title: Association Between Nocturnal Blood Pressure Dips and Optic Disc Hemorrhage in Patients With Normal-Tension Glaucoma.
abstract: OBJECTIVE
  To investigate the effect of nocturnal blood pressure (BP) dips on the occurrence of optic disc hemorrhage (ODH) in normal-tension glaucoma (NTG) patients and determine whether ODH is associated with greater likelihood of visual field progression (VFP).
  
  
  METHODS
  Prospective case-control study.
  
  
  METHODS
  This study enrolled 698 eyes of 349 consecutive NTG patients who were ≥40 years old, underwent 24-hour intraocular pressure and ambulatory BP monitoring in the habitual position, were examined for ODH every 4-6 months with optic disc photography, and had ≥5 reliable visual field tests with minimum follow-up of 3 years. NTG patients were classified into 2 groups: "nonphysiologic" dippers, including nondippers and overdippers, and "physiologic" dippers. Odds ratios for the association between the "nonphysiologic" group and ODH were calculated using logistic regression models. Kaplan-Meier analyses were performed to compare outcomes with reference to the presence of ODH for VFP.
  
  
  RESULTS
  Overall, ODH and VFP were detected in 107 (15.3%) eyes and 60 (8.6%) eyes among total 698 eyes, respectively. Overdippers showed a significantly greater frequency of ODH than nondippers or dippers. Being an overdipper was a significant and an independent risk factor for ODH occurrence during follow-up. The rates of VFP were 6%, 7%, and 24% for dippers, nondippers, and overdippers, respectively. Eyes with ODH were associated with greater likelihoods of subsequent VFP than those without. VFP occurred only in eyes with ODH.
  
  
  CONCLUSIONS
  Being an overdipper is a significant risk factor for ODH in NTG eyes. The detection of ODH during follow-up is a potent predictor of future VFP.
authors.affiliation: Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, South Korea.
authors.forename: Junki
authors.initials: J
authors.lastname: Kwon
authors.affiliation: Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, South Korea.
authors.forename: Jinyoung
authors.initials: J
authors.lastname: Lee
authors.affiliation: Central Seoul Eye Center, Seoul, South Korea.
authors.forename: Jaewan
authors.initials: J
authors.lastname: Choi
authors.affiliation: Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, South Korea.
authors.forename: Dawoon
authors.initials: D
authors.lastname: Jeong
authors.affiliation: Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, South Korea. Electronic address: mskook@amc.seoul.kr.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kook
mesh_terms: D001794:Blood Pressure / Q000502:physiology*; D016022:Case-Control Studies; D002940:Circadian Rhythm / Q000502:physiology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D057066:Low Tension Glaucoma / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009898:Optic Disk / Q000098:blood supply*; D009901:Optic Nerve Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D011446:Prospective Studies; D012166:Retinal Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D013997:Time Factors; D041623:Tomography, Optical Coherence