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

Anuradhaa Subramanian, Diana Han, Tasanee Braithwaite, Rasiah Thayakaran, Dawit T Zemedikun, Krishna M Gokhale, Wen Hwa Lee, Jesse Coker, Pearse A Keane, Alastair K Denniston, Krishnarajah Nirantharakumar, Laurent Azoulay, Nicola J Adderley

Research output: Contribution to journalArticlepeer-review


AIM: 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 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 database, 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 (SMR) weighted Cox proportional hazards model was used to estimate hazard ratios (HRs) 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% CI 2.2-2.6) and 2.2 (2.0-2.4) per 1,000 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 (aHR: 1.07 (95% CI 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.

Original languageEnglish
JournalBritish Journal of Clinical Pharmacology
Publication statusAccepted/In press - 4 Apr 2022

Bibliographical note

Final Version of Record not yet available as of 10/05/2022.


  • Angiotensin-converting enzyme inhibitors
  • age-related macular degeneration
  • hypertension


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