Long-Term Use of β-Blockers May Lower Risk of AMD Development

An analysis of the National Health and Nutrition Examination Survey (NHANES) suggests long-term treatment with β-blockers was associated with a lower risk of developing age-related macular degeneration (AMD) among patients with hypertension.¹

The research indicates non-selective oral β-blockers had a beneficial effect against the risk of late-stage AMD, but investigators could not confirm the same outcome in a population with geographic atrophy (GA).

“Even though a significant protective effect of the long-term use of β-blockers against GA was found, due to the limited number of cases of GA in the NHANES database, the outcome cannot be considered reliable,” wrote the investigative team. “However, this result may provide the basis for the future clinical use of β-blockers and may guide future treatment strategies for patients with AMD.”

The team, led by Professor Haihua Zheng, Department of Ophthalmology, The Second Affiliated Hospital of Wenzhou Medical University, investigated the association between different types of β-blockers and the risk of developing different stages of AMD, due a lack of previously reported data on this association.

The NHANES database included retinal examinations from two cycles (2005 - 2006 and 2007-2008). The database classified AMD into no AMD, early-stage AMD, and late-stage AMD, with any GA or exudative neovascularization in the retinal examination defined as late-stage AMD.

A self-reported prescription questionnaire identified the use of β-blockers, with the duration of use obtained into four quartiles (First quartile, ≤2 years; Second quartile, 2 - 4 years; Third quartile, 4 - 6 years; fourth quartile >6 years). Multivariate-adjusted survey-weighted univariate logistic regression was used to confirm the association between the use of β-blockers and the risk of developing AMD.

A total of 3,311 participants were enrolled in the present study. Upon analysis, data showed a significant correlation between the use of β-blockers and risk of developing AMD, but the correlation was attenuated following multivariate adjustment.

However, in the multivariate adjusted model, results suggest the use of β-blockers had a beneficial effect (odds ratio [OR], 0.34; 95% confidence interval [CI], 0.13 – 0.92; P = .04) against late-stage AMD. When classified into non-selective and selective β-blockers, the protective effect in late-stage AMD was still observed in the non-selective β-blockers (OR, 0.20; 95% CI, 0.07 – 0.61; P <.001), according to the data. There was no significant association observed with selective β-blockers.

When compared to patients not on β-blocker treatment, a decreased risk of developing AMD was only found in the last quartile of β-blockers treatment duration (OR, 0.65; 95% CI, 0.43 – 0.98; P = .04). Only the fourth quartile of β-blocker treatment duration exhibited a significant association with the risks of late-stage AMD compared with non-users (OR, 0.13; 95% CI, 0.03 – 0.63; P = .01).

As previous assessments only focused on nAMD without considering GA and early stage-AMD, the long-term use of β-blockers was investigated to determine its influence on different subtypes. The findings suggested there was no association between long-term use of β-blockers and two subtypes of early-stage AMD. Meanwhile, in late-stage AMD, the long-term use of β-blockers was a protective factor for GA (OR, 0.07; 95% CI, 0.02 – 0.28; P <.001).

Investigators noted that while the findings suggest the long-term use of β-blockers is protective against AMD risk among hypertensive patients, further validation is required.

“However, the outcomes obtained need to be further validated in completely randomized or multi-center clinical trials involving the use of β-blockers and GA,” they wrote.

References

1. Luo Y, Liu J, Feng W, et al. Use of β‑blockers and risk of age‑related macular degeneration among hypertensive patients: An insight from The National Health and Nutrition Examination Survey. Med Int (Lond). 2023;3(1):10. Published 2023 Jan 30. doi:10.3892/mi.2023.70