Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
The School of Immunology and Microbial Sciences and The School of Life Course Sciences, Kings College London, London, UK.
Br J Clin Pharmacol. 2022 Sep;88(9):4199-4210. doi: 10.1111/bcp.15366. Epub 2022 May 11.
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.
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.
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).
We found no evidence that the use of ACE-I is associated with risk of AMD in patients with hypertension.
几项观察性研究已经研究了血管紧张素转换酶抑制剂（ACE-I）的使用对年龄相关性黄斑变性（AMD）风险的潜在保护作用，并由于混杂和时间相关的偏倚，得出了相互矛盾的结果。我们旨在通过英国初级保健数据库 IQVIA Medical Research Data 中的数据，评估在高血压新 ACE-I 使用者与钙通道阻滞剂（CCB）新使用者的基础队列中，与 ACE-I 相比，新使用者患 AMD 的风险。
在这项研究中，分别纳入了 1995 年至 2019 年期间使用 ACE-I 和 CCB 的 53832 名和 43106 名新使用者。在治疗期间分析中，患者从起始指数药物开始至 AMD 诊断、失访、停药或转换为比较药物的日期进行随访。使用综合的协变量来估计 ACE-I 和 CCB 新使用者的倾向评分以进行加权和匹配。标准化死亡率比加权 Cox 比例风险模型用于估计发展为 AMD 的风险比。
在中位随访 2 年（四分位距 1-5 年）期间，加权 ACE-I 和 CCB 新使用者的 AMD 发生率分别为 2.4（95%置信区间 2.2-2.6）和 2.2（2.0-2.4）/1000 人年。在倾向评分加权或匹配的治疗期间分析中，ACE-I 与 CCB 相比，ACE-I 的使用与 AMD 风险无关联（调整后的风险比：1.07 [95%置信区间 0.90-1.27]和 0.87 [0.71-1.07]）。
我们没有发现 ACE-I 的使用与高血压患者 AMD 风险相关的证据。
