Systemic antihypertensive medications exert diverse effects on glaucoma, IOP

The effects of systemic antihypertensive medications on glaucoma and intraocular pressure (IOP) appear to vary widely, according to the results of a systematic review and meta-analysis.

Multiple online databases were searched for studies on systemic antihypertensive medications, such as beta blockers (BB), calcium channel blockers (CCB), angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), and diuretics.

The inclusion criteria were studies in which the following were assessed: 1) the association between systemic antihypertensive medications with glaucoma or 2) the association between systemic antihypertensive medications with IOP in those without glaucoma or ocular hypertension.

A total of 11 studies met the criteria and were included in the review, and 10 studies were included in the meta-analysis. The three studies on IOP had a cross-sectional design, while the eight studies on glaucoma were longitudinal.

Pooled data showed that BBs were associated with lower odds of glaucoma (odds ratio [OR], 0.83, 95 percent confidence interval [CI], 0.75–0.92; seven studies, n=219,535) and an IOP-lowering effect (β, –0.53, 95 percent CI, –1.05 to –0.02; three studies, n=28,683).

Meanwhile, CCBs showed an association with higher odds of glaucoma (OR, 1.13, 95 percent CI, 1.03 to 1.24; seven studies, n=219,535) but not with IOP (β, –0.11, 95 percent CI, –0.25 to 0.03; two studies, n=20,620).

No consistent associations were seen between ACEis, ARBs, or diuretics and glaucoma or IOP.

The findings suggest that systemic antihypertensive medications may mask elevated IOP or positively or negatively affect the risk of glaucoma.