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Blood pressure control and diabetic retinopathy
  1. R Klein,
  2. B E K Klein
  1. Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, 610 North Walnut Street, 460 WARF, Madison, WI 53705-2397, USA
  1. Correspondence to: Ronald Klein; kleinr{at}

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It is nearly 25 years since the Diabetic Retinopathy Study, a multicentred controlled clinical trial, first reported the efficacy of treatment by photocoagulation of proliferative diabetic retinopathy with high risk characteristics for visual loss.1 In 1985, the Early Treatment Diabetic Retinopathy Study (ETDRS) demonstrated the beneficial effects of focal laser treatment for clinically significant macular oedema in patients with diabetes.2 Based on data from these studies, it was estimated that timely detection and photocoagulation treatment of vision threatening retinopathy could prevent nearly 95% of severe visual loss in patients with diabetes.3 Despite the resulting development of guidelines and education and screening programmes for early detection and treatment of these problems, diabetic retinopathy still remains an important cause of visual loss.4–6 More recently, the Diabetes Control and Complications Trial (DCCT)7–12 and the United Kingdom Prospective Diabetes Study (UKPDS)1315 have demonstrated the efficacy and cost effectiveness of glycaemic control in reducing the incidence and progression of retinopathy. However, data from these and other studies12,16,17 have confirmed how difficult it is to achieve and maintain good glycaemic control over a long period. For this reason, intervention on other risk factors such as hypertension have been studied in an effort to decrease the risk of visual loss due to diabetic retinopathy. The purpose of this commentary is to briefly describe new findings regarding the role of blood pressure control in the prevention of visual loss in people with diabetes and to review whether specific classes of antihypertensive medications are associated with reduced incidence and progression of retinopathy even in normotensive people with diabetes.


Increased blood pressure has been hypothesised, through the effects of increased blood flow, to damage the retinal capillary endothelial cells in eyes of people with diabetes. …

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