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Angiotensin-converting enzyme inhibitors and risk of age-related macular degeneration in individuals with hypertension
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  • Anuradhaa Subramanian,
  • Diana Han,
  • Tasanee Braithwaite,
  • Rasiah Thayakaran,
  • Dawit Zemedikun,
  • Krishna Gokhale,
  • Wen Lee,
  • Jesse Coker,
  • Pearse Keane,
  • Alastair Denniston,
  • Krishnarajah Nirantharakumar,
  • Laurent Azoulay,
  • Nicola Jaime Adderley
Anuradhaa Subramanian
University of Birmingham College of Medical and Dental Sciences

Corresponding Author:[email protected]

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Diana Han
University of Birmingham College of Medical and Dental Sciences
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Tasanee Braithwaite
Guy's and St Thomas' Hospitals NHS Trust
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Rasiah Thayakaran
University of Birmingham College of Medical and Dental Sciences
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Dawit Zemedikun
University of Birmingham College of Medical and Dental Sciences
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Krishna Gokhale
University of Birmingham College of Medical and Dental Sciences
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Wen Lee
action against age related macular degeneration
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Jesse Coker
action against age related macular degeneration
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Pearse Keane
NIHR Moorfields Biomedical Research Centre
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Alastair Denniston
University of Birmingham College of Medical and Dental Sciences
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Krishnarajah Nirantharakumar
University of Birmingham College of Medical and Dental Sciences
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Laurent Azoulay
MCGill University
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Nicola Jaime Adderley
University of Birmingham
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Abstract

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. 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. During a median follow-up of 2 years (interquartile range 1-5 years), the incidence rate of AMD was 2.4 and 2.2 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).
23 Nov 2021Submitted to British Journal of Clinical Pharmacology
25 Nov 2021Submission Checks Completed
25 Nov 2021Assigned to Editor
05 Jan 2022Reviewer(s) Assigned
04 Mar 2022Review(s) Completed, Editorial Evaluation Pending
06 Mar 2022Editorial Decision: Revise Major
19 Mar 20221st Revision Received
21 Mar 2022Submission Checks Completed
21 Mar 2022Assigned to Editor
21 Mar 2022Review(s) Completed, Editorial Evaluation Pending
28 Mar 2022Reviewer(s) Assigned
04 Apr 2022Editorial Decision: Accept
Sep 2022Published in British Journal of Clinical Pharmacology volume 88 issue 9 on pages 4199-4210. 10.1111/bcp.15366