Hypoperfusion of the optic nerve might be involved in the pathogenesis of normal-tension glaucomatous optic neuropathy (GON). Mean arterial pressure (MAP) drives ocular perfusion, but no previous studies have addressed the risk of GON in relation to blood pressure (BP) variability, independent of BP level. In a cross-sectional study, 93 residents of Maracaibo, Venezuela, underwent optical coherence tomography, visual field assessments and 24-h ambulatory BP monitoring between 2011 and 2016. We investigated the association of normal-tension GON with or without visual field defects with reading-to reading variability of 24-h MAP, as captured by variability independent of the MAP level (VIM_map). Odds ratios (ORs) were adjusted for 24-h MAP level and for a propensity score of up to five risk factors. Among the 93 participants (87.1% women; mean age, 61.9 years), 26 had open-angle normal-tension GON at both eyes; 14 had visual field defects; and 19 did not have visual field defects. The OR ratios for normal-tension GON, expressed per 1-SD increment in VIM_map (2 mm Hg), were 2.17 (95% confidence interval, 1.33–3.53) unadjusted; 2.20 (1.35–3.61) adjusted for 24-h MAP level only; 1.93 (1.10–3.41) with additional adjustment for age, educational attainment, high-density lipoprotein (HDL) cholesterol and office hypertension; and 1.95 (1.10–3.45) in models including intraocular pressure. We confirmed our a priori hypothesis that BP variability, most likely operating via hypoperfusion of the optic nerve, is associated with normal-tension GON. 24-H ambulatory BP monitoring might therefore help stratify the risk of normal-tension GON.

视神经灌注不足可能与正常眼压性青光眼性视神经病变 (GON) 的发病机制有关。平均动脉压 (MAP) 驱动眼部灌注，但以前没有研究表明 GON 与血压 (BP) 变异性相关的风险，与血压水平无关。在一项横断面研究中，委内瑞拉马拉开波的 93 名居民在 2011 年至 2016 年期间接受了光学相干断层扫描、视野评估和 24 小时动态血压监测。我们调查了正常张力 GON 伴或不伴视野缺损与24 小时 MAP 的读数到读数的变异性，由独立于 MAP 水平的变异性捕获（VIM_图）。优势比 (OR) 针对 24 小时 MAP 水平和多达五个风险因素的倾向评分进行了调整。在 93 名参与者中（87.1% 为女性；平均年龄为 61.9 岁），26 名双眼有开角正常张力 GON；14 人有视野缺损；19 人没有视野缺损。正常张力 GON 的 OR 比，在 VIM_{图中以每 1-SD 增量表示}（2 mm Hg），未经调整为 2.17（95% 置信区间，1.33-3.53）；2.20 (1.35–3.61) 仅针对 24 小时 MAP 水平进行调整；1.93 (1.10–3.41) 额外调整年龄、教育程度、高密度脂蛋白 (HDL) 胆固醇和诊室高血压；在包括眼压在内的模型中为 1.95 (1.10–3.45)。我们证实了我们的先验假设，即最有可能通过视神经灌注不足的血压变异性与正常张力 GON 相关。因此，24 小时动态血压监测可能有助于对正常血压 GON 的风险进行分层。