP, IOP fluctuation, the ocular perfusion pressurefluctuation, and pulse pressure fluctuation of POAG group were significantly higher than those of control group (t =3.22, 6.57, 2.29, 2.39, respectively, all P <0.05). ②The mean systolic blood pressure of POAG group was significantly higher than that of control group (t =3.02, P =0.003). The highest systolic blood pressure, systolic blood pressure fluctuations, nighttime average systolic blood pressure, highest nighttime systolic blood pressure value and fluctuation of POAG group were also significantly higher than those of control group (t =4.38, 5.27, 4.13, 4.13, 4.14, all P <0.001). ③The mean 24-hour diastolic pressure, the maximum diastolic pressure, the mean nighttime diastolic pressure, and the maximum nighttime diastolic pressure of POAG group were significantly higher than those of control group (t =2.22, 2.50, 2.29, 2.10, all P <0.05). ④In POAG group, the mean IOP was negatively correlated with the visual field mean defect in POAG (b =-0.44, P =0.004), and the RNFL thickness was negatively correlated with mean IOP (b =-0.956, P =0.001), IOP fluctuation (b =-1.125, P =0.003). The mean nighttime diastolic pressure (b =0.395, P <0.001)
and the mean nighttime arterial pressure (b =0.046, P =0.001) were positively correlated with AP100 and AP50 values, respectively. Conclusions: ①There was a correlation between the blood pressure parameters and the optic nerve damage in POAG. ②The nighttime optic perfusion pressure, the nighttime diastolic blood pressure, and the nighttime arterial pressure may be influential factors affecting optic nerve damage of POAG. ③In the treatment of POAG, a stable normal blood pressure and stable target IOP are beneficial to maintain an effective and stable optic perfusion pressure. This suggests that we should pay attention to the treatment of POAG with IOP reduction and changes of blood pressure at the same time.
曾流芝,何宇,鲜依鲆,范罕英,陈鸣,杨蓉,杨洋,姚曼,荆琳,樊敏. 24小时血压参数与原发性开角型青光眼视神经损害的相关性[J]. 中华眼视光学与视觉科学杂志, 2018, 20(2): 79-.
Liuzhi Zeng, Yu He, Yiping Xian, Hanying Fan, Ming Chen, Rong Yang, Yang Yang, Man Yao, Lin Jing, Min Fan. Correlation between 24-Hour Blood Pressure Parameters and Optic Nerve Damage in Primary Open-Angle Glaucoma. Chinese Journal of Optometry Ophthalmology and Visual science, 2018, 20(2): 79-. DOI: 10.3760/cma.j.issn.1674-845X.2018.02.003.
Tham YC, Li X, Wong TY, et al. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology, 2014, 121(11): 2081-2090. DOI: 10.1016/j.ophtha.2014.05.013.
Bae HW, Lee N, Lee HS, et al. Systemic hypertension as a risk factor for open-angle glaucoma: a meta-analysis of populationbased studies. PLoS One, 2014, 9(9): e108226. DOI: 10.1371/journal.pone.0108226.
[5]
Christopher K, Leung, Dennis S. Lam, et al. Glaucoma Diagnostics, 2010: 62.
[6]
Hulsman CA, Vingerling JR, Hofman A, et al. Blood pressure, arterial stiffness, and open-angle glaucoma: the Rotterdam study. Arch Ophthalmol, 2007, 125(6): 805-812. DOI: 10.1001/archopht.125.6.805.
[7]
Topouzis F, Coleman AL, Harris A, et al. Association of blood pressure status with the optic disk structure in non-glaucoma subjects: The Thessaloniki Eye Study. Am J Ophthalmol, 2006,142(1): 60-67. DOI: 10.1016/j.ajo.2006.02.055.
[8]
Leske MC, Heijl A, Hyman L, et al. Predictors of long-term progression in the early manifest glaucoma trial. Ophthalmology,2007, 114(11): 1965-1972. DOI: 10.1016/j.ophtha.2007.03.016.
[9]
Klein BE, Klein R, Knudtson MD. Intraocular pressure and systemic blood pressure: longitudinal perspective: The Beaver Dam Eye Study. Br J Ophthalmol, 2005, 89(3): 284-287. DOI:10.1136/bjo.2004.048710.
[4]
叶天才, 王宁利. 临床青光眼图谱. 北京: 人民卫生出版社,2007: 206.
[10]
李美玉. 青光眼学. 北京: 人民卫生出版社, 2004: 503-504.
[5]
Christopher K, Leung, Dennis S. Lam, et al. Glaucoma Diagnostics, 2010: 62.
[6]
Hulsman CA, Vingerling JR, Hofman A, et al. Blood pressure, arterial stiffness, and open-angle glaucoma: the Rotterdam study. Arch Ophthalmol, 2007, 125(6): 805-812. DOI: 10.1001/archopht.125.6.805.
[7]
Topouzis F, Coleman AL, Harris A, et al. Association of blood pressure status with the optic disk structure in non-glaucoma subjects: The Thessaloniki Eye Study. Am J Ophthalmol, 2006,142(1): 60-67. DOI: 10.1016/j.ajo.2006.02.055.
[8]
Leske MC, Heijl A, Hyman L, et al. Predictors of long-term progression in the early manifest glaucoma trial. Ophthalmology,2007, 114(11): 1965-1972. DOI: 10.1016/j.ophtha.2007.03.016.
[9]
Klein BE, Klein R, Knudtson MD. Intraocular pressure and systemic blood pressure: longitudinal perspective: The Beaver Dam Eye Study. Br J Ophthalmol, 2005, 89(3): 284-287. DOI:10.1136/bjo.2004.048710.
[11]
Zheng Y, Wong TY, Mitchell P, et al. Distribution of ocular perfusion pressure and its relationship with open-angle glaucoma: The Singapore Malay Eye Study. Invest Ophthalmol
Vis Sci, 2010, 51(7): 3399-3404. DOI: 10.1167/iovs.09-4867.
Zheng Y, Wong TY, Mitchell P, et al. Distribution of ocular perfusion pressure and its relationship with open-angle glaucoma: The Singapore Malay Eye Study. Invest Ophthalmol
Vis Sci, 2010, 51(7): 3399-3404. DOI: 10.1167/iovs.09-4867.
Topouzis F,Wilson MR,Harris A,et al.Association of open-angle glaucoma with perfusion pressure status in the Thessaloniki Eye Study. Am J Ophthalmol, 2013, 155(5): 843-851. DOI: 10.1016/j.ajo.2012.12.007.
[15]
Krasińska B, Banach M, Karolczak-Kulesza M, et al. Observations on degenerative changes within the optic nerve in patients with primary open glaucoma and arterial hypertension:6-month follow-up. J Clin Hypertens (Greenwich), 2012,14(10): 701-710. DOI: 10.1111/j.1751-7176.2012.00694.x.
Topouzis F,Wilson MR,Harris A,et al.Association of open-angle glaucoma with perfusion pressure status in the Thessaloniki Eye Study. Am J Ophthalmol, 2013, 155(5): 843-851. DOI: 10.1016/j.ajo.2012.12.007.
[15]
Krasińska B, Banach M, Karolczak-Kulesza M, et al. Observations on degenerative changes within the optic nerve in patients with primary open glaucoma and arterial hypertension:6-month follow-up. J Clin Hypertens (Greenwich), 2012,14(10): 701-710. DOI: 10.1111/j.1751-7176.2012.00694.x.