The aim of the study was to evaluate the relationship between blood pressure (BP), ocular perfusion pressure (OPP) and occurrence of primary open-angle glaucoma (POAG) among patients with systemic hypertension.A cross-sectional study of hypertensive patients was conducted in six cities in Colombia. The participants underwent a complete ophthalmological examination. The intraocular pressure measurement was obtained by Goldmann tonometry. The diagnosis of glaucoma was confirmed by visual field and optic nerve photos. Interviews and questionnaires were used to evaluate participants' lifestyle and other health conditions. A multinomial logistic regression was used to assess the relationship between BP, OPP and presence of suspected or confirmed POAG.A total of 1,272 individuals were included in this study; 131 (10.3%) were diagnosed with suspected glaucoma and 65 (5.1%) with confirmed glaucoma. High values of diastolic BP (>90 mmHg) and low values of OPP (<40 mmHg) were associated to an increased risk of confirmed POAG. The type of antihypertensive treatment did not modify these relationships.This study suggests that there is a close relationship between OPP and confirmed glaucoma in hypertensive patients, providing further evidence of the vascular mechanism in glaucoma pathogenesis.