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Exp Gerontol. 2019 Jan 22;119:14-24. doi: 10.1016/j.exger.2019.01.009. [Epub ahead of print]

Orthostatic blood pressure variability is associated with lower visual contrast sensitivity function: Findings from The Irish Longitudinal Study on Aging.

Author information

1
Department of Medical Gerontology, School of Medicine, Trinity College Dublin, The University of Dublin, Old Stone Building, Trinity Centre for Health Sciences, St James's Hospital, James's Street, Dublin 8, Ireland. Electronic address: nibhuacb@tcd.ie.
2
The Irish Longitudinal Study on Aging (TILDA), Lincoln Gate, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland. Electronic address: Christine.McGarrigle@tcd.ie.
3
The Irish Longitudinal Study on Aging (TILDA), Lincoln Gate, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland. Electronic address: olearyne@tcd.ie.
4
Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. Electronic address: akuffokwadwoowusu@knust.edu.gh.
5
Head of Reading Centre, 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, United Kingdom. Electronic address: Tunde.Peto@moorfields.nhs.uk.
6
Macular Pigment Research Group, Vision Research Centre, Carriganore House, Waterford Institute of Technology, Waterford, Ireland. Electronic address: sbeatty@wit.ie.
7
Department of Medical Gerontology, School of Medicine, Trinity College Dublin, The University of Dublin, Old Stone Building, Trinity Centre for Health Sciences, St James's Hospital, James's Street, Dublin 8, Ireland; The Irish Longitudinal Study on Aging (TILDA), Lincoln Gate, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland. Electronic address: rkenny@tcd.ie.

Abstract

BACKGROUND:

Hypertension is established to cause vascular end-organ damage. Other forms of dysregulated blood pressure (BP) behaviour, such as orthostatic hypotension have also been associated with cardiovascular (CV) events. The eye is potentially vulnerable to dysregulated systemic BP if ocular circulation autoregulation is impaired. We investigated whether phenotypes of abnormal BP stabilisation after orthostasis, an autonomic stressor, had a relationship with contrast sensitivity (CS), an outcome measure of subtle psychophysical visual function.

METHODS:

This was a cross-sectional study from wave 1 of The Irish Longitudinal Study on Ageing (TILDA). From beat-to-beat orthostatic BP (BP), measured by digital photoplethysmography during active stand, 4 phenotypes have been defined 1) normal stabilisation 2) orthostatic hypotension, 3) orthostatic hypertension 4) BP variability. Contrast sensitivity was measured using a Functional Visual Analyzer. Multivariable linear regression models investigated the relationship between orthostatic BP phenotypes and contrast sensitivity in 4289 adults aged ≥50 years adjusting for, demographics, cardiovascular risk factors, self-reported eye pathologies, objective hypertension and antihypertensives. A sensitivity analysis adjusted for age-related macular degeneration, glaucoma, diabetic retinopathy and maculopathy identified on retinal photographs. Finally models were compared, adjusting for alternative measures of cataract versus not, to examine the potential effect of cataract on any associations.

RESULTS:

Systolic orthostatic BP variability was associated with worse contrast sensitivity, in the primary and the sensitivity analysis. Adjusting for alternative measures of clinical cataract attenuated the association by 18%.

CONCLUSIONS:

Orthostatic BP variability is associated with worse contrast sensitivity, independent of hypertension and retinal pathology and may be a cardiovascular biomarker of early ocular pathology.

KEYWORDS:

Blood pressure variability; Contrast sensitivity; End-organ damage; Eye; Orthostatic hypertension; Orthostatic hypotension

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