Damian McNamara

May 24, 2013

SEATTLE, Washington — Medication to fight hypertension might have the added benefit of lowering the risk for both forms of age-related macular degeneration, according to a large retrospective study.

Angiotensin-converting-enzyme (ACE) inhibitors and beta blockers were associated with the greatest reduction in risk for age-related macular degeneration, Partho Kalyani, MD, a fellow in the Department of Ophthalmology and Visual Sciences at the University of Michigan at Ann Arbor, told Medscape Medical News.

Dr. Kalyani presented the study results here at the Association for Research in Vision and Ophthalmology 2013 Annual Meeting.

Although previous studies have been small, they have suggested an association between these 2 common disorders, he said.

Therefore, Dr. Kalyani and his team assessed all members of a managed care network in the United States who had hypertension, were 55 years and older, and had at least 1 visit to an eye care provider.

An analysis of International Classification of Diseases, 9th Revision billing codes revealed that 28,589 of 416,897 people (6.8%) with systemic arterial hypertension developed incident cases of nonexudative or exudative age-related macular degeneration during the follow-up period.

Treatment with any hypertensive medication at least 20% of the time was associated with a significantly lower risk for age-related macular degeneration.

Table. Relative Risk Reduction With Any Antihypertensive Treatment

Age-Related Macular Degeneration Risk Reduction, % Adjusted Hazard Ratio 95% Confidence Interval P Value
All 17.7 0.833 0.811–0.855 .0001
Nonexudative 18.1 0.829 0.807–0.851 .0001
Exudative 16.0 0.840 0.778–0.906 .0001


"People on beta blockers and ACE inhibitors were most likely to have a reduced risk for dry age-related macular degeneration, the most common form," Dr. Kalyani reported.

On multivariable Cox regression analysis, after adjustment for sociodemographic factors and ocular and medical comorbidities, beta blockers were associated with a 10.4% reduction in the risk for nonexudative age-related macular degeneration, and ACE inhibitors were associated with a 4.3% reduction.

"Some people are on multiple antihypertensives; that is even more beneficial, presumably because of better control," Dr. Kalyani said. However, he added that it might be because "people on multiple medications are at higher risk for age-related macular degeneration in the first place."

Brian VanderBeek, MD, from the Scheie Eye Institute at the University of Pennsylvania in Philadelphia, who was asked by Medscape Medical News to comment on the study, explained that "this suggests that the risk for age-related macular degeneration can be modified with treatment for hypertension, something previously not demonstrated in the literature."

"It also supports current literature that suggests that beta receptors play a role in the pathogenesis of age-related macular degeneration. Beta blockers should be further explored as a preventative medicine for age-related macular degeneration," he noted.

The finding that treatment for hypertension might be beneficial is good news. "Anything to reduce risk is helpful," said Dr. Kalyani.

However, the results of this retrospective study need to be borne out in prospective investigations, he noted. Future studies could look at how the severity of hypertension or the duration of antihypertensive treatment affect risk for age-related macular degeneration.

Although this was a large study, age-related macular degeneration is a multifactorial condition, and the fact that unknown factors, such as exposure to sunlight and tobacco use, were not considered is a potential limitation, Dr. Kalyani acknowledged.

This study was supported by the Beckman Institute for Macular Research, an unrestricted Research to Prevent Blindness grant, a National Eye Institute K23 Mentored Clinician Scientist Award, and a Research to Prevent Blindness Physician Scientist Award. Dr. Kalyani and Dr. VanderBeek have disclosed no relevant financial relationships. Study coauthor David Zacks, MD, reports being an investor in ONL Therapeutics. Study coauthor Joshua Stein, MD, reports holding a patent on a time to next glaucoma test algorithm.

Association for Research in Vision and Ophthalmology (ARVO) 2013 Annual Meeting: Abstract D0093. Presented May 6, 2013.


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