Morning BP surge predicts visual field progression in glaucoma patients with hypertension

Normal-tension glaucoma (NTG) patients with hypertension who experience morning blood pressure (BP) surge are likely to have visual field progression, as shown in a study.

For the study, researchers looked at the 2-year follow-up data from 127 patients with a new diagnosis of NTG (127 eyes) and were receiving treatment for systemic hypertension. All patients underwent baseline 24-hour ambulatory BP monitoring (ABPM) and at least five serial visual field examinations during the follow-up period.

Visual field progression was determined according to the Early Manifest Glaucoma Trial criteria. Cox regression analyses were performed to estimate the associations of visual field progression with 24-hour ABPM-based parameters (including morning BP surge) and other clinical variables. Visual field survival estimates in patients with and without morning BP surge were compared using Kaplan−Meier survival analysis.

A total of 38 eyes (29.9 percent) showed visual field progression over a mean follow-up of 5.2 years. In a multivariate Cox regression model, the following factors emerged as significant independent predictors of subsequent visual field progression: a greater morning BP surge (hazard ratio [HR], 1.033, p=0.024) and lower night-time mean arterial pressure trough (HR, 0.965, p=0.031) at baseline.

Additional data confirmed that patients with higher morning BP surge at baseline were significantly more likely to experience visual field progression (p=0.021).

The present data provide evidence that a morning BP surge may serve as a relevant parameter for identifying subsequent visual field progression in hypertensive NTG patients receiving oral BP-lowering medication.