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

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.