24-Hour Blood Pressure Patterns in NAION: Exploring the Impact of Dipping Classifications and Comorbidities

Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION) is a leading cause of sudden visual loss, particularly in older individuals. Vascular risk factors, including hypertension and diabetes, play a significant role in its pathogenesis. This study explores the association between 24-hour blood pressure patterns, newly diagnosed hypertension, and visual loss in NAION patients, emphasizing the impact of dipping classifications and comorbidities. A retrospective analysis was conducted on 41 NAION patients (aged 27-86 years). Ambulatory blood pressure monitoring (ABPM) over 24 hours categorized patients into four groups: dipper, non-dipper, reverse dipper, and extreme dipper. Blood pressure values were classified into diurnal (08:00-22:59) and nocturnal (23:00-07:59) periods. Visual acuity was assessed using the LogMAR scale, and systemic comorbidities, including hypertension, diabetes, and body mass index (BMI), were recorded. Significant variations in blood pressure patterns were observed, with non-dipper and reverse dipper patients showing the greatest discrepancies between daytime and nighttime blood pressure levels. Visual acuity loss was most severe in reverse dippers (LogMAR 2.00 ± 0.15) and extreme dippers (LogMAR 2.00). Newly diagnosed hypertension was prevalent, emphasizing the importance of ABPM. Nocturnal hypertension was strongly associated with worse visual outcomes, with 83.9% of these patients classified as non-dipper or reverse dipper. Abnormal blood pressure patterns, particularly non-dipper and reverse dipper classifications, correlate with visual loss in NAION. The frequent detection of undiagnosed hypertension supports the integration of routine blood pressure monitoring, particularly nocturnal measurements, into NAION evaluation. A comprehensive vascular assessment in NAION management may improve patient outcomes.