Bláithín Ní Bhuachalla1, Christine A McGarrigle2, Kwadwo Owusu Akuffo3, Tunde Peto4, Stephen Beatty5, Rose Anne Kenny6,7. 1. Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, St James's Hospital, Old Stone Building, James's Street, Dublin 8, Ireland. nibhuacb@tcd.ie. 2. The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, College Green, Lincoln Gate, Dublin 2, Ireland. Christine.McGarrigle@tcd.ie. 3. Macular Pigment Research Group, Vision Research Centre Carriganore House, Waterford Institute of Technology, Waterford, Ireland. kakuffo@wit.ie. 4. Department of Research and Development, National Institute of Health Research Biomedical Research Centre at Moorfields Eye Hospital National Health Service Foundation Trust and UCL Institute of Ophthalmology, London, UK. Tunde.Peto@moorfields.nhs.uk. 5. Macular Pigment Research Group, Vision Research Centre Carriganore House, Waterford Institute of Technology, Waterford, Ireland. sbeatty@wit.ie. 6. Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, St James's Hospital, Old Stone Building, James's Street, Dublin 8, Ireland. rkenny@tcd.ie. 7. The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, College Green, Lincoln Gate, Dublin 2, Ireland. rkenny@tcd.ie.
Abstract
BACKGROUND: Manifestations of neurocardiovascular instability (NCVI), including orthostatic hypotension (OH) orthostatic hypertension (OHTN) and impaired blood pressure variability (BPV), have been associated with cardiovascular (CV) events. The eye is highly vascular and we propose an ideal target end organ to investigate pathological implications of NCVI. OBJECTIVE: To identify and define clinically applicable phenotypes of orthostatic blood pressure (BP) behaviour, analogous to OH, OHTN, and orthostatic BPV and to investigate their relationship to vision. METHODS: Wave one data from the Irish Longitudinal Study on Ageing (TILDA) were used. Orthostatic BP (OBP) phenotypes were identified and defined from beat-to-beat BP data, measured by digital photoplethysmography during an active stand (AS) lasting 110 s (s). Visual acuity (VA) was assessed using the Early Treatment Diabetic Retinopathy Study (EDTRS) LogMAR chart. The relationship between OBP phenotypes and VA in 4355 adults aged ≥50 years was investigated through multivariate linear regression models. RESULTS: There was a wide fluctuation in the prevalence of OH and OHTN up to 20 s after standing. After 30 s, four distinct OBP phenotypes were identified: in 70 % BP stabilised to within 20/10 mmHg of baseline BP, 4 % had persistent OH, 2 % had persistent OHTN and 25 % had exaggerated orthostatic blood pressure variability BPV. Systolic BPV was associated with worse VA (P = 0.02) as was diastolic BPV (P = 0.03), following adjustment for demographics, health behaviours, self-report eye diseases and diabetes, uncorrected refractive error, objective hypertension and antihypertensives. CONCLUSIONS: The hypothesis that NCVI may independently modulate CV risk is supported the independent association of exaggerated BPV and worse VA.
BACKGROUND: Manifestations of neurocardiovascular instability (NCVI), including orthostatic hypotension (OH) orthostatic hypertension (OHTN) and impaired blood pressure variability (BPV), have been associated with cardiovascular (CV) events. The eye is highly vascular and we propose an ideal target end organ to investigate pathological implications of NCVI. OBJECTIVE: To identify and define clinically applicable phenotypes of orthostatic blood pressure (BP) behaviour, analogous to OH, OHTN, and orthostatic BPV and to investigate their relationship to vision. METHODS: Wave one data from the Irish Longitudinal Study on Ageing (TILDA) were used. Orthostatic BP (OBP) phenotypes were identified and defined from beat-to-beat BP data, measured by digital photoplethysmography during an active stand (AS) lasting 110 s (s). Visual acuity (VA) was assessed using the Early Treatment Diabetic Retinopathy Study (EDTRS) LogMAR chart. The relationship between OBP phenotypes and VA in 4355 adults aged ≥50 years was investigated through multivariate linear regression models. RESULTS: There was a wide fluctuation in the prevalence of OH and OHTN up to 20 s after standing. After 30 s, four distinct OBP phenotypes were identified: in 70 % BP stabilised to within 20/10 mmHg of baseline BP, 4 % had persistent OH, 2 % had persistent OHTN and 25 % had exaggerated orthostatic blood pressure variability BPV. Systolic BPV was associated with worse VA (P = 0.02) as was diastolic BPV (P = 0.03), following adjustment for demographics, health behaviours, self-report eye diseases and diabetes, uncorrected refractive error, objective hypertension and antihypertensives. CONCLUSIONS: The hypothesis that NCVI may independently modulate CV risk is supported the independent association of exaggerated BPV and worse VA.
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