Circadian Variation in Arterial Blood Pressure and Glaucomatous Optic Neuropathy-A Systematic Review and Meta-Analysis
Circadian Variation in Arterial Blood Pressure and Glaucomatous Optic Neuropathy-A Systematic Review and Meta-Analysis
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DOI：
10.1093/ajh/hpv016
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发表时间：
2015-09-01
影响因子：
3.2
通讯作者：
Steffen, Hans-Michael
中科院分区：
文献类型：
--
作者：
Bowe, Andrea;Gruenig, Michael;Steffen, Hans-Michael
背景：流行病学研究表明，动脉血压是青光眼损害发生的危险因素，而青光眼的进行性视野丧失与夜间低血压有关，尤其是口服降压药联合β-受体阻滞剂滴眼液时。为了回答动态血压监测中夜间血压或血压下降是否与进行性视野丧失有关的问题，我们对原发性开角型青光眼和正常眼压青光眼患者的研究进行了系统的回顾和荟萃分析。方法在搜索MEDLINE、Cochrane图书馆和EMBASE后，只有5篇研究报告了动态血压测量方法、白天和夜间血压的单独数据、夜间血压下降的定义以及至少2年的视野评估。夜间收缩压或舒张压下降10%，视野恶化2年以上的优势比分别为3.32(1.84-6.00)和2.09(1.20-3.64)。结论夜间血压下降是青光眼进行性视野丧失的危险因素。然而，需要进行前瞻性研究来确定可容忍的浸泡程度。青光眼患者的降压治疗应通过动态血压监测进行控制。
BACKGROUNDEpidemiological studies have led to equivocal results concerning the role of arterial blood pressure as a risk factor for the development of glaucomatous damage and progressive visual field loss in glaucoma has been attributed to low nighttime blood pressure, especially when oral antihypertensives have been combined with beta-blocking eyedrops. In order to answer the question whether nocturnal blood pressure or blood pressure dip during ambulatory blood pressure monitoring are associated with progressive visual field loss we performed a systematic review and meta-analysis of studies in patients with primary open-angle glaucoma and normal tension glaucoma.METHODSAfter searching MEDLINE, the Cochrane Library, and EMBASE, only 5 studies could be found reporting information on the method of ambulatory blood pressure measurements, separate data for daytime and nighttime blood pressure, definition of nocturnal blood pressure dip, and assessment of visual fields over a period of at least 2 years.RESULTSThere was no difference in mean systolic or diastolic diurnal and nocturnal blood pressure between patients with or without progressive visual field loss. The odds ratio for deteriorating visual fields over 2 years with nocturnal dips >10% in systolic or diastolic blood pressure was 3.32 (1.84-6.00) and 2.09 (1.20-3.64), respectively. Data allowing a separate analysis of over-dipping were not available.CONCLUSIONSNocturnal blood pressure fall is a risk factor for progressive visual field loss in glaucoma. However, prospective studies are needed to define a tolerable degree of dipping. Antihypertensive therapy in glaucomatous patients should be controlled with ambulatory blood pressure monitoring.