Normal-tension glaucoma: nocturnal diastolic BP dip may predict subsequent visual field progression risk

  • Kwon J & al.
  • Ophthalmology
  • 7 Mar 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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  • Patients with normal-tension glaucoma (NTG) and nocturnal diastolic blood pressure (DBP) dip are at increased risk for subsequent visual field (VF) progression.
  • Nocturnal DBP dip may have a greater effect on future VF progression than systolic BP (SBP) dip in patients with NTG.

Why this matters

  • The role of nocturnal hypotension in glaucoma prognosis has been documented by multiple BP measurements or automated BP monitoring device during sleep hours.
  • However, the role of systemic hypotension occurring at different times over the entire 24-hour period (diurnal vs nocturnal) in patients with glaucoma remains unclear.

Study design

  • This prospective cohort study included 119 newly diagnosed patients with NTG who were followed up for at least 2 years and underwent 24-hour ambulatory BP monitoring and measurements of intraocular pressure.
  • VF progression was based on Early Manifest Glaucoma Trial criteria.
  • Main outcome: factors associated with VF progression over time.
  • Funding: None disclosed.

Key results

  • During follow-up, overall 41 (34%) patients with NTG showed VF progression.
  • multivariate Cox regression revealed that lower (HR, 0.953; P=.023) and greater nighttime DBP dip ‘area’ (time multiplied by nocturnal DBP >10 mmHg below mean daytime DBP; HR, 1.017; P=.003) at baseline were significantly associated with subsequent VF progression.
  • Greater number of nocturnal DBP parameters vs SBP parameters were associated with subsequent VF progression.


  • Different oral anti-hypertensive drugs were not stratified because of lack of self-reported information.

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