Study of nycthemeral variations in blood pressure in patients with non-arteritic anterior ischemic optic neuropathy

Abstract

Purpose

The objective of this study was to analyze the nycthemeral variations in blood pressure (BP) in individuals who presented with non-arteritic anterior ischemic optic neuropathy (NAION).

Methods

BP was recorded for 24 h (ambulatory blood pressure monitoring, ABPM) in 65 patients with acute NAION. Three definitions of nighttime periods were used: definition 1, 1 a.m.–6 a.m.; definition 2, 10 p.m.–7 a.m.; and definition 3, 10 p.m.–8 a.m. For each of these definitions, patients were classified according to the value of nocturnal reduction in BP into dippers (10–20%), mild dippers (0–10%), reverse dippers (< 0%), and extreme dippers (> 20%).

Results

The proportions of dippers, mild dippers, reverse dippers, and extreme dippers varied significantly depending on the definition chosen. We found the highest number of patients with extreme dipping (23%) when using the strictest definition of nighttime period (definition 1, 1 a.m.–6 a.m.), as compared with 6.2% and 1.5% for the other definitions, respectively. Overall, 13 of 33 patients without known systemic hypertension (39%) were diagnosed with hypertension after ABPM. No risk factor for NAION was associated with the extreme-dipping profile. Finally, the prevalence of systemic hypertension was high (69%).

Conclusion

In our population of patients who had an episode of NAION, the proportion of extreme dippers was higher than that usually found in the literature. However, extreme dipping is not a frequent feature of patients with NAION as compared to patients with systemic hypertension. ABPM is recommended for all patients with NAION and unknown history of systemic hypertension.