24 HOUR BLOOD PRESSURE PROFILE IN YOUNG AND MIDDLE-AGED PATIENTS WITH RETINAL VEIN OCCLUSION

Background. Absence of nocturnal decrease (non-dipper) or an extreme decrease of blood pressure (BP) (overdipper) may be a sign of vascular dysregulation. Non-dipper pattern is associated with increased risk of strokes and cardiovascular events. Over-dipper pattern increases the risk of non-arteritic anterior ischemic neuropathy and glaucoma progression. Daily BP profile in young and middle-aged adults with retinal vein occlusion (RVO) has not been previously examined. The target organ damage is determined by BP dynamics, regional microcirculation and associated perfusion pressure decrease, which verifies the relevance of our study. Objective. To evaluate the diurnal BP variation, the prevalence of arterial hypertension (HTN) and its character, ocular blood flow in RVO in young and middle-aged adults. Design and methods. The study included 30 patients with RVO. In all patients, routine ophthalmic examination was performed, as well as an additional ocular blood flow assessment (ophthalmoplethysmography, ophthalmorheography, ophthalmosphygmography, and fluorescein angiography). 24‑hour blood pressure monitoring (BPM) was performed to estimate systemic hemodynamics. Results. Statistically significant differences between eyes were noted in visual acuity (p = 0,001) and retinal thickness in macular area (p < 0,001). Patients with HTN showed lower visual acuity (р = 0,04), ocular blood flow parameters (p < 0,05) and retinal mean sensitivity (RMS) (р = 0,02) according to automated static perimetry. Fluorescein angiography showed zones of peripheral retinal ischemia with a mean area of 103 mm² (from 0 to 250 mm² ). 8 patients had masked HTN according to ambulatory BPM. Depending on the night decrease of BP 13 patients had an extreme decrease of BP (over-dipper), 12 had non-dipper pattern and 5 had dipper pattern. No relation between evaluated parameters was found. However, non-dippers showed a tendency towards lower hemodynamic and automated static perimetry parameters. Conclusions. The prevalence of HTN was 57%, while 47% demonstrated masked HTN. Lower ocular blood flow parameters and RMS according to automated static perimetry were associated with HTN. Vascular dysregulation is considered as a possible cause of RVO in young and middle-aged adults. Its manifestation is the equal frequency of non-dipper and over-dipper patterns. Ambulatory BPM in patients with RVO can be recommended for the detection of HTN, BP profiles, and indirectly, for the evaluation of ocular perfusion pressure, risk stratification and the selection of adequate and individualized antihypertensive therapy to reduce the risk of developing and progressing cardiovascular diseases and mortality.

1. Deb AK, Kaliaperumal S, Rao VA, Sengupta S. Relationship between systemic hypertension, perfusion pressure and glaucoma: a comparative study in an adult Indian population. Indian J Ophthalmol. 2014;62(9):917–922. doi:10.4103/0301–4738.143927

2. Klein R, Moss SE, Meuer SM, Klein BE. The 15-year cumulative incidence of retinal vein occlusion: the Beaver Dam Eye Study. Arch Ophthalmol. 2008;126(4):513–518.

3. Шишкин А. И., Лындина М. Л. Эндотелиальная дисфункция и артериальная гипертензия. Артериальная гипертензия. 2008;14(4):315–319. [Shishkin AI, Lyndina ML. Endothelial dysfunction and arterial hypertension. Arterial’naya Gipertenziya = Arterial Hypertension. 2008;14(4):315–319. In Russian].

4. Choi J, Kook MS. Systemic and ocular hemodynamic risk factors in glaucoma. Biomed Res Int. 2015;2015:141905. doi:10. 1155/2015/141905

5. Hayreh H. Blood flow in optic nerve head and factors that may influence it. Prog Retin Eye Res. 2001;20(5):595–624.

6. Caprioli J, Coleman AL. Blood pressure, perfusion pressure, and glaucoma. American Journal of Ophthalmology. 2010;149(5): 704–712.

7. Fan N, Wang P, Tang L, Liu X. Ocular blood flow and normal tension glaucoma. Biomed Research International. 2015:2015:308505. doi:10.1155/2015/308505

8. Flammer J. The glaucomatous optic neuropathy: a re-perfusion damage. Klinische Monatsblatter fur Augenheilkunde. 2001;218(5):290–291.

9. Choi J, Jeong J, Cho HS. Effect of nocturnal blood pressure reduction on circadian fluctuation of mean ocular perfusion pressure: a risk factor for normal tension glaucoma. Invest Ophthalmol. 2004;48(4):380–385.

