Role of nocturnal arterial hypotension in optic nerve head ischemic disorders

Ophthalmologica. 1999;213(2):76-96. doi: 10.1159/000027399.


Objective: To investigate the role of nocturnal arterial hypotension, intraocular pressure (IOP) and heart rate in optic nerve head (ONH) ischemic disorders, and the effects of systemic factors and topical beta-blocker eye-drops on nocturnal arterial hypotension and heart rate.

Methods: We investigated prospectively, by 24-hour ambulatory blood pressure (BP) monitoring and diurnal curve of the IOP, 275 white patients with anterior ischemic optic neuropathy (AION - 114), normal tension glaucoma (NTG - 131) and primary open angle glaucoma (POAG - 30).

Results: Hourly average BP data analyses showed a significantly greater drop in mean diastolic BP (p < 0.009) at night in NTG than AION. Cases with visual field deterioration had significantly (p = 0.05) lower minimum nighttime diastolic BP. Arterial hypertensives on oral hypotensive therapy showed a significantly lower mean nighttime systolic BP (p = 0.006) and larger mean percentage drop in systolic (p < 0.0001), diastolic (p = 0.0009) and mean (p < 0.0001) BPs. Normotensives and hypertensives without therapy had no such difference. IOP showed no significant correlation with visual field deterioration in any of these conditions. Patients using beta-blocker eyedrops, compared with those not using them, had greater percentage drop in diastolic BP (p = 0.028), lower minimum nighttime diastolic BP (p = 0.072) and lower minimum nighttime heart rate (p = 0.002).

Conclusions: Findings of our study suggest that nocturnal hypotension, by reducing the ONH blood flow below a crucial level during sleep in a vulnerable ONH, may play a role in the pathogenesis of AION and glaucomatous optic neuropathy (GON) and progression of visual loss in them. Thus, nocturnal hypotension may be the final insult in a multifactorial situation.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adrenergic beta-Antagonists / administration & dosage
  • Adrenergic beta-Antagonists / therapeutic use
  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Pressure / drug effects
  • Blood Pressure / physiology*
  • Blood Pressure Monitoring, Ambulatory
  • Circadian Rhythm / physiology*
  • Female
  • Follow-Up Studies
  • Glaucoma, Open-Angle / complications
  • Glaucoma, Open-Angle / drug therapy
  • Glaucoma, Open-Angle / physiopathology
  • Heart Rate / drug effects
  • Heart Rate / physiology
  • Humans
  • Hypotension / complications
  • Hypotension / drug therapy
  • Hypotension / physiopathology*
  • Intraocular Pressure / drug effects
  • Intraocular Pressure / physiology
  • Male
  • Middle Aged
  • Ophthalmic Solutions
  • Optic Disk / blood supply*
  • Optic Neuropathy, Ischemic / drug therapy
  • Optic Neuropathy, Ischemic / etiology
  • Optic Neuropathy, Ischemic / physiopathology*
  • Prospective Studies
  • Visual Fields


  • Adrenergic beta-Antagonists
  • Ophthalmic Solutions