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Partho Kalyani, Taylor Blachley, David Zacks, Joshua Stein; Does Treatment of Hypertension Affect the Risk of Developing Macular Degeneration or Disease Progression?. Invest. Ophthalmol. Vis. Sci. 2013;54(15):248.
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Age-related macular degeneration (AMD) is the most common cause of visual loss in the developed world. While, the pathogenesis of AMD remains unclear, hypertension is generally regarded as a risk factor for AMD development. Yet, little is known on the impact of treating hypertension on AMD risk. We studied the effect of treating hypertension on the incidence of non-exudative (NE) and exudative (E) AMD in a large population of patients with systemic arterial hypertension.
Claims data from a United States managed care network were reviewed to identify all persons with hypertension, ≥ 55 years old, who had ≥ 1 visits to an eye provider between 2001 and 2011. International Classification of Disease (ICD-9CM) billing codes were used to identify incident cases of any form of AMD, non-exudative macular degeneration (NE-AMD), exudative macular degeneration (E-AMD), and conversion from NE to E-AMD. Multivariable Cox regression modeling was performed to determine the impact of antihypertensive medication use on hazard of developing different forms of AMD, with adjustment for socio-demographic factors, ocular and medical comorbidities.
Of 416,897 enrollees who met inclusion criteria, there were 28,589 incident cases of NE-AMD (6.8%) and 3,503 cases (0.8%) of E-AMD during the follow-up period. Use of any antihypertensive agent ≥ 20% of time significantly reduced the hazard of developing any form of AMD by 17.7% (adjusted hazard ratio [HR], 0.833; 95% confidence interval [CI], 0.811-0.855), NE-AMD by 18.1% (HR, 0.829; CI, 0.807-0.851), and E-AMD by 16.0% (HR, 0.840; CI, 0.778-0.906) relative to persons with untreated hypertension (p<0.0001 for all comparisons).
In this large cohort of persons with hypertension, use of antihypertensive medications appears to reduce the risk of development of all forms of AMD. Additional analyses are needed to assess the impact of different classes of antihypertensive medications and duration of medication use on AMD risk and how severity of hypertension affects the risk of AMD. Should these findings be confirmed in a prospective trial, they may lead to novel options for the prevention or treatment of AMD.
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