10. Graham SL, Drance SM. Nocturnal hypotension: Role in glaucoma progression. Surv Ophthalmol. 1999;43(Suppl 1): S10–6.

11. Graham SL, Drance SM, Wijsman K, Douglas GR, Mikelberg FS. Ambulatory blood pressure monitoring in glaucoma. Ophthalmology. 1995;102(1):61–69.

12. Акопов Е. Л., Астахов Ю. С., Нефедова Д. М. Сосудистые факторы риска развития первичной открытоугольной глаукомы. Клин. офтальмол. 2008;2:68–71. [Akopov EL, Astakhov US, Nefedova DM. Vascular risk factors in primary open-angle glaucoma. Clin Ophthalmology. 2008;2:68–71. In Russian].

13. Астахов Ю. С., Гозиев С. Д., Шихалиев Д. Р. Влияние нефиксированной и фиксированной комбинации 0,5 % тимолола и 0,005 % латанопроста на местную и системную гемодинамику при лечении пациентов с ПОУГ. Офтальмологические ведомости. 2009;2(1):12–17. [Astakhov US, Goziev SD, Shikhaliev DR. The influence of unfixed and fixed combination of timolol 0,5 % and latanoprost 0,005 % on local and systemic hemodynamics in treatment of patients with POAG. Oftalmolog icheskie Vedomosti = Ophthalmology Bulletin. 2009;2(1):12–17. In Russian].

14. Астахов Ю. С., Устинова Е. И., Катинас Г. С., Устинов С. Н., Байгушева С. С. О традиционных и современных способах исследования колебаний офтальмотонуса. Офтальмологические ведомости. 2008;1(2):7–12. [Astakhov US, Ustinova EI, Katinas GS, Ustinov SN, Baigusheva SS. On traditional and modern methods of ophthalmotonus fluctuations investigation. Ophthalmologicheskie Vedomosti = Ophthalmology Bulletin. 2008;1(2):7–12. In Russian].

15. Matsui Y, Eguchi K, Ishikawa J, Hoshide S, Shimada K, Kario K et al. Subclinical arterial damage in untreated masked hypertensive subjects detected by home blood pressure measurement. Am J Hypertens. 2007;20 (4):385–391.

16. White WB. The night-time might be the right time for cardiovascular event prediction. Hypertension. 2012;60(1):8–9.

17. Hansen TW, Li Y, Boggia J, Thijs L, Richart T, Staessen JA. Predictive role of the night-time blood pressure. Hypertension. 2011;57(1):3–10.

18. Liu JE, Roman MJ, Pini R, Schwartz JE, Pickering TG, Devereux RB. Cardiac and arterial target organ damage in adults with elevated ambulatory and normal office blood pressure. Ann Intern Med. 1999;131(8):564–572.

19. Rosa AA, Ortega KC, Mion DJ, Nakashima Y. Prevalence of arterial hypertension in branch retinal vein occlusion patients. Arq Bras Oftalmol. 2008;71(2):162–166.

20. Rao VN, Ulrich JK, Viera AJ, Parlin A, Fekrat S, Chavala SH. Ambulatory blood pressure patterns in patients with retinal vein occlusion. Ophthalmic Communications Society. 2016; 36(12):2304–2310.

21. Park SJ, Moon SW, Lim SH, Yoon IH, Choi KN, Lee HY. Diurnal blood pressure variation in the retinal vein occlusion. J Korean Ophthalmol Soc. 2013;54(9):1371–1378. doi:10.3341/ jkos.2014.54.9.1371

22. Konieczka K, Ritch R, Traverso CE, Kim DM, Kook MS, Gallino A et al. Flammer Syndrome. The EPMA J. 2014:5(1):11.

23. Тульцева С. Н., Титаренко А. И., Руховец А. Г. Ха-рактеристика системной и регионарной гемодинамики при ишемической окклюзии вен сетчатки у лиц молодого и среднего возраста. Регионарное кровообращение и микроциркуляция. 2016;2(58):24–31. [Tultseva SN, Titarenko AI, Rukhovets AG. Systemic and regional hemodynamics in ischemic occlusion of retinal veins in young and middle-aged adults. Regionarnoe Krovoobrashchenie i Mikrotsirkylyatsiya = Regional Circulation and Microcirculation. 2016;2(58):24–31. In Russian].

24. Koseki N, Araie M, Tomidokoro A, Nagahara M, Hasegawa T, Tamaki Y et al. A placebo-controlled 3 year study of a calcium blocker on visual field and ocular circulation in glaucoma with low-normal pressure. Ophthalmology. 2008;115(11):2049–2057.

