Renin-Angiotensin System Inhibitor Usage and Age-Related Macular Degeneration among Hypertensive Patients: Results from the National Health and Nutrition Examination Survey, 2005-2008.

Chi Ren,Peirong Lu,Bingyu Zhang,Weiming Liu,Xue Yin

doi:10.1155/2020/4252031

Abstract

Purpose To assess whether renin-angiotensin system inhibitor (RASI) utilization is associated with age-related macular degeneration (AMD) prevalence among hypertensive patients. Methods A US population-based, cross-sectional study was conducted. 3,023 hypertensive participants aged 40 years and older with gradable retinal images and ascertained RASI usage in the National Health and Nutrition Examination Survey (NHANES), 2005–2008, were finally enrolled into the study. RASI usage was obtained by interview, and AMD was determined through retinal image assessment. We performed multivariable analyses to assess the relationship between utilization of RASIs and AMD prevalence. We also took drug treatment duration into account, in order to better understand the effects of RASIs. Results Multivariable logistic regression analyses revealed that AMD prevalence had no significant association with RASI usage but was inversely correlated with RASI treatment duration (odds ratio (OR) = 0.87, 95% confidence interval (CI) = 0.78–0.98, p=0.02). Long-term usage (>5 years) of RASIs was significantly associated with not only reduced overall risk of AMD (OR = 0.23, 95% CI = 0.14–0.38, p < 0.001) but also lower propensity to have early (OR = 0.23, 95% CI = 0.14–0.37, p < 0.001) and late (OR = 0.25, 95% CI = 0.07–0.87, p=0.03) AMD. Furthermore, long-term RASI users were less prone to develop soft drusen (OR = 0.67, 95% CI = 0.45–0.99, p=0.04) and geographic atrophy (GA) (OR = 0.39, 95% CI = 0.22–0.71, p=0.003). Conclusions Evidence supporting that RASI utilization could directly protect against AMD in hypertensive patients was still insufficient, but long-term RASI treatment seemed to be beneficial for both early and late AMD, implicating a promising therapeutic approach that RASIs might offer for AMD prevention and management.

Highlights

Age-related macular degeneration (AMD) is a major cause of visual impairment and blindness among elderly people in developed countries [1], accounting for more than 50% of blindness in white population aged 40 years and older in the US [2]
Since the previous assessments only included the data obtained at one time point, without considering the potential cumulative effects of time, we investigated whether different renin-angiotensin system inhibitor (RASI) treatment duration would make any difference among RASI users, but we did not test the longterm effect according to the type of RASI because of limited sample size
Based on the data from the National Health and Nutrition Examination Survey (NHANES), 2005–2008, there was insufficient evidence for determining the association between RASI usage and AMD prevalence, we found a less tendency of long-term RASI users to develop both early and late AMD, especially soft drusen and geographic atrophy (GA)

Summary

Introduction

Age-related macular degeneration (AMD) is a major cause of visual impairment and blindness among elderly people in developed countries [1], accounting for more than 50% of blindness in white population aged 40 years and older in the US [2]. It is well known that odds of AMD increase sharply as age increases, and with prolonged average lifespan expectancy, the prevalence of visual disability caused by AMD is projected to increase drastically [1, 3, 4], appealing for plenty of attention in the literature. Apart from that, hypertension is involved as a risk factor for AMD [5, 12], multiplying the difficulties in developing efficient AMD treatment approaches for hypertensive patients. A variety of agents are approved for AMD (mainly for wet AMD) treatment, their therapeutic effects are limited and vision loss prevention is still challenging [13]

Methods

Results

Conclusion