The Association of Blood Pressure and Primary Open-Angle Glaucoma: A Meta-analysis

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 (TOP). The pooled average increase in TOP 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. (C) 2014 by Elsevier Inc. All rights reserved.