망막정맥폐쇄에서 혈압의 일중 변동 양상 분석
Diurnal Blood Pressure Variation in the Retinal Vein Occlusion
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목적: 망막정맥폐쇄 환자를 대상으로 24시간 활동혈압 측정을 시행하여 혈압의 일중 변동 유무 및 변화 양상을 알아보고자 하였다. 대상과 방법: 2012년 5월부터 2012년 12월까지 본원 안과를 방문하여 망막분지정맥폐쇄 또는 망막중심정맥폐쇄로 진단된 환자 중 이전에고혈압 진단 및 고혈압 약물 복용 과거력이 없는 환자를 대상으로 하였다. 주간 수축기 혈압에 비해 야간 수축기 혈압이 10% 미만으로감소한 경우는 야간혈압 비강하자(non-dipper)로 정의하였으며, 망막정맥폐쇄 환자와 대조군 간에 24시간 활동혈압 측정치를 비교해보았다. 결과: 야간 평균 수축기 혈압을 제외한 다른 평균혈압이 모두 망막정맥폐쇄군에서 대조군에 비해 통계적으로 유의하게 높게 나타났다. 그리고 망막정맥폐쇄군에서 야간혈압 강하자에 대한 야간혈압 비강하자의 비차비가 대조군에 비해서 1.81배 높았다. 망막정맥폐쇄 환자에서 측정한 수시 수축기 및 이완기 혈압은 고혈압군과 비고혈압군에서 통계적으로 유의한 차이를 보이지 않았으나, 24시간 평균수축기 및 이완기 혈압에서는 고혈압의 유무에 따라 통계적으로 유의한 차이를 보였다. 결론: 망막정맥폐쇄 환자의 경우 하루 중 대부분 높은 혈압을 유지하는 경향이 있으며, 비록 고혈압을 가지고 있지 않더라도 야간 혈압비강하자는 망막정맥폐쇄의 위험인자라고 볼 수 있다. 따라서 24시간 활동혈압 측정은 망막정맥폐쇄 환자에서 고혈압의 치료 및 엄격한 혈압 조절에 유용할 것으로 기대된다.
Abstract
Purpose: The purpose of this study was to determine the diurnal blood pressure variation with retinal vein occlusion (RVO)using 24-hour ambulatory blood pressure monitoring (24-hour ABPM). Methods: The subjects in this study visited the department of ophthalmology from May 2012 to December 2012 and were diagnosed with RVO but had no history of hypertension (HTN). Non-dipper was defined as a nocturnal systolic blood pressure (SBP) decrease less than 10%. These values were used to compare the 24-hour ABPM values of the RVO and the control groups. Results: The 24-hour ABPM values, with the exception of the mean nightly SBP, were statistically different whne the RVO group was compared with the control group. The odds of an RVO patient being a non-dipper compared to dipper were 1.81times greater than in the control. Additionally, the clinical SBP and DBP in the RVO group were not significantly different when the HTN group and the non-HTN group were compared. In contrast, the mean 24-hour SBP and the mean DBP were significantly different in regard to HTN. Conclusions: Patients with RVO have a tendency to maintain high BP throughout the day and also during the night. A patient with non-dipper status can be at risk for RVO, even if the patient does not have HTN. Therefore, 24-hour ABPM is an effective management approach for HTN in addition to strict BP control in patients with RVO.
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