Blood pressure control in type II diabetics with diabetic retinopathy

Sivaprasad, Sobha; Jackson, Heather

doi:10.1038/sj.eye.6702307

Cited by 14 publications

(13 citation statements)

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“…The combination of diabetes and hypertension is a particularly strong cardiovascular risk factor and blood pressure control is often suboptimal in patients with diabetes [3,4]. Blocking the renin-angiotensinaldosterone system (RAAS) has obviously been a very successful therapeutic strategy in both heart failure and diabetes mellitus.…”

Section: Introductionmentioning

confidence: 99%

Spironolactone for poorly controlled hypertension in type 2 diabetes: conflicting effects on blood pressure, endothelial function, glycaemic control and hormonal profiles

et al. 2008

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Aims/hypothesis Aldosterone antagonism improves endothelial function (and reduces deaths) in chronic heart failure. It is not known whether similar effects occur in other high-risk groups such as patients with diabetes and hypertension. We therefore assessed the full effects of aldosterone blockade in poorly controlled hypertensive patients with type 2 diabetes, focussing on blood pressure, endothelial function, glycaemic control and key hormones. Methods We performed a randomised, placebo-controlled, double-blind, crossover study on 50 patients with type 2 diabetes and treated but poorly controlled hypertension, comparing spironolactone versus placebo. Patients had their endothelial function assessed by standard forearm venous occlusion plethysmography. Results There was no significant improvement in endotheliumdependent vasodilatation in response to acetylcholine, despite highly significant reductions in systolic and diastolic blood pressure. However, spironolactone significantly worsened glycaemic control, plasma angiotensin II and cortisol. Conclusions/interpretation Spironolactone is highly effective in lowering blood pressure in patients with type 2 diabetes and poorly controlled hypertension on standard treatment, but does not improve vascular endothelial function in this group. We speculate that any tendency for the spironolactoneinduced lowering of blood pressure to improve endothelial function is offset by its tendency to worsen glycaemic control and increase the levels of angiotensin II and even possibly cortisol.Trials Registry no.: ISRCTN 76558770

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Section: Introductionmentioning

confidence: 99%

Spironolactone for poorly controlled hypertension in type 2 diabetes: conflicting effects on blood pressure, endothelial function, glycaemic control and hormonal profiles

et al. 2008

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“…The UKPDS found that tight control of blood pressure led to a 34% reduction in the rate of progression of retinopathy; more specifically, this trial found that for each 10 mmHg decrease in systolic blood pressure there was a 13% reduction in the risk of retinopathy [3, 5]. The UKPDS also showed that in patients with T2D, systolic blood pressure was strongly linked to the incidence of diabetic retinopathy [24].…”

Section: Discussionmentioning

confidence: 99%

“…These findings suggest that blood pressure, a very easily measured parameter, may be a strong determining factor in identifying patients who would benefit from referral to the diabetologist. One study has suggested that blood pressure should be measured in all patients at every diabetes clinic appointment with the ophthalmologist [5]. However, in another study blood pressure recordings at an eye clinic were found to be significantly higher than comparative diabetes clinic measurements, possibly secondary to the white-coat effect [28].…”

Section: Discussionmentioning

confidence: 99%

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Optimizing Medical Management in Patients with Sight-Threatening Diabetic Retinopathy

et al. 2016

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IntroductionDiabetic retinopathy is a leading cause of blindness in adults of working age. Patients with sight-threatening diabetic retinopathy (STDR) often have poor control of modifiable risk factors, including blood pressure and blood glucose. Patients in our eye department with STDR whose diabetes was managed only by their general practitioner (GP) were referred to a diabetes specialist. We have reviewed these referrals and assessed the control of modifiable risk factors in these patients at the time of referral.MethodsA retrospective study was performed which identified 54 patients with STDR who had been referred from our eye department to a diabetes specialist between May 2013 and August 2014. Patient demographics, grades of retinopathy, glycated hemoglobin (HbA1c) levels, blood pressure, and lipid profiles were noted from the initial clinic visit and the first clinic appointment after 12 months. Initial management and any subsequent changes to management were recorded.ResultsOf the 54 patients initially referred to the dedicated diabetic retinopathy clinic, data from 32 patients were available for analysis; 22 patients failed to attend the clinic. The majority of patients who presented to the clinic were found to have inadequate control of modifiable risk factors. At the initial clinic visit, nine of the 32 (28%) patients had a blood pressure that was less than the target of 130/80 mmHg and only two (6%) had a HbA1c level of less than the target of 48 mmol/L for type 2 diabetes and 58 mmol/L for type 1 diabetes, respectively. Changes were made to the management in 24 (75%) of the patients. Blood pressure management was changed in 18 (56%) patients. Overall, changes were made to blood pressure management and lipid and glycemic medication, including insulin.ConclusionThe majority of patients with STDR were receiving suboptimal medical management. Collaboration between GPs, diabetes specialists, and ophthalmologists can lead to optimized medical management. All eye departments should develop protocols specifying when patients with diabetic retinopathy should be referred for to a diabetes specialist for input.

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“…[51520] Approximately 60% of adults with Type 2 diabetes have comorbid hypertension. [21] A follow-up study of hypertensive diabetics showed that tight control of hypertension decreased the risk of diabetic complications compared to less aggressive control. [1622]…”

Section: Discussionmentioning

confidence: 99%

Effect of macular photocoagulation on visual acuity of Omani patients with clinically significant macular edema

Zaidi

Jacob

2009

Oman J Ophthalmol

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Background:The aim of this study was to determine the effect of macular laser treatment on the visual acuity (VA) of Omani diabetic patients with clinically significant macular edema (CSME). Visual outcome was also correlated with duration and control of diabetes and presence or absence of hypertension and hyperlipidemia.Materials and Methods:This is a retrospective noncomparative cohort study involving 101 eyes of 72 Omani diabetic patients. Change in VA was determined using Snellen′s VA chart. The mean duration of follow-up was approximately 21 months (range, 16-24 months).Results:29.7% of the patients maintained their vision, 35.6% showed improvement, whereas 34.7% showed a decrease in their vision. Positive visual outcome showed a statistically significant direct relationship with tight control of diabetes and absence of hypertension and an inverse relationship with the duration of diabetes. Presence of hyperlipedemia did not show a statistically significant relationship with positive visual outcome. However, it showed a trend to better visual outcome in the absence of hyperlipedemia. Peak incidence of macular edema was seen at the age of 52.3 years.Conclusion:Macular photocoagulation was found to be an effective method of treatment for CSME among Omani diabetic patients, which has resulted in a positive visual outcome in 65.3% of the patients (stable and improved vision). Effective control of diabetes, duration of diabetes, and hypertension are the factors which influence the postlaser visual outcome.

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Blood pressure control in type II diabetics with diabetic retinopathy

Cited by 14 publications

References 14 publications

Spironolactone for poorly controlled hypertension in type 2 diabetes: conflicting effects on blood pressure, endothelial function, glycaemic control and hormonal profiles

Spironolactone for poorly controlled hypertension in type 2 diabetes: conflicting effects on blood pressure, endothelial function, glycaemic control and hormonal profiles

Optimizing Medical Management in Patients with Sight-Threatening Diabetic Retinopathy

Effect of macular photocoagulation on visual acuity of Omani patients with clinically significant macular edema

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