[Daily and nightly fluctuation of intraocular pressure and blood pressure in glaucoma and non-glaucoma patients].
OBJECTIVE
To determine and compare 24-hour fluctuations of intraocular pressure (IOP) and systemic blood pressure (BP) in patients with ocular hypertension (OHT) and primary open angle glaucoma (POAG) versus non-glaucoma patients.


METHODS
Applanation IOP and BP were measured every 2 hours by one observer for 24 hours in 102 patients. The patients were classified: group 1 - 21 patients with OHT and POAG without treatment, group 2 - 40 patients with OHT and POAG with a satisfactory diurnal therapeutic control of IOP (daytime IOP ? 21 mmHg), group 3 - 13 patients with POAG with unsatisfactory control of IOP under maximal tolerated medication (daytime IOP > 21 mmHg), and group 0-28 non-glaucoma patients (control group).


RESULTS
In all glaucoma patients groups 24-hour IOP fluctuations were greater than in the control group (group 0 - 3.62 +/- 0.82 mmHg, ANOVA p < 0.001). Untreated OHT/POAG had 24-hour IOP fluctuations significantly greater than those with good therapeutic control (group 1 - 5.66 +/- 1.66 mmHg versus group 2 - 4.27 +/- 1.86 mmHg, p = 0.0001). POAG with uncontrolled IOP under maximal tolerated medication had the 24-hour IOP fluctuations significantly greater than the other groups (group 3 - 8.38 +/- 3.78 mmHg, p?0.0001). In these patients there was an evident nocturnal mean IOP peak between 0-2 am which temporally correlates with nocturnal systemic BP "dip". Nocturnal IOP peaks (between 11 pm-7 am) were found more frequently in treated glaucoma patients (45.28% - groups 2 and 3 versus 10.2% - groups 0 and 1, p < 0.0001).


CONCLUSIONS
Circadian lOP fluctuations in glaucoma patients, even with a satisfactory diurnal therapeutic control, are greater than in the age-matched control subjects. Patients with uncontrolled lOP under topical maximal tolerated medication had the greatest 24-hour lOP fluctuations. Nocturnal lOP peaks occur more often in medically treated patients and 24-hour monitoring of lOP may be useful in this patients.
Chiseliţă
D
D
Clinica I Oftalmologie, Sp. Sf. Spiridon, Iaşi.
Moţoc
Irina
I
Danielescu
C
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D018660:Blood Pressure Monitoring, Ambulatory; D016022:Case-Control Studies; D002940:Circadian Rhythm; D005260:Female; D005902:Glaucoma, Open-Angle / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012307:Risk Factors; D012383:Romania; D014065:Tonometry, Ocular; D014794:Visual Fields