title: Nocturnal systemic hypotension increases the risk of glaucoma progression.
abstract: OBJECTIVE
  The objective of this prospective, longitudinal study of patients with normal-tension glaucoma (NTG) was to determine whether patients with nocturnal hypotension are at greater risk for visual field (VF) loss over 12 months than those without nocturnal hypotension.
  
  
  METHODS
  Prospective, longitudinal study.
  
  
  METHODS
  Consecutive patients with NTG with at least 5 prior VF tests were screened for eligibility.
  
  
  METHODS
  The baseline evaluation assessed demographic and clinical characteristics, covering systemic comorbid conditions, including systemic hypertension. All oral and ophthalmologic medications were recorded. A complete ophthalmological examination was performed at baseline and follow-up. Patients had their blood pressure (BP) monitored every 30 minutes for 48 hours with an ambulatory recording device at baseline and 6 and 12 months.
  
  
  METHODS
  The primary outcome was based on the global rates of VF progression by linear regression of the mean VF threshold sensitivity over time (decibels/year).
  
  
  RESULTS
  Eighty-five patients with NTG (166 eyes; mean age, 65 years; 67% were women) were included. Of the 85 patients, 29% had progressed in the 5 VFs collected before study enrollment. The nocturnal mean arterial pressure (MAP) was compared with the daytime MAP. Multivariate analysis showed that the total time that sleep MAP was 10 mmHg below the daytime MAP was a significant predictor of subsequent VF progression (P<0.02).
  
  
  CONCLUSIONS
  Cumulative nocturnal hypotension predicted VF loss in this cohort. Our data suggest that the duration and magnitude of decrease in nocturnal blood pressure below the daytime MAP, especially pressures that are 10 mmHg lower than daytime MAP, predict progression of NTG. Low nocturnal blood pressure, whether occurring spontaneously or as a result of medications, may lead to worsening of VF defects.
authors.affiliation: Center for Integrative Medicine, Weill Cornell Medical College, New York, New York. Electronic address: mecharl@med.cornell.edu.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Charlson
authors.affiliation: Einhorn Clinical Research Center, New York Eye and Ear Infirmary at Mount Sinai School of Medicine, New York, New York; Department of Ophthalmology, New York University Medical Center, New York, New York.
authors.forename: Carlos Gustavo
authors.initials: CG
authors.lastname: de Moraes
authors.affiliation: Center for Integrative Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Alissa
authors.initials: A
authors.lastname: Link
authors.affiliation: Department of Statistical Science, Cornell University, Ithaca, New York.
authors.forename: Martin T
authors.initials: MT
authors.lastname: Wells
authors.affiliation: Department of Ophthalmology, Weill Cornell Medical College, New York, New York.
authors.forename: Gregory
authors.initials: G
authors.lastname: Harmon
authors.affiliation: Center for Integrative Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Janey C
authors.initials: JC
authors.lastname: Peterson
authors.affiliation: Einhorn Clinical Research Center, New York Eye and Ear Infirmary at Mount Sinai School of Medicine, New York, New York.
authors.forename: Robert
authors.initials: R
authors.lastname: Ritch
authors.affiliation: Einhorn Clinical Research Center, New York Eye and Ear Infirmary at Mount Sinai School of Medicine, New York, New York; Department of Ophthalmology, New York University Medical Center, New York, New York.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Liebmann
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D002940:Circadian Rhythm / Q000502:physiology*; D018450:Disease Progression; D005260:Female; D005901:Glaucoma / Q000503:physiopathology*; D006801:Humans; D007022:Hypotension / Q000503:physiopathology*; D007429:Intraocular Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D014794:Visual Fields / Q000502:physiology