Long-Term Blood Pressure and Age-Related Macular Degeneration: The ALIENOR Study

Abstract

PURPOSE.To explore the association of AMD with long-term average blood pressure (BP) parameters, including pulse pressure (PP). METHODS.The ALIENOR study is a population-based study on age-related eye diseases in 963 residents of Bordeaux, France, aged 73 years or older. AMD was graded from nonmydriatic color retinal photographs, in three exclusive stages: no AMD (1015 eyes), large soft distinct drusen and/or large soft indistinct drusen and/or reticular drusen and/or pigmentary abnormalities (early AMD, 276 eyes), and late AMD (66 eyes). BP parameters were measured at four occasions over a 7-year period. PP was defined as systolic BP minus diastolic BP. Associations of AMD with BP parameters were estimated using generalized estimating equation logistic regressions. Statistical analyses included 702 subjects (1357 eyes) with complete data. RESULTS.After adjustment for age, sex, educational level, smoking, body mass index, plasma HDL and LDL cholesterol, CFH Y402H, ApoE2, ApoE4, and ARMS2 A69S polymorphisms, elevated PP was significantly associated with an increased risk of late AMD (odds ratio [OR] ¼ 1.37 for a 10-mm Hg increase, 95% confidence interval [CI]: 1.03-1.82). Associations were similar for late atrophic and late neovascular AMD (OR ¼ 1.39, 95% CI: 1.01-1.92, P ¼ 0.04, and OR ¼ 1.43, 95% CI: 0.90-2.23, P ¼ 0.13, respectively). Association with early AMD was in the same direction but did not reach statistical significance (OR ¼ 1.12, 95% CI: 0.98-1.28). Early and late AMD were not significantly associated with systolic or diastolic BP, hypertension, or use of antihypertensive medications.CONCLUSIONS. This study suggests that high PP may be associated with increased risk for AMD. (Invest Ophthalmol Vis Sci. 2013;54:1905-1912) DOI:10.1167/iovs.12-10192 A ge-related macular degeneration (AMD) is the leading cause of visual impairment and blindness in the elderly in North America and other Western countries. 1 The resulting loss of vision is associated with significant limitations in activities of daily living, while life expectancy is still increasing. AMD is a multifactorial disease, resulting from both nonmodifiable factors (age, sex, genetic susceptibility) and modifiable factors (smoking, nutrition). The control of these modifiable factors may represent a preventive means to reduce its incidence. Among these factors, cardiovascular risk factors, including smoking, 3-9 abdominal obesity, 4,7,10,11 and blood pressure (BP), 12-18 have received much attention for their potential role in the development and progression of AMD. However, except for smoking, epidemiological studies have reported conflicting results, particularly for BP, as some studies [13][14][15][16][17][18] found associations between higher risk of AMD and elevated blood pressure, while others did not. 7,8,10,[19][20][21][22][23] Studies that explored the impact of BP on cardiovascular diseases have demonstrated that long-term average BP is a better determinant of risk for cardiovascular disease events, 24,25 as the effect of high BP seems...

Essential hypertension in the pathogenesis of age-related macular degeneration

“…Neither PP nor HTN was associated with progression of AMD Cougnard-Gregoire et al [48] Prospective, population-based 963 7 Elevated PP associated with an increased risk of late AMD. No association for HTN, SBP or DBP.…”

“…Paradoxically, however, the latter study found that pulse pressure was associated with higher risks of incidence of early AMD. The Antioxydants, Lipides Essentiels, Nutrition et maladies OculaiRes (ALIENOR) study was a population-based study of age-related eye diseases in 963 residents of Bordeaux, France, aged 73 years or older [48]. In that study, elevated pulse pressure was significantly associated with an increased risk of late AMD.…”

“…Furthermore, from a substudy that investigated the association between a history of vasodilator and blood pressure-lowering drug use and the incidence and progression of early and late AMD, it emerged that oral nitroglycerin (HR, 1.81; 95% CI, 1.14-2.90) was associated with an increased risk of early AMD, whereas oral b-blocking agents treatment was associated with an increased risk of incident exudative AMD [hazard ratio (HR), 1.71; 95% CI, 1.04-2.82], but not pure geographic atrophy (HR, 0.51; 95% CI, 0.20-1.29) or AMD progression (HR, 0.92; 95% CI, 0.67-1.28) over a 20-year period Table 2 [33,34,37,38,40,41,[43][44][45][46][47][48][49][50]58]. The mechanisms leading to the above observations are not easy to understand, especially when we consider that vasoconstriction of the retinal and choroidal vessels seems to be involved in the pathogenesis of AMD, while vasodilators have been used to resolve the vasoconstriction.…”

No Clinically Significant Association between CFH and ARMS2 Genotypes and Response to Nutritional Supplements

“…Epidemiological studies have revealed the exponential increase in prevalence of AMD with age, an increase in risk conferred by smoking, a protective effect of fatty fish and green leafy vegetable consumption, and a less consistent association with body mass index and hypertension. 3,4,5,6,7,8,9 Genetic studies have identified 19 susceptibility loci that appear to explain over 50% of the risk of developing AMD. 10 These studies point to biological pathways that may contribute to AMD pathogenesis; these include alternative complement activation, high density lipoprotein cholesterol transport and metabolism, extracellular matrix integrity and cell adhesion, and angiogenesis.…”

Epidemiology of age-related macular degeneration (AMD): associations with cardiovascular disease phenotypes and lipid factors

“…The BDES [109] observed significant associations of higher systolic blood pressure with RPE depigmentation and neovascular AMD as well as higher pulse pressure with RPE depigmentation, retinal hyperpigmentation, neovascular AMD, and progression of AMD. Cougnard-Grégoire et al [145] reported a significant association between elevated pulse pressure and risk of late AMD in the Antioxydants, Lipids Essentiels, Nutrition et maladies OculaiRes (ALIENOR) study in a French population. Yang et al [126] reported that rural Chinese subjects with untreated hypertension had increased risk of early AMD.…”