A Systematic Review and Meta-analysis of Systemic Antihypertensive Medications With Intraocular Pressure and Glaucoma

source extracted confidence: high 2026-04-09
#humans #antihypertensive-agents #intraocular-pressure #glaucoma #ocular-hypertension

A Systematic Review and Meta-analysis of Systemic Antihypertensive Medications With Intraocular Pressure and Glaucoma

Leung et al., 2023 | Am J Ophthalmol | Meta Analysis

Citation

Leung Gareth, Grant Alyssa, ... Freeman Ellen E. A Systematic Review and Meta-analysis of Systemic Antihypertensive Medications With Intraocular Pressure and Glaucoma. Am J Ophthalmol. 2023-Nov;255:7-17. doi:10.1016/j.ajo.2023.03.014

Abstract

PURPOSE: We synthesized the literature on the association between systemic antihypertensive medications with intraocular pressure (IOP) and glaucoma. Antihypertensive medications included β-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and diuretics. DESIGN: Systematic review and meta-analysis. METHODS: Databases were searched for relevant articles until December 5, 2022. Studies were eligible if they examined (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. The protocol was registered at PROSPERO (International Prospective Register of Systematic Reviews; registration ID: CRD42022352028). RESULTS: A total of 11 studies were included in the review and 10 studies in the meta-analysis. The 3 studies on IOP were cross-sectional, whereas the 8 studies on glaucoma were primarily longitudinal. In the meta-analysis, β-blockers were associated with a lower odds of glaucoma (odds ratio: 0.83, 95% CI: 0.75-0.92, 7 studies, n = 219,535) and lower IOP (β: -0.53, 95% CI: -1.05 to -0.02, 3 studies, n = 28,683). Calcium channel blockers were associated with a higher odds of glaucoma (odds ratio: 1.13, 95% CI: 1.03-1.24, 7 studies, n = 219,535) but not with IOP (β: -0.11, 95% CI: -0.25 to 0.03, 2 studies, n = 20,620). There were no consistent associations between angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or diuretics with glaucoma or IOP. CONCLUSIONS: Systemic antihypertensive medications have heterogeneous effects on glaucoma and IOP. Clinicians should be aware that systemic antihypertensive medications may mask elevated IOP or positively or negatively affect the risk of glaucoma.

Key Findings

A total of 11 studies were included in the review and 10 studies in the meta-analysis. The 3 studies on IOP were cross-sectional, whereas the 8 studies on glaucoma were primarily longitudinal. In the meta-analysis, β-blockers were associated with a lower odds of glaucoma (odds ratio: 0.83, 95% CI: 0.75-0.92, 7 studies, n = 219,535) and lower IOP (β: -0.53, 95% CI: -1.05 to -0.02, 3 studies, n = 28,683). Calcium channel blockers were associated with a higher odds of glaucoma (odds ratio: 1.13, 95

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size 219535
Age Range See abstract
Condition hypertension

MeSH Terms

  • Humans
  • Antihypertensive Agents
  • Intraocular Pressure
  • Glaucoma
  • Ocular Hypertension
  • Tonometry, Ocular
  • Angiotensin-Converting Enzyme Inhibitors

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Systematic Review, Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't
  • Vertical: calcium

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09