Systemic Hypertension as a Risk Factor for Open-Angle Glaucoma: A Meta-Analysis of Population-Based Studies

Abstract

Background/AimsSystemic hypertension is thought to increase the risk for developing open-angle glaucoma (OAG) through several mechanisms. However, previous epidemiological studies have shown conflicting results regarding this potential association. We systematically evaluated this issue by conducting a meta-analysis of population-based studies.MethodsA comprehensive search for articles published before 31 March 2014 was performed using PubMed, Embase, and reference lists. The pooled odds ratio (OR) was calculated using the fixed- and random-effects models, and meta-regression was performed according to age. Subgroup analyses were also conducted, and publication bias was assessed using a funnel plot and Egger’s regression test.ResultsThis meta-analysis included 16 studies involving 60,084 individuals, with substantial homogeneity among the studies. The pooled OR for OAG was 1.22 (95% confidence interval, CI: 1.09–1.36) using the fixed-effects model and 1.22 (95% CI: 1.08–1.37) using the random-effects model in all included studies. For subgroup analyses, the pooled OR for high-tension glaucoma (HTG) was higher than that for normal-tension glaucoma (NTG) (OR = 1.92 and 0.94, respectively). No significant difference was detected between Asian and Western populations, and no publication bias was detected in either analysis.ConclusionsSystemic hypertension increases the risk for developing OAG, especially in those with HTG.

Prevalence of Glaucoma in Type 2 Diabetes Mellitus and Its Relation to Hypertension

“…Systemic hypertension showed a modest positive association with elevated intraocular pressure. 12 In our study, glaucoma was more in diabetic patients with HT. Connection between diabetes and simple glaucoma was observed in 1924 by Grafe.…”

“…10,11 The incidence is more for high-tension glaucoma. 12 Recent studies have also demonstrated that the effects on the visual field due to elevation of intraocular pressure was related to diastolic ophthalmic artery pressure. Systemic hypertension showed a modest positive association with elevated intraocular pressure.…”

Presence and Risk Factors for Glaucoma in Patients with Diabetes

“…The authors of the study postulate that low diastolic blood pressure can lead to decreased ocular perfusion pressures, which is consistent with the vascular hypothesis of glaucomatous optic neuropathy, whereas changes associated with chronic systemic hypertension, such as arteriosclerosis, can also decrease ocular perfusion [181]. A recent meta-analysis of 16 studies found that individuals with systemic hypertension had a pooled odds ratio of 1.2 for the development of glaucoma compared to normotensive individuals [182]. Several studies have, however, shown a positive correlation between IOP and systemic hypertension, particularly elevated systolic blood pressure [80,175,183–189].…”

Increased stroke risk among patients with open-angle glaucoma: a 10-year follow-up cohort study

“…Hypertension and diabetes mellitus are well-known risk factors for stroke 11. Although controversial, several large population-based studies have reported associations between hypertension and OAG12 or between diabetes mellitus and OAG 13. Chronic kidney disease is thought to be a risk factor for OAG, as well as for stroke,14 and there is a higher risk of glaucoma15 and higher intraocular pressure16 among patients with chronic renal failure.…”