Kayembe-Mulumba Blondy, Leffondré Karen, Merle Bénédicte M J, Korobelnik Jean-François, Helmer Catherine, Tzourio Christophe, Delcourt Cécile, Cougnard-Grégoire Audrey, Delyfer Marie-Noëlle
University of Bordeaux, INSERM, BPH, U1219, Bordeaux, France.
CHU de Bordeaux, Service d'Ophtalmologie, Université de Bordeaux, Bordeaux, France.
Ophthalmol Sci. 2025 Jul 8;5(6):100878. doi: 10.1016/j.xops.2025.100878. eCollection 2025 Nov-Dec.
Long-term blood pressure variability (BPV) has emerged as a risk factor for various health problems, including eye diseases, independent of blood pressure (BP) levels. Yet, its role in age-related macular degeneration (AMD) progression remains unknown. This study aimed to assess associations between long-term BPV and the risk of AMD.
Prospective analysis of 14-year data from the ALIENOR (Antioxydants, LIpides Essentiels, Nutrition et maladies OculaiRes) study, a French longitudinal population-based cohort study (2006-2020).
The ALIENOR study included 963 participants aged ≥73 years from the Three-City (3C) study in Bordeaux, for an ophthalmic follow-up.
Systolic BPV (SBPV), diastolic BPV (DBPV), and pulse pressure variability (PPV) were determined as the standard deviation of available BP measurements in 3C visits (1999-2017).
Age-related macular degeneration was assessed using retinal color photographs and OCT imaging every 2 years from 2006 to 2020. Shared random effects joint models fitted BPV current values and quantified their effect on AMD onset. The implemented Bayesian approach yielded the mean of adjusted posterior hazard ratios of AMD and their 95% credibility intervals (CrIs).
Of the 692 (median age: 79.0 years; 63.5% female) and 475 (median age: 78.5 years; 61.1% female) at-risk participants, 10% and 36% developed advanced and intermediate AMD, respectively. The hazard of advanced AMD was significantly increased by 54% for a 5-mmHg increase in DBPV (adjusted hazard ratio [aHR]: 1.54, 95% CrI: 1.02-2.44), whereas statistical significance was not reached for a 5-mmHg increase in SBPV (aHR: 1.20, 95% CrI: 0.96-1.51) and PPV (aHR: 1.17, 95% CrI: 0.88-1.54). Conversely, BPV was not significantly associated with intermediate AMD (aHR: 0.96, 95% CrI: 0.83-1.11; aHR: 0.96, 95% CrI: 0.71-1.30; and aHR: 0.92, 95% CrI: 0.77-1.09; for a 5-mmHg increase in SBPV, DBPV, and PPV, respectively).
This study suggested that long-term variability in BP may be associated with an increased risk of advanced AMD, particularly for DBP. These findings underscore the need for further research to confirm this association, explore the underlying mechanisms, and propose potential interventions that could mitigate this risk.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
长期血压变异性（BPV）已成为包括眼部疾病在内的各种健康问题的危险因素，独立于血压（BP）水平。然而，其在年龄相关性黄斑变性（AMD）进展中的作用仍不清楚。本研究旨在评估长期BPV与AMD风险之间的关联。
对来自ALIENOR（抗氧化剂、必需脂质、营养与眼部疾病）研究的14年数据进行前瞻性分析，这是一项基于法国人群的纵向队列研究（2006 - 2020年）。
ALIENOR研究纳入了来自波尔多三城市（3C）研究的963名年龄≥73岁的参与者进行眼科随访。
收缩压变异性（SBPV）、舒张压变异性（DBPV）和脉压变异性（PPV）被确定为3C研究访视（1999 - 2017年）中可用血压测量值的标准差。
从2006年到2020年，每两年使用视网膜彩色照片和光学相干断层扫描（OCT）成像评估年龄相关性黄斑变性。共享随机效应联合模型拟合BPV当前值并量化其对AMD发病的影响。所采用的贝叶斯方法得出AMD调整后后验风险比的均值及其95%可信区间（CrI）。
在692名（中位年龄：79.0岁；63.5%为女性）和475名（中位年龄：78.5岁；61.1%为女性）有风险的参与者中，分别有10%和36%发生了晚期和中期AMD。DBPV每增加5 mmHg，晚期AMD的风险显著增加54%（调整后风险比[aHR]：1.54，95% CrI：1.02 - 2.44），而SBPV增加5 mmHg（aHR：1.20，95% CrI：0.96 - 1.51）和PPV增加5 mmHg（aHR：1.17，95% CrI：0.88 - 1.54）未达到统计学显著性。相反，BPV与中期AMD无显著关联（SBPV、DBPV和PPV每增加5 mmHg时，aHR分别为0.96，95% CrI：0.83 - 1.11；aHR为0.96，95% CrI：0.71 - 1.30；aHR为0.92，95% CrI：0.77 - 1.09）。
本研究表明，血压的长期变异性可能与晚期AMD风险增加有关，尤其是舒张压。这些发现强调需要进一步研究以证实这种关联，探索潜在机制，并提出可能降低这种风险的潜在干预措施。
在本文末尾的脚注和披露中可能会发现专有或商业披露信息。
