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Retina Twenty-four-hour Blood Pressure Monitoring in Central Serous Chorioretinopathy – A Case-control Study Pradeep Venkatesh, 1 Vikas Jain 2 and Satpal Garg 3 1. Additional Professor, Retina Services; 2. Resident; 3. Professor, Retina Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India Abstract Purpose: A case-control study to explore the diurnal variation of blood pressure (BP) in patients with central serous chorioretinopathy (CSCR). Methods: One-hundred patients (50 cases with central serous chorioretinopathy and 50 age- and sex-matched controls) participated in this study. Twenty-four-hour BP was recorded by auscultatory method using manual standard mercury sphygmomanometer by a single, trained observer. Hypertension was categorised according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VII) classification. Results: Mean systolic BP (SBP) and diastolic BP (DBP) in cases and controls were 123.4 mmHg (range 112.3–134.6), 81.72 mmHg (range 73.0–90.5); 118.33 mmHg (range 108.4–128.2); and 77.50  mmHg (range 71.4–83.6), respectively. The difference in SBP and DBP was statistically significant at p=0.02 for the former and p=0.006 for the latter. The mean difference in maximum and minimum SBP in cases was 18 (±15.81) mmHg versus 9.04 (±3.08) mmHg in controls (p=0.001). Mean difference for DBP in cases was 15.16 (±7.86) mmHg versus 9.16 (±3.68) mmHg in controls (0.001). On the JNC-VII classification scale for hypertension, 66 % of cases were found to be pre-hypertensive (60 %) or hypertensive (6 %). Comparative figures for controls were pre-hypertension (30 %) and hypertension (2 %). The mean SBP and DBP was consistently higher in patients with CSCR compared with controls over the entire 24-hour period. The difference in variation between maximum and minimum SBP and DBP was also found to be statistically significant between the groups. Conclusion: A significant correlation exists between higher values BP and central serous chorioretinopathy. Screening of CSCR patients for pre-hypertension may be useful in decreasing the risk of progression to established hypertension, with its associated risks. Keywords Blood pressure, hypertension, central serous retinopathy, case-control study Disclosure: The authors have no conflicts of interest to declare. Received: 20 October 2012 Accepted: 14 March 2013 Citation: European Ophthalmic Review, 2013;7(1):42–4 Correspondence: Pradeep Venkatesh, E-104, AIIMS campus, Ansari Nagar (East), New Delhi-110029, India. E: Hypertension has previously been reported as a possible risk factor for the development of central serous chorioretinopathy (CSCR). In these studies, hypertension was documented retrospectively and based on patient questionnaires or as an incidental finding during the evaluation of sympathetic–parasympathetic nervous system in patients with central serous retinopathy. 1–3 We report herein, for the first time, results of a prospective, case-control study that was designed to address the role of hypertension in CSCR by determining its diurnal variation and comparing with a control group. Methods A total of 100 patients (50 cases with CSCR and 50 age- and sex- matched controls) participated in this study. The study was approved by the Institute Ethics committee, and each subject provided Informed consent before the start of the study. All cases had clinical features of CSCR and this was confirmed by the documentation of active leakage on fluorescein angiography. All patients presented with the first episode and the duration of symptoms ranged from 1 week to 6  weeks. None of these patients had received any treatment prior to enrolment. Those wrongly being treated with corticosteroids prescribed elsewhere were not included in the study. Young adults admitted for vitreoretinal surgery (unilateral retinal detachment or 42 idiopathic vitreous haemorrhage) were chosen as controls. The reason for choosing young patients with the above pathologies as controls was twofold. First, to have a group of patients who were about the same age group in which CSCR tends to occur. Second, to address the possible role of stress-related blood pressure (BP) changes (due to unilateral loss of vision and also from hospital admission ‘white coat hypertension’). Patients with vitreous haemorrhage included in this study did not have any systemic ailment that could have affected the BP. In both groups, patients with known hypertension were not enrolled into the study. No BP evaluation was performed prior to admitting the patients for the study and all measurements were prospectively undertaken. BP was recorded by auscultatory method using standard mercury sphygmomanometer by a single, trained observer (VJ). Subjects were advised to rest for at least 15 minutes before each BP recording and refrain from taking any food or beverages for 2 hours prior to the test. BP was measured at 3 hourly intervals in the right upper arm starting from 10.00 AM to 7.00 AM the next morning. Two readings at 3 minute intervals were taken at each recording, with the patient in supine position and using an appropriately sized cuff. Korotkoff phase 1 was considered as systolic BP (SBP) and phase 5 as diastolic BP (DBP). © Touch ME dical ME dia 2013