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Perspective
Hypertension and diabetic retinopathy—what’s the story?
  1. J T GILLOW,
  2. J M GIBSON,
  3. P M DODSON
  1. Departments of Medical Ophthalmology, Birmingham and Midland Eye Centre, and Birmingham Heartlands Hospital, Birmingham
  1. J T Gillow, Birmingham and Midland Eye Centre, City Hospital NHS Trust, Dudley Road, Birmingham B18 7QU.

https://doi.org/10.1136/bjo.83.9.1083

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    Improved understanding of the role of hypertension in the pathogenesis of diabetic retinopathy presents both a challenge and an opportunity for ophthalmologists and other diabetic healthcare professionals to improve patient care. Around 40% of patients with type 2 diabetes are hypertensive, the proportion increasing to 60% by the age of 75.1 Recent reports from the United Kingdom Prospective Diabetes Study (UKPDS) have focused attention on the links between hypertension and sight loss in diabetes.1 2 These reports in type 2 diabetes accord with previous observational studies in type 1 diabetes3 4 and demonstrate both hypertension as a risk factor for diabetic retinopathy and the beneficial effects of tight blood pressure control. This review summarises recent papers, including the UKPDS reports, and discusses the implications for management of people with diabetes.

    Prevalence of hypertension in diabetes

    Diabetes and hypertension are among the commonest diseases in developed countries, and the frequency of both diseases rises with age. In the Wisconsin study examining patients with type 1 diabetes, hypertension was defined by current antihypertensive treatment or a mean blood pressure ⩾160/95 (or ⩾140/90 in those under 25 years). The prevalence of hypertension at baseline was 17.3%, and the 10 year incidence was 25.9%.5 Hypertension is more common in type 2 diabetes, and in the UKPDS 38% of newly diagnosed patients with type 2 diabetes had hypertension defined as repeated blood pressure ⩾160/90 (or ⩾150/85 in those on antihypertensive medication).6 In the years after diagnosis of type 2 diabetes the incidence of hypertension is higher than in the age matched general population.

    In type 1 diabetes the development of diabetic nephropathy may play a major role in the subsequent development of hypertension since microalbuminuria is present in about 80% of type 1 diabetic subjects before the onset of hypertension.7 The pathogenesis of hypertension …

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