ROLE OF ARTERIAL BLOOD-PRESSURE AND PROGR ESSION OF GLAUCOMATOUS DAMAGE

Purpose In a significant number of glaucoma patients, progression of v isual field loss occurs despite adequate intraocular pressure (IOP) co ntrol. Other factors, mainly vascular seem to play a role in the patho genesis of these glaucomas. The put-pose of this study was to investig ate the role of blood pressure (BP) as one of the vascular risk factor s for progression of glaucomatous damage. Methods Eighty-three glaucom a patients were categorizated as to whether their visual field defect were stable or progressive in the face of clinically stable IOP; all p atients were followed for at least two years. The mean systolic and di astolic BP were determined using a 24-hour ambulatory recording device , during diurnal (6 am-10 pm) and nocturnal (10 pm-6 am) periods. For each patient the nocturnal systolic and diastolic dips, and the BP var iability (i.e. standart deviation and percentage decrease from maximal to minimal readings) were determined. Results Forty-three patients ha d stable visual fields (25 females, 58.9 years old +/- 6.88; 18 males, 58.6 years old +/- 11), while 40 patients showed progressive visual f ield loss (23 females, 67.4 years old +/- 9.98; 17 males, 64.5 years o ld +/- 9.44). In the progressive group, women were older (p = 0.017), systolic (p = 0.0375) and diastolic (p = 0.0083) dips were greater, as also BP variability : systolic standard deviation was greater (p = 0. 027) as percentage decrease from maximal systolic readings (p = 0.034) . There were no difference for systolic, diastolic, diurnal or nocturn al mean BP in these two groups. Conclusions The finding in this study suggests that age, decreased nocturnal BP and high BP variability may be additional risk factors for progression of glaucomatous field loss.