We synthesized the literature on the association between systemic antihypertensive medications with intraocular pressure (IOP) and glaucoma. Antihypertensive medications included beta blockers (BB), calcium channel blockers (CCB), angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), and diuretics.
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 (PROSPERO registration ID: CRD42022352028).
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 while the 8 studies on glaucoma were primarily longitudinal. In the meta-analysis, BBs were associated with a lower odds of glaucoma (OR = 0.83, 95% CI: 0.75, 0.92, 7 studies, n=219,535) and lower IOP (β = -0.53, 95% CI: -1.05, -0.02, 3 studies, n=28,683). CCBs were associated with a higher odds of glaucoma (OR=1.13, 95% CI: 1.03, 1.24, 7 studies, n=219,535), but not with IOP (β = -0.11, 95% CI: -0.25, 0.03, 2 studies, n=20,620). There were no consistent associations between ACEis, ARBs, or diuretics with glaucoma or IOP.
Systemic antihypertensive medications have heterogenous 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.

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