Hypertension, cardiovascular disease, and age-related macular degeneration

Objectives: To describe a case-control study of risk factors for neovascula r and non-neovascular age-related macular degeneration (AMD) and to present findings on associations with systemic hypertension and cardiovascular dis ease. Methods: Participants with and without neovascular and non-neovascular AMD were recruited from 11 ophthalmology practices in the New York, NY, metropo litan area. Comprehensive data collection included (1) a standardized inter view, (2) blood pressure measurements, and (3) blood samples. Cases and con trols were classified from fundus photograph gradings. Polychotomous logist ic regression analyses were used to evaluate associations. Results: Classification of 1222 sets of available photographs resulted in t he inclusion of a neovascular case group (n = 182), a non-neovascular case group (n = 227), and a control group (n = 235). Neovascular AMD was positiv ely associated with diastolic blood pressure greater than 95 mm Hg (odds ra tio [OR] = 4.4),self-reported use of potent antihypertensive medication (OR = 2.1), physician-reported history of hypertension (OR = 1.8), use of anti hypertensive medication (OR = 2.5), combinations of self-reported and physi cian-reported data on hypertension and its treatment (OR = 1.7), high-densi ty lipoprotein level (OR = 2.3), and dietary cholesterol level (OR = 2.2). Non-neovascular AMD was unrelated to hypertension or cholesterol level. No associations were found between either AMD type and other definitions of hy pertension or other cardiovascular disease. Conclusions: These findings suggest that neovascular AMD is associated with moderate to severe hypertension, particularly among patients receiving ant ihypertensive treatment. They also support the hypotheses that neovascular and non-neovascular AMD may have a different pathogenesis and that neovascu lar AMD and hypertensive disease may have a similar underlying systemic pro cess.