Angiotensin-converting enzyme inhibitors and risk of age-related macular
degeneration in individuals with hypertension
Abstract
Several observational studies have examined the potential protective
effect of angiotensin-converting enzyme inhibitor (ACE-I) use on the
risk of age-related macular degeneration (AMD) and have reported
contradictory results owing to confounding and time-related biases. We
aimed to assess the risk of AMD in a base cohort of patients aged 40 and
above with hypertension among new users of ACE-I compared to an active
comparator cohort of new users of calcium channel blockers (CCB) using
data obtained from IQVIA Medical Research database, a primary care
database in the UK. In this study, 53,832 and 43,106 new users of ACE-I
and CCB were included between 1995 and 2019, respectively. In an
on-treatment analysis, patients were followed up from the time of index
drug initiation to the date of AMD diagnosis, loss to follow-up,
discontinuation or switch to the comparator drug. A comprehensive range
of covariates were used to estimate propensity scores to weight and
match new users of ACE-I and CCB. Standardized mortality ratio (SMR)
weighted Cox proportional hazards model was used to estimate hazard
ratios (HRs) of developing AMD. During a median follow-up of 2 years
(interquartile range 1-5 years), the incidence rate of AMD was 2.4 and
2.2 per 1,000 person-years among the weighted new users of ACE-I and
CCB, respectively. There was no association of ACE-I use on the risk of
AMD compared to CCB use in either the propensity score weighted or
matched, on-treatment analysis (aHR: 1.07 (95% CI 0.90-1.27) and 0.87
(0.71-1.07) respectively).