AMD: Antihypertensives Do Not Prevent Neovascularization

Beth Skwarecki

October 01, 2015

Patients with neovascular age-related macular degeneration (AMD) were no more likely than those with dry macular degeneration to have used systemic beta blockers, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin receptor blockers in a single-center retrospective case-control study. The drugs had been hypothesized to protect against neovascularization.

"This case–control study found no protective effect of systemic use of [these drugs] in development of [choroidal neovascularization] in patients with AMD. This is in contrast to regression or inhibition of ocular neovascularization in the reported experimental models," Akshay S. Thomas, MD, and colleagues write in an article published in the October issue of Retina.

This may be because the doses that prevented neovascularization in rodents were many times greater than the dose used to control blood pressure in patients. In addition, the route of administration was intraperitoneal or subcutaneous in the rodents and oral in the patients. Rodent models also use a laser-induced version of neovascularization, which the authors speculate may account for differences.

In the study, investigators examined medical records of 500 randomly selected patients with age-related macular degeneration seen between 2008 and 2013. Half the patients had choroidal neovascularization and half did not. The two groups did not show significant differences in current or past use of systemic beta blockers (P = .57), ACE inhibitors (P = .20), or angiotensin receptor blockers (P = .61). The groups were also similar in their use of multiple medications.

The odds of developing neovascularization were not significantly different for patients who took the medications compared with those who did not, after adjustment for potential confounders. The odds ratio after adjusting for age, sex, smoking status, hypertension, and cardiovascular disease was 0.85 for beta blockers (95% confidence interval, 0.56 - 1.23), 1.30 for ACE inhibitors (95% confidence interval, 0.84 - 2.02), and 0.89 for angiotensin receptor blockers (95% confidence interval, 0.52 - 1.53).

The study only considered the ability of these drugs to prevent and not to treat choroidal neovascularization. The authors also note that they did not examine the duration of use or the specific drugs used.

The authors have disclosed no relevant financial relationships.

Retina. 2015;35:1964-1968. Abstract


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