NOCTURNAL ARTERIAL-HYPOTENSION AND ITS ROLE IN OPTIC-NERVE HEAD AND OCULAR ISCHEMIC DISORDERS
NOCTURNAL ARTERIAL-HYPOTENSION AND ITS ROLE IN OPTIC-NERVE HEAD AND OCULAR ISCHEMIC DISORDERS
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DOI：
10.1016/s0002-9394(14)70067-4
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发表时间：
1994-05-15
影响因子：
4.2
通讯作者：
ALWARD, WLM
中科院分区：
文献类型：
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作者：
HAYREH, SS;ZIMMERMAN, MB;ALWARD, WLM
我们对 166 名患有前部缺血性视神经病变、正常眼压性青光眼、原发性开角型青光眼和其他视神经乳头疾病的白人患者进行了 24 小时动态血压监测和眼压日变化曲线。每小时平均血压数据分析显示，夜间平均收缩压 (26%) 和舒张压 (33%) 测量值显着 (P < .0001) 下降。与前部缺血性视神经病变相比，正常眼压青光眼的夜间平均舒张压显着降低（P = .0028），舒张压平均下降百分比显着更高（P = .0044）。接受口服降压治疗的动脉高血压患者显示，进行性视野恶化与夜间低血压之间存在显着相关性，特别是在前部缺血性视神经病变中。在任何这些情况下，眼压与视野恶化都没有显着相关性。我们的研究结果表明，在存在其他血管危险因素的情况下，夜间低血压可能会将视神经乳头血流量减少至临界水平以下，从而可能在前部缺血性视神经病变和青光眼性视神经病变的发病机制中发挥作用；也就是说，夜间低血压可能是多因素情况下的最后伤害。相同的机制可能也适用于许多其他眼部缺血性疾病。这一发现为理解和管理这些视力障碍疾病开辟了新的维度。
We measured 24-hour ambulatory blood pressure monitoring and diurnal curve of the intraocular pressure in 166 white patients with anterior ischemic optic neuropathy, normal-tension glaucoma, primary open-angle glaucoma, and other optic nerve head disorders. Hourly average blood pressure data analyses showed a significant (P < .0001) decrease in mean systolic (26%) and diastolic (33%) blood pressure measurements at night. A significantly (P = .0028) lower nighttime mean diastolic blood pressure and a significantly (P = .0044) greater mean percentage decrease in diastolic blood pressure were noted in normal-tension glaucoma than in anterior ischemic optic neuropathy. Patients with arterial hypertension taking oral hypotensive therapy showed a significant association between progressive visual field deterioration and nocturnal hypotension, particularly in anterior ischemic optic neuropathy. Intraocular pressure showed no significant correlation with visual field deterioration in any of these conditions. Our findings suggest that nocturnal hypotension, in the presence of other vascular risk factors, may reduce the optic nerve head blood flow below a critical level, and thereby may play a role in the pathogenesis of anterior ischemic optic neuropathy and glaucomatous optic neuropathy; that is, nocturnal hypotension may be the final insult in a multifactorial situation. The same mechanisms may be true of a number of other ocular ischemic disorders. This finding opens a new dimension in the understanding and management of these visually disabling diseases.