The association of blood pressure and primary open-angle glaucoma: a meta-analysis

Am J Ophthalmol. 2014 Sep;158(3):615-27.e9. doi: 10.1016/j.ajo.2014.05.029. Epub 2014 May 28.


Purpose: To conduct a systematic review and meta-analysis of the association between blood pressure levels and hypertension with primary open-angle glaucoma and intraocular pressure endpoints.

Design: Systematic review with quantitative meta-analysis.

Methods: Studies were identified by searching the PubMed and EMBASE databases. Inverse-variance weighted random-effects models were used to summarize relative risks. Subgroup analyses and meta-regression were used to explore potential sources of heterogeneity across studies.

Results: Sixty observational studies were included. The pooled relative risk for primary open-angle glaucoma comparing patients with hypertension to those without hypertension was 1.16 (95% CI = 1.05-1.28), with modest heterogeneity across studies (I(2) 34.5%). Virtually all studies reported a positive association between blood pressure and intraocular pressure (IOP). The pooled average increase in IOP associated with a 10 mm Hg increase in systolic blood pressure was 0.26 mm Hg (95% CI 0.23-0.28, I(2) 30.7%), and the average increase associated with a 5 mm Hg increase in diastolic blood pressure was 0.17 mm Hg (95% CI 0.11-0.23, I(2) 90.5%).

Conclusions: In this meta-analysis, hypertension was associated with increased intraocular pressure. The association between hypertension and primary open-angle glaucoma was stronger in cross-sectional compared with case-control and longitudinal studies. Our findings support a role of increased blood pressure in elevated intraocular pressure and possibly in the development of glaucoma.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Blood Pressure / physiology*
  • Glaucoma, Open-Angle* / epidemiology
  • Glaucoma, Open-Angle* / etiology
  • Glaucoma, Open-Angle* / physiopathology
  • Global Health
  • Humans
  • Hypertension / complications*
  • Hypertension / physiopathology
  • Incidence
  • Intraocular Pressure
  • Risk Factors