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

https://doi.org/10.1016/j.ajo.2014.05.029Get rights and content

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 (I2 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, I2 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, I2 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.

Section snippets

Search Strategy

Our systematic review and meta-analysis was conducted according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines.26 To identify relevant studies, we searched MEDLINE and EMBASE for observational studies investigating the relation of BP or hypertension with POAG, IOP, or ocular hypertension (OHT), with no restrictions on language or publication date. The search period was through April 2013. Keywords included systolic blood pressure, diastolic blood pressure,

Study Characteristics

We identified 60 studies (44 cross-sectional, 9 case-control, and 7 longitudinal cohort studies) that met our inclusion criteria (Figure 1, Supplementary Table 1, available at AJO.com). Twenty-six studies were performed in Asia, 13 in the United States, 9 in Europe, 3 in the West Indies, 3 in Australia, 3 in Canada, 2 in the Middle East, and 1 in Congo. The prevalence of POAG in cross-sectional studies ranged from 0.7% to 9%. The number of studies that presented quantitative estimates and 95%

Discussion

In this comprehensive meta-analysis, hypertension and increased SBP and DBP were consistently associated with increased IOP across published studies. Hypertension was also positively associated with the risk of POAG, although the association was significant in cross-sectional but not in case-control or longitudinal studies. The dose-response relationship between SBP and DBP and the risk of glaucoma was also positive but weak. On the other hand, our findings support a role of increased BP in

Di Zhao, MHS is a PhD student in Epidemiology at the Johns Hopkins University Bloomberg School of Public Health. Her primary interest is in population based chronic disease research and in investigating risk factors associated with intraocular pressure, glaucoma and other eye diseases.

References (53)

  • S. Deokule et al.

    Relationships among systemic blood pressure, intraocular pressure, and open-angle glaucoma

    Can J Ophthalmol

    (2008)
  • A. Hennis et al.

    Hypertension, diabetes, and longitudinal changes in intraocular pressure

    Ophthalmology

    (2003)
  • L. Xu et al.

    Intraocular pressure correlated with arterial blood pressure: the Beijing Eye Study

    Am J Ophthalmol

    (2007)
  • R.-F. Wang et al.

    Effect of CS-088, an angiotensin AT1 receptor antagonist, on intraocular pressure in glaucomatous monkey eyes

    Exp Eye Res

    (2005)
  • J. Flammer et al.

    The impact of ocular blood flow in glaucoma

    Prog Retin Eye Res

    (2002)
  • I. Dielemans et al.

    Primary open-angle glaucoma, intraocular pressure, and systemic blood pressure in the general elderly population. The Rotterdam Study

    Ophthalmology

    (1995)
  • S. Hayreh et al.

    Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders

    Am J Ophthalmol

    (1994)
  • S.L. Graham et al.

    Ambulatory blood pressure monitoring in glaucoma. The nocturnal dip

    Ophthalmology

    (1995)
  • J.E. Grunwald et al.

    Retinal autoregulation in open-angle glaucoma

    Ophthalmology

    (1984)
  • M. Araie et al.

    Use of calcium channel blockers for glaucoma

    Prog Retin Eye Res

    (2011)
  • M.C. Leske et al.

    Predictors of long-term progression in the Early Manifest Glaucoma Trial

    Ophthalmology

    (2007)
  • H. Murgatroyd et al.

    Intraocular pressure

    Contin Educ Anaesth Crit Care Pain

    (2008)
  • M.B. Shields

    The non-contact tonometer. Its value and limitations

    Surv Ophthalmol

    (1980)
  • H.A. Quigley et al.

    The number of people with glaucoma worldwide in 2010 and 2020

    Br J Ophthalmol

    (2006)
  • M. Pakravan et al.

    Central corneal thickness and correlation to optic disc size: a potential link for susceptibility to glaucoma

    Br J Ophthalmol

    (2007)
  • S.-J. Chen et al.

    High myopia as a risk factor in primary open angle glaucoma

    Int J Ophthalmol

    (2012)
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    Di Zhao, MHS is a PhD student in Epidemiology at the Johns Hopkins University Bloomberg School of Public Health. Her primary interest is in population based chronic disease research and in investigating risk factors associated with intraocular pressure, glaucoma and other eye diseases.

    Supplemental Material available at AJO.com.

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