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Could a beta-blocker a day keep glaucoma at bay when choosing systemic antihypertensive medication?

Title of Article: A Systematic Review and Meta-Analysis of Systemic Antihypertensive Medications with Intraocular Pressure and Glaucoma

What are the key takeaway points from this article?

The effects of systemic blood pressure medication on intraocular pressure (IOP) and glaucoma are not well understood with conflicting associations reported in the literature. In this study, five classes of systemic antihypertensive medications were included to determine the association between choice of blood pressure medication and intraocular pressure (IOP) both in individuals with glaucoma and those without a diagnosis of glaucoma or ocular hypertension. A systematic review (11 studies, n=249,295) and meta-analysis (10 studies) were conducted on the most current literature up to December 2022. Medication classes chosen were beta-blockers (BBs), calcium-channel blockers (CCBs), angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), and diuretics.

Findings from the meta-analysis revealed that BBs were associated with both a lower odds of glaucoma (pooled odds ratio [OR]= 0.83, 95% confidence interval [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). Interestingly, CCBs were associated with a higher odds of glaucoma (pooled OR=1.13, 95% CI: 1.03, 1.24, 7 studies, n=219,535) but not with higher IOP (β = -0.11, 95% CI: -0.25, 0.03, 2 studies, n=20,620). There was inconclusive evidence on associations between ACEis, ARBS or diuretics with glaucoma status or IOP.

Though further research, including randomized control trials would be necessary to determine true clinical implications, this study suggests that BBs may be an antihypertensive medication of choice in hypertensive patients that are glaucoma suspects (i.e.., strong family history, increased IOP, optic nerve changes) and that CCBs should be avoided when possible.


Publication Date: March 14, 2023

Reference:

Leung G, Grant A, Garas AN, Li G, Freeman EE. A Systematic Review and Meta-Analysis of Systemic Antihypertensive Medications with Intraocular Pressure and Glaucoma [published online ahead of print, 2023 Mar 24]. Am J Ophthalmol. 2023;S0002-9394(23)00119-8. doi:10.1016/j.ajo.2023.03.014

Summary by: Brooklyn Rawlyk


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