Early ReportEffect of lisinopril on progression of retinopathy in normotensive people with type 1 diabetes
Introduction
Retinopathy eventually develops in 70–100% of people with type 1 diabetes (insulin-dependent diabetes mellitus) and remains a common cause of visual impairment and eventual blindness.1, 2, 3 The only intervention that prevents development and slows progression of retinopathy is tight glycaemic control.4 However, this approach is not wholly effective, and other interventions must be sought.
Blood pressure is an important risk factor for the development of retinopathy.5, 6, 7 Antihypertensive therapy, especially inhibitors of angiotensin-converting enzyme (ACE), slow the progression of nephropathy,8, 9 but whether these agents have a beneficial effect on retinopathy is much less clear. Previous randomised controlled trials of these drugs in people with type 1 diabetes either did not collect standardised data on retinopathy status,9 or did not have sufficient power10, 11 to show an effect. We report the retinopathy results from the EUCLID (EURODIAB Controlled Trial of Lisinopril in Insulin-Dependent Diabetes Mellitus) study.12
Section snippets
Methods
The EUCLID study was a double-blind, randomised, parallel-design clinical trial of lisinopril, an ACE inhibitor, and placebo in 18 European centres, in 530 patients. Men and women with type 1 diabetes13 aged 20–59 years were recruited if resting blood pressure was 75–90 mm Hg diastolic, and 155 mm Hg or less systolic. Most of the patients were normoalbuminuric (albumin-excretion rate <20 μg/min); 15% were microalbuminuric (albumin-excretion rate 20–200 μg/min).
Trained photographers took retinal
Results
409 of 530 patients had gradable baseline photographs. 121 patients did not have photographs. Therefore, gradable photographs were obtained at baseline and follow-up for 354 (81·6%) of 434 eligible patients (figure 1). The only significant differences in baseline characteristics between patients with and without photograhs were for diastolic blood pressure (81 vs 79 mm Hg in patients with and without photographs; p=0·0001), and distribution of sex (47 vs 37% women of patients with and without
Discussion
We show that lisinopril had beneficial effects on progression of retinopathy. Non-significant benefits have been shown previously with other ACE inhibitors in people with type 110, 11, 19 and type 2 (non-insulin-dependent diabetes mellitus).17
The analyses for retinopathy were included in the EUCLID protocol, but the study was not primarily designed to assess the effects of ACE inhibitors on retinopathy. However, retinal photographs taken by standard methods are an accepted way of assessing
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