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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