EASDEC European Association for the Study of Diabetic Eye Complications

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Abstracts: Wold

E. Wold and S-A. Johnsen.

Department of Ophthalmology and Internal Medicine, Boras Hospital, Sweden.

Middle term effect of an ACE-inhibitor on progression of diabetic retinopathy.

Purpose

To compare the effect of ACE-inhibition and conventional therapy (Ca channel blockers and beta blockers) on the progression of diabetic retinopathy in patients with microalbuminuria.

Method

In a controlled, randomised parallel-design clinical trial 80 IDDM patients with and without hypertension and with microalbuminuria were included. Target mean arterial blood pressure was < 95 mmHg.. Fundus photographs were taken from three areas from each eye at baseline and yearly, and assessed according to the EURODIAB-grading system. Patients with macroalbuminuria and those who could not show progression were excluded.

Results

Eligible were 29 patients in the captopril and 30 in the control group. Mean age and diabetes duration was equal in both groups. Follow up time was 6 years.
Mean HbA1c during the study was 7,3% in both groups. Mean arterial blood pressure was during the whole follow up time below target pressure ( 95 mmHg) in both groups with no significant difference. Mean 92 in the captopril and 93 in the conventional treatment group. Median follow up time was 5 years in both groups.

Our main result is that the retinopathy progressed equally in the two groups and the progression levels out after 4 Years of treatment in both groups. There was a progress by at least one level in the worst eye from baseline to the final follow up in 14 (48%) in the captopril and in 12 (40%) in the control group (ns).
We then analysed the whole material to see if a history of hypertension influenced the progression of retinopathy. The patients with antihypertensive treatment before randomisation have a more pronounced progression (p=O,001).The progress levels out after four years of treatment in both groups.

Conclusion

There is no difference in the progression of diabetic retinopathy in patients with microalbuminuria treated with ACE-inhibitors or with conventional therapy, when a mean arterial bloodpresure of less than 95 mmHg and good metabolic control with a HbA1c of less than 7,5 % is achieved. The progression is accelerated in patients with a history of hypertension. Antihypertensive therapy seems to slow down the progression after four years of treatment.


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Last modified: April 06, 1999
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diabetes.uk web site= http://www.diabetic.org.uk/main1.htm
British Diabetic Association= http://www.diabetes.org.uk
Royal National Institute for the Blind= http://www.rnib.org.uk/info/eyeimpoi/diabetic.htm