Gender as an effect modifier in the relationship between treated hypertension and reticular pseudodrusen in patients with early or intermediate age-related macular degeneration

Abstract

Purpose : To determine whether the prevalence of treated hypertension is higher among males and females with early or intermediate (E/I) age-related macular degeneration (AMD) who also have bilateral reticular pseudodrusen (RPD) or no RPD.

Methods : Patients were recruited into the Colorado AMD registry (July 2014- November 2019) and determined to have E/I AMD using the AMD Ferris criteria and multi-modal imaging. Images were also reviewed for the presence or absence of RPD. Controls were patients presenting for cataract surgery who did not have AMD. Patients were categorized into three groups: 1) E/I AMD with RPD; 2) E/I AMD without RPD; and 3) controls. Treated hypertension was determined via patient interview and medical record review. For the statistical analysis, we used univariate and multinomial logistic regression for adjusted analysis (P<0.05).

Results : There were 260 patients with E/I AMD of which 101 had bilateral RPD and 159 had no RPD. The number of controls was 221. Both E/I AMD groups were older than the controls, 77.4 years for E/I AMD/RPD and 75.4 years for E/I AMD/no RPD versus 72.6 for controls. Overall 62% of patients were female and the three groups did not differ by gender. Treated hypertension was not significantly different across the three groups. When stratified by gender, the female E/I AMD/RPD group had a higher prevalence of hypertension, 64.1% versus 45.2% for controls, OR=2.2 (95%CI: 1.2-4.0). The E/I AMD/no RPD group had a higher prevalence (54.1%) but it did not significantly differ compared to controls, OR=1.4 (95%CI: 0.8-2.4; Table 1). Among males, prevalence rates of treated hypertension did not differ for either E/I AMD group compared to controls. In multivariable analysis, the interaction of treated hypertension and gender was significant for the E/I AMD/RPD group compared to controls (p=0.032) but was not significant for the E/I AMD/no RPD group (p=0.269).

Conclusions : Among females treated hypertension was significantly higher among E/I AMD/RPD patients, and higher but not significantly so for AMD/no RPD patients compared to controls, whereas for males there was no association. Since patients with RPD are at higher risk for advanced AMD, hypertensive disease may be a modifiable risk factor for disease progression, particularly for females.

This is a 2020 ARVO Annual Meeting abstract.

 

Table 1.