Purpose: To investigate the relationship between systemic hypertension, ocular perfusion pressure (OPP), and primary open angle glaucoma (POAG) in a tertiary care center in Mandya, India.

Methods: This hospital-based observational study included 60 POAG patients. Blood pressure, intraocular pressure (IOP), and other ocular parameters were measured. Mean ocular perfusion pressure (MOPP) was calculated. The association between hypertension, antihypertensive medication use, and MOPP was analyzed. Correlation and multivariate analyses were performed to identify factors associated with MOPP.

Results: Hypertensive POAG patients had significantly lower MOPP compared to non-hypertensive POAG patients (54.2 ± 5.8 mmHg vs. 60.1 ± 5.6 mmHg, P = 0.001). POAG patients on antihypertensive medication had significantly lower MOPP than those not on medication (55.8 ± 6.1 mmHg vs. 59.4 ± 5.9 mmHg, P = 0.028). MOPP was significantly correlated with systolic blood pressure (r = -0.42, P = 0.001), IOP (r = -0.56, P < 0.001), and cup-to-disc ratio (r = -0.49, P < 0.001). Multivariate analysis identified systolic blood pressure, IOP, cup-to-disc ratio, visual field mean deviation, and antihypertensive medication use as significant factors associated with MOPP.

Conclusion: Systemic hypertension and antihypertensive medication use were associated with lower MOPP in POAG patients. The findings suggest that blood pressure and OPP may play a role in the pathogenesis of POAG and highlight the importance of considering systemic factors in the management of glaucoma patients.