25. Pesin N, Mandelcorn ED, Felfeli T, Ogilvie RI, Brent MH. The role of occult hypertension in retinal vein occlusions and diabetic retinopathy. Can J Ophthalmol. 2016;1:1–3. http://dx.doi. org/10.1016/j.jcjo.2016.09.009

26. Hayreh SS, Zimmerman B, Mccarthy MJ, Podhajsky P. Systemic diseases associated with various types of retinal vein occlusion. Elsevier Science Inc. 2001;131(1):61–77.

27. Sinawat S, Bunyavee C, Ratanapakorn T, Sinawat S, Laovirojjanakul W, Yospaiboon Y. Systemic abnormalities associated with retinal vein occlusion in young patients. Clinical Ophthalmology. 2017;11:441–447. doi:10.2147/OPTH.S128341.

28. O’Mahoney PR, Wong DT, Ray JG. Retinal vein occlusion and traditional risk factors for atherosclerosis. Arch Ophthalmol. 2008;126(5):692–699.

29. Werther W, Chu L, Holekamp N, Do DV, Rubio RG. Myocardial infarction and cerebrovascular accident in patients with retinal vein occlusion. Arch Ophthalmol. 2001;129(3):326–331.

30. Lee J, Choi J, Jeong D, Kim S, Kook MS. Relationship between daytime variability of blood pressure or ocular perfusion pressure and glaucomatous visual field progression. Am J Ophthalmol. 2015;160(3):522–537.

31. Ho JD, Liou SW, Lin HC. Retinal vein occlusion and the risk of stroke development: a five-year follow-up study. Am J Ophthalmol. 2009;147(2):283–290.

32. Tsaloumas MD, Kirwan J, Vinall H, O’Leary MB, Prior P, Kritzinger EE et al. Nine year follow-up study of morbidity and mortality in retinal vein occlusion. Eye (Lond). 2000;14(Pt 6): 821–827.

33. Hu C, Ho J, Lin H. Retinal vein occlusion and the risk of acute myocardial infarction: a 3-year follow-up study. Br J Ophthalmol. 2009;93(6):717–720.

34. Mansour A, Walsh J, Henkind P. Mortality and morbidity in patients with central retinal vein occlusion. Ophthalmologica. 1992;204(4):199–203.

35. Park SJ, Choi NK, Yang BR, Park KH, Woo SJ. Risk of stroke in retinal vein occlusion. Neurology. 2015;85(18):1578– 1584.

36. Bertelsen M, Linneberg A, Christoffersen N, Vorum H, Gade E, Larsen M. Mortality in patients with central retinal occlusion. Ophthalmology. 2014;121(3):637–642.

37. Flammer J, Konieczka K, Flammer AJ. The primary vascular dysregulation syndrome: implications for eye diseases. EPMA J. 2013;4(1):14.

38. Fraenkl SA, Mozaffarieh M, Flammer J. Retinal vein occlusions: the potential impact of a dysregulation of the retinal veins. EPMA J. 2010;1(2):253–261.

39. Tanano I, Nagaoka T, Sogawa K, Tani T, Omae T, Nakabayashi S et al. Impaired systemic vascular endothelial function in patients with branch retinal vein occlusion. Curr Eye Res. 2013;38(1):114–118.

40. Hollo G. Plasma endothelial-1 concentrations in patients with retinal vein occlusions. Br J Ophthalmol. 1999;83(1):127–128.

41. Flammer J, Konieczka K. Retinal venous pressure: the role of endothelin. EPMA J. 2015;6:1–12. doi:10.1186/s13167– 015–0043–1.

42. McAlister I, Tan M, Smithies L, Wong WL. The Effect of Central retinal venous pressure in patients with central retinal vein occlusion and a high mean area of nonperfusion. Am Acad Ophthalmol. 2014;121(11):2228–2236.

43. Малишевская Т. Н., Астахов С. Ю. Реактивность сосудистого эндотелия у пожилых пациентов с первичной открытоугольной глаукомой и физиологически стареющих людей в зависимости от выраженности эндотелиальной дисфункции. Регионарное кровообращение и микроциркуляция. 2016;15(4): 59–67. [Malishevskaya TN, Astakhov SU. Reactivity of vascular endothelium in elderly patients with primary open-angle glaucoma and physiologically aging people depending on the severity of endothelium dysfunction. Regionarnoye Krovoobrashcheniye i Mikrotsirkulyatsiya = Regional Circulation and Microcirculation. 2016;15(4):59–67. In Russian].

44. Kaur C, Foulds WS, Ling EA. Blood-retinal barrier in hypoxic ischaemic conditions: basic concepts, clinical features and management. Prog Retina Eye Res. 2008;27(6):622–647.