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The Effect of 24-Hour Blood Pressure on Rates of Central and Peripheral Glaucomatous Visual Field Progression
Alessandro A Jammal1, Richard Donkor1, David S Greenfield1
1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Palm Beach Gardens, Florida.
Purpose:
To examine the effect of 24-hour ambulatory blood pressure (BP) measurements on the rates of change in central and peripheral visual field (VF) loss in eyes with glaucoma and suspected glaucoma.
Design:
Prospective cohort study.
Participants:
One hundred twenty-four eyes of 63 subjects with glaucoma or suspect of glaucoma at baseline.
Methods:
Participants underwent 24-hour ambulatory BP measurement acquired at the baseline visit and 24-2C standard automated perimetry (SAP) every 4 months for up to 48 months. The rates of change in mean sensitivity (MS) were calculated with linear mixed models and used to investigate the effect of BP on the rates of VF loss in the central (≤10°, 26 points) and peripheral (>10°, 36 points) regions separately. Models were adjusted for age, gender, race, intraocular pressure during follow-up, baseline glaucoma severity, and central corneal thickness.
Main Outcome Measures:
Effect of 24-hour BP values on the rates of future central and peripheral VF loss.
Results:
Eyes had an average of 7.7 ± 2.2 SAP tests over 27.4 ± 6.4 months of follow-up. The median rate in global mean deviation change was 0.23 dB/year (range -1.00 to 0.94 dB/year). Each 10 mmHg lower in 24-hour average systolic BP (SBP) and diurnal mean arterial pressure (MAP) were associated with -0.119 dB/year (P = 0.021) and -0.162 dB/year (P = 0.018) faster rates of MS loss in the central region, respectively, after adjusting for confounding factors. Lower diurnal MAP was also significantly associated (P = 0.003) with faster progression in the peripheral VF. Eyes of subjects within the lowest tertile of average 24-hour SBP (range 100-116 mmHg) had significantly faster rates of central VF loss than the highest tertile (range 125-168 mmHg; difference between tertiles 0.06 dB/year faster; P = 0.045), but not faster peripheral loss (P = 0.101).
Conclusions:
Lower baseline 24-hour ambulatory BP measurements were significantly associated with faster rates of SAP progression in the central and peripheral regions. Subjects with the lowest values of average 24-hour SBP demonstrated significantly faster rates of central VF loss and may be used as a predictor for severe glaucomatous progression.
Financial Disclosure(S):
The authors have no proprietary or commercial interest in any materials discussed in this article.
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