Angiotensin‐converting enzyme inhibitors and risk of age‐related macular degeneration in individuals with hypertension

Abstract

Aims 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 years 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 Data, a primary care database in the UK. Methods 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 weighted Cox proportional hazards model was used to estimate hazard ratios of developing AMD. Results During a median follow‐up of 2 years (interquartile range 1–5 years), the incidence rate of AMD was 2.4 (95% confidence interval 2.2–2.6) and 2.2 (2.0–2.4) per 1000 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 (adjusted hazard ratio: 1.07 [95% confidence interval 0.90–1.27] and 0.87 [0.71–1.07], respectively). Conclusion We found no evidence that the use of ACE‐I is associated with risk of AMD in patients with hypertension.

Association of sildenafil use with age-related macular degeneration: a retrospective cohort study

“…including metformin, 14 15 angiotensin-converting enzyme (ACE) inhibitors 16 and statins, have been investigated for their pleiotropic effects. 17 Sildenafil serves as a notable example of drug repurposing, having been originally developed as an antihypertensive drug for the pulmonary system and angina before gaining recognition for its efficacy in treating erectile dysfunction (ED).…”

“…In this context, there is a growing interest in the concept of drug repurposing or AMD prevention and treatment 13. Several drugs, including metformin,14 15 angiotensin-converting enzyme (ACE) inhibitors16 and statins, have been investigated for their pleiotropic effects 17…”

Critique of “Angiotensin‐converting enzyme inhibitors reduce community‐acquired pneumonia hospitalization and mortality”

“…Thus, differences in baseline mortality risk between the groups likely remain, despite confounding adjustment. Comparison with another anti-hypertensive (e.g., calcium-channel blockers) [7][8][9] may have better attenuated CBI.…”