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Evelyn Voigt, Karin R Pillunat, Eberhard Spoerl, Lutz E Pillunat; Diurnal arterial hypertension in retinal vein occlusion. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3735.
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© ARVO (1962-2015); The Authors (2016-present)
To study the diurnal blood pressure behavior in patients with central (CRVO) and branch retinal vein occlusion (BRVO).
Data of 121 patients (61male/ 60 female; age 68.5+13.4 years) with retinal vein occlusion in one eye (65xCRVO and 56xBRVO) who were examined and treated in our clinic were enrolled. Each patient had 24-hour blood pressure monitoring (24h-BPM). According to the European Guidelines for Hypertension BP was considered normal if the daytime systolic/diastolic BP means were <135/85 mmHg and the nighttime SBP/DBP <120/70 mmHg. Elevated BP otherwise. A mean arterial nocturnal blood pressure dipping between 10%-20% was considered as physiological dipping, of less than 10% as non-dipping and of more than 20% as over-dipping. ANOVA with post-hoc Sidak test served for statistical analysis.
115 (95%) patients suffered from arterial hypertension, 12 were treated sufficiently, 8 were not treated at all and 95 were hypertensive despite antihypertensive medication. Only 6 (5%) patients were normotensive. Mean systolic BP showed a statistically significant difference between CRVO and BRVO (day: 147.7mmHg vs. 156.2mmHg, P=0.001; night: 111.2mmHg vs. 139.9mmHg, P=0.001). Mean arterial pressure (MAP= DBP + 1/3(SBP-DBP) is also statistically significant different between CRVO and BRVO (day: 105.6mmHg vs. 111mmHg; P=0.003; night: 96 mmHg vs. 99mmHg; P=0.020). In both occlusion types, CRVO and BRVO, most of the patients were nocturnal non-dippers (54% vs. 46%). Mean nocturnal systolic BP was 141 mmHg respectively 147 mmHg in this group. 35% vs. 45% were physiological dippers with a mean nocturnal systolic BP of 125 mmHg respectively 134 mmHg. Even physiological dippers did not reach nocturnal normotension (SBP/DBP <120/70 mmHg). 11% vs. 9% showed a nocturnal over-dipping. Mean nocturnal systolic BPs were 111 mmHg for CRVO respectively 133 mmHg for BRVO.
Most of the patients with CRVO or BRVO showed hypertensive daytime and nighttime 24h-BPs regardless of the dipping pattern. It is well accepted that arterial hypertension causes arteriosclerotic changes first in arterioles. This might explain the statistically significant higher daytime and nighttime BP levels in BRVO. 24h-BPM and optimization of diurnal BP might be an important tool for prevention.
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