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야간혈압하강이 녹내장의 진행에 미치는 영향

Correlation Between Nocturnal Dip and Progression of Glaucoma

류원열|노세현|서홍융
대한안과학회 (The Korean Ophthalmological Society)|2010.11|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제51권 제11호|pp. 1471-1478

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참고문헌

키워드

DipperNocturnal dipProgression of visual field defect24-hour blood pressure monitoringHypertension treatment
주제분류안과학

초록

목적: 야간혈압하강이 시야 결손의 진행에 미치는 영향을 알아보고자 하였다. 대상과 방법: NTG 140명(280안)과 POAG 84명(168안)을 대상으로 24시간 활동 혈압 검사와 시야검사를 시행하였다. 야간혈압하강이 10% 미만인 경우를 non-dipper, 10% 이상인 경우를 dipper로 나누어, 야간혈압하강과 시야 결손의 진행, 그리고 고혈압 치료와의 관계를 알아보고자 하였다. 결과: 수축기와 이완기에서의 dipper는 NTG에서 시야 결손을 진행시켰으며, 이는 약 3배의 위험성을 보였다. 고혈압 치료는 NTG, POAG에서 시야 결손의 진행에 영향을 주지 않았으나, NTG에서는 수축기와 이완기 모두에서, POAG에서는 이완기에서 dipper를 유발 하였다. 야간혈압하강은 NTG에서 시야 결손의 진행이 있는 경우에 없는 경우보다 유의하게 크게 나타났다. 결론: Dipper는 NTG에서 시야 결손의 진행을 유발하며, 이러한 dipper는 NTG와 POAG에서 고혈압 치료에 영향을 받는다. 목표안압 이하로 안압이 유지됨에도 불구하고 시야 결손의 진행을 보이는 경우 24시간 활동 혈압 검사가 유용할 것이며, 고혈압 치료 또한 녹내 장 치료에 중요한 인자로 고려해야 할 것이다.

Abstract

Purpose: To investigate the effect of nocturnal dip influence on the progression of glaucomatous visual field defect. Methods: We performed 24hr ABPM and V/F tests on patients diagnosed with NTG (140 patients, 280 eyes) and POAG (84 patients, 168 eyes). Nocturnal dips below 10% were classified as non-dippers, and those above 10% were noted as dippers. The correlations among nocturnal dip, progression of glaucomatous visual field defect, and hypertension treatment were examined. Results: In NTG, dippers in both systolic and diastolic blood pressure furthered glaucomatous visual field defects, with a relative risk of approximately three times that of non-dippers. Hypertension treatment was not influenced by the progression of glaucomatous visual field defect but was influenced by dips in the systolic and diastolic pressures in NTG and in diastolic pressure in POAG. Nocturnal dips were more frequent in the group with progression of the visual field compared to those in the group with non-progression of the visual field in NTG. Conclusions: Dipper caused a progression of glaucomatous visual field defects in NTG and was influenced by hypertension treatment in NTG and POAG. Performing 24hr ABPM should be helpful for glaucoma patients with progression of a glaucomatous visual field defect even when the IOP is less than the target pressure. In addition, hypertension treatment should be considered an important factor in the treatment of glaucoma.

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