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R. Van Leeuwen, J.R. Vingerling, J.C. Witteman, A. Hofman, P.T. De Jong; Blood Pressure, Atherosclerosis, and Risk of Age-related Maculopathy: The Rotterdam Study . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2110.
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Purpose: To determine whether blood pressure and atherosclerosis are associated with the incidence of age-related maculopathy (ARM). Methods: The study sample consisted of 4822 participants in the population-based Rotterdam Study, who at baseline were 55 years or older, free of ARM, and who participated in at least one follow-up examination. Participants underwent, among others, stereo fundus photography, blood pressure measurements of arm and ankle, carotid ultrasonography, and radiography of the abdominal aorta. ARM was diagnosed according to the International Classification System, and defined as large soft distinct drusen (>63 mm) with pigmentary irregularities, indistinct drusen (>125 mm), reticular drusen, or atrophic or neovascular age-related macular degeneration. Results: After a mean follow-up of 5.2 years, 417 subjects were diagnosed with incident ARM. Increased systolic and diastolic blood pressure, as well as pulse pressure, were associated with a higher risk of ARM. Adjusted for age, gender, and other potential confounders, rate ratios (RR) per 10 mm Hg increase were 1.08 (95% confidence interval (CI) 1.03-1.14), 1.07 (95% CI, 0.97-1.17), and 1.11 (95% CI, 1.04-1.18), respectively. An increase in carotid wall thickness (RR per SD, 1.15 [95% CI 1.03-1.29]), and carotid plaques (RR per plaque, 1.06 [95% CI 0.98, 1.14]) increased the incidence of ARM. Lowest compared to highest tertile of ankle-arm index carried a RR of 1.32 (95% CI, 1.00-1.75). Also, a positive association was found between aortic calcifications and risk of ARM (RR severe compared to no calcifications, 1.39 (95% CI 0.98, 1.98). Conclusions: Elevated systolic and diastolic blood pressure as well as atherosclerosis may increase the risk of ARM.
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