Chronic Hypertension and Conversion from Intermediate Age-Related Macular Degeneration (iAMD) to the Advanced Phenotypes

Purpose To assess the relationship between chronic hypertension (cHTN) and progression from intermediate age-related macular degeneration (iAMD) to geographic atrophy (GA) and neovascular AMD (NVAMD).Methods We examined the records of iAMD patients recruited to the University of Colorado AMD Registry (July 2014 – June 2024). cHTN was self-reported at enrollment and confirmed by review of the Electronic Health Record (EHR). Number of prescribed antihypertensive medication classes was also collected. Conversion to GA and NVAMD was assessed through November 2024 with multi-modal imaging for each eye. Cox proportional hazards models with sandwich estimators were used to assess time to conversion.Results We studied 900 eyes from 450 iAMD patients, of which 115 eyes (12.8%) converted to GA and 74 eyes (8.2%) converted to NVAMD. Neither measure of hypertension was associated with conversion to GA. In univariate analysis, patients with cHTN were at a 1.81 (95% CI: 1.06, 3.06, p = 0.029) times greater risk of conversion to NVAMD and were at a 1.30 (95% CI: 1.05, 1.62, p = 0.019) times greater risk of conversion to NVAMD for each additional antihypertensive medication class prescribed. In a body mass index (BMI) stratified analysis, the two measures of cHTN were associated with an elevated risk of conversion among overweight/obese patients (BMI ≥ 25 kg/m2) but not underweight/healthy patients (BMI < 25 kg/m2).Conclusions cHTN and antihypertensive medication class count were associated with conversion to NVAMD. BMI may be an effect modifier in the relationship between cHTN and progression from iAMD to NVAMD.