Morning Blood Pressure Surge and Glaucomatous Visual Field Progression in Normal-Tension Glaucoma Patients With Systemic Hypertension

& BULL; PURPOSE: To investigate the impact of a morning blood pressure surge (MBPS) at baseline on subsequent visual field (VF) progression in hypertensive, normal-tension glaucoma (NTG) patients receiving oral anti-hypertensive treatment. & BULL; DESIGN: Retrospective cohort study. & BULL; METHODS: A total of 127 eyes from 127 newly diag-nosed NTG patients treated for systemic hypertension and followed up for at least 2 years were analyzed. All patients underwent baseline 24-hour ambulatory blood pressure monitoring (ABPM) and at least 5 serial VF examinations during the follow-up period. VF progres-sion was defined according to the Early Manifest Glau-coma Trial criteria. The associations of VF progression with 24-hour ABPM-based blood pressure (BP) parame-ters (including MBPS) and other clinical variables were analyzed using Cox regression analyses. Kaplan -Meier survival analysis was used to compare VF survival esti-mates in patients with and without MBPS. & BULL; RESULTS: VF progression was detected in 38 eyes (29.9%) over a 5.2-year mean follow-up. In the multi-variate Cox regression model, a greater MBPS (hazard ra-tio [HR] = 1.033; P = .024) and lower nighttime mean arterial pressure (MAP) trough (HR = 0.965; P = .031) at baseline were significant independent predictors of subsequent VF progression. The likelihood of VF pro-gression was significantly greater in patients with higher MBPS ( P = .021) at baseline according to Kaplan -Meier survival analysis. & BULL; CONCLUSIONS: An increased MBPS at baseline is a sig-nificant independent predictor of subsequent VF progres-sion in NTG patients with systemic hypertension. This may be another relevant BP parameter associated with VF progression in hypertensive NTG patients receiving oral anti-hypertensive treatment. (Am J Ophthalmol 2023;254: 161-176. & COPY; 2023 Elsevier Inc. All rights re-served.)