Long-Term Blood Pressure Variability and Risk of Age-Related Macular Degeneration in Older Adults: The ALIENOR Study

IF 4.6 Q1 OPHTHALMOLOGY

Ophthalmology science Pub Date : 2025-07-08 DOI:10.1016/j.xops.2025.100878

Blondy Kayembe-Mulumba MD, MPH , Karen Leffondré PhD , Bénédicte M.J. Merle PhD , Jean-François Korobelnik MD, PhD , Catherine Helmer MD, PhD , Christophe Tzourio MD, PhD , Cécile Delcourt PhD , Audrey Cougnard-Grégoire PhD , Marie-Noëlle Delyfer MD, PhD

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Abstract

Purpose

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.

Design

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).

Participants

The ALIENOR study included 963 participants aged ≥73 years from the Three-City (3C) study in Bordeaux, for an ophthalmic follow-up.

Methods

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).

Main Outcome Measures

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).

Results

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).

Conclusions

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.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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老年人长期血压变异性和年龄相关性黄斑变性的风险：ALIENOR研究

长期血压变异性（BPV）已成为各种健康问题（包括眼病）的危险因素，与血压（BP）水平无关。然而，它在年龄相关性黄斑变性（AMD）进展中的作用仍然未知。本研究旨在评估长期BPV与AMD风险之间的关系。设计前瞻性分析来自法国纵向人群队列研究ALIENOR（抗氧化剂、必需脂质、营养和眼部疾病）研究的14年数据（2006-2020）。ALIENOR研究纳入了963名年龄≥73岁的参与者，他们来自波尔多的三城（3C）研究，进行了眼科随访。方法将收缩期BPV （SBPV）、舒张期BPV （DBPV）和脉压变异性（PPV）作为1999-2017年3C就诊中可用血压测量值的标准差。主要观察指标：从2006年到2020年，每2年使用视网膜彩色照片和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电流值并量化其对AMD发病的影响。实施贝叶斯方法得出AMD的调整后验风险比及其95%可信区间（CrIs）的平均值。结果692例患者中位年龄79.0岁；63.5%女性)和475人(年龄中位数：78.5岁；61.1%（女性），10%和36%分别发展为晚期和中期AMD。DBPV升高5 mmhg，发生晚期AMD的风险显著增加54%（校正风险比[aHR]: 1.54, 95% CrI: 1.02-2.44），而SBPV升高5 mmhg （aHR: 1.20, 95% CrI: 0.96-1.51）和PPV （aHR: 1.17, 95% CrI: 0.88-1.54）未达到统计学意义。相反，BPV与中度AMD无显著相关性(aHR: 0.96, 95% CrI: 0.83-1.11；aHR: 0.96, 95% CrI: 0.71-1.30；aHR: 0.92, 95% CrI: 0.77-1.09；SBPV、DBPV和PPV分别升高5mmhg)。结论：该研究表明，血压的长期变异性可能与晚期AMD的风险增加有关，尤其是舒张压。这些发现强调需要进一步的研究来证实这种关联，探索潜在的机制，并提出可能减轻这种风险的潜在干预措施。财务披露专有或商业披露可在本文末尾的脚注和披露中找到。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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