24 hr BP Fluctuation and Glaucoma

I am healthy but was put on Aceon 4mg/day for essential hypertension in 03/08. Optometrists have told me since my first eye check-up at age 37 that my optic nerves looked "suspicious", but my vision is great.  An opthalmologist told me in Nov '08 that my RNFL's seem to be thinning and I am at risk for glaucoma. I see him again in 6 months. (IOP on Aceon : 16mmHg both eyes; off meds:18 both eyes - both daytime readings.) I have recently changed my lifestyle significantly (diet, weight loss, exercise) and discontinued Aceon under medical supervision a couple of weeks ago.  24 hr ABPM done two days ago shows a wide fluctuation in readings. Highest at 3.30PM: 139/90; lowest at 3.25AM: 96/55. I am allowed to stay off  BP meds under supervision. Question: Does the huge drop in BP at night "starve" my optic nerves of adequate blood supply and cause RNFL thinning? Would the Aceon have caused even more marked nighttime hypotension and worsened the condition? I have a strong family history of HT, early MI and death and will probably need BP meds in future. (Female, age 47 now) This looks like a catch 22 - how can HT and glaucoma be treated if lowering the BP and IOP at night will cause even more harm? Is there a way to "even out " BP and IOP over a 24 hr period by raising BP at night and lowering it during daytime? Without meds, my highest nighttime reading was only 116/68 (just an hour after the 96/55 reading.) I am confused.  

[Sandy Feldman, MD, MS]

Dear Jesse1188,

I would recommend that you seek the care of a glaucoma specialist and/or neuro-ophthalmologist to evaluate your eyes.  

Dr. Feldman

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California