Diabetic retinopathy and blockade of the renin–angiotensin system: new data from the DIRECT study programme

A.D. Wright, P.M. Dodson

Research output: Contribution to journalArticle

Abstract

The pathogenesis and medical management of diabetic retinopathy is reviewed. The importance of good control of blood glucose and blood pressure remain key elements in the prevention and treatment of diabetic retinopathy, and a number of specific metabolic pathways have been identified that may be useful additional targets for therapeutic intervention. Trial data, however, aimed specifically to answer the questions of optimum medical management are limited, so the DIRECT study of renin-angiotensin blockade using oral candesartan 32 mg daily is a welcome addition to our knowledge. This arose from the promising improvement of retinopathy outcomes in the EUCLID study of lisinopril in type I diabetes. In DIRECT, 5 years of candesartan treatment in type I diabetes reduced the incidence of retinopathy by two or more steps (EDTRS) in severity by 18% (P = 0.0508) and, in a post hoc analysis, reduced the incidence of retinopathy by three-step progression by 35% (P = 0.034). In type I diabetes patients there was no effect on progression of established retinopathy. In contrast, in type II diabetes, 5 years of candesartan treatment resulted in 34% regression of retinopathy (P ≤0.009). Importantly, an overall significant change towards less-severe retinopathy was noted in both type I and II diabetes (P0.03). Although there is still no absolute proof that these effects were specific to RAS blockade, or just an effect of lower blood pressure, it is reasonable to conclude that candesartan has earned a place in the medical management of diabetic retinopathy, to prevent the problem in type I diabetes and to treat the early stages in type II diabetes.

Original languageEnglish
Pages (from-to)1-6
Number of pages6
JournalEye
Volume24
Issue number1
Early online date24 Jul 2009
DOIs
Publication statusPublished - Jan 2010

Fingerprint

Diabetic Retinopathy
Type 1 Diabetes Mellitus
Information Systems
Type 2 Diabetes Mellitus
Blood Pressure
Lisinopril
Incidence
Angiotensins
Therapeutics
Metabolic Networks and Pathways
Renin
Blood Glucose
candesartan

Keywords

  • candesartan
  • diabetic retinopathy
  • EUCLID and RASS studies
  • Lisinopril
  • Renin-angiotensin blockade
  • DIRECT

Cite this

@article{a3498956d6e947c98a7eda98a3ea2c0d,
title = "Diabetic retinopathy and blockade of the renin–angiotensin system: new data from the DIRECT study programme",
abstract = "The pathogenesis and medical management of diabetic retinopathy is reviewed. The importance of good control of blood glucose and blood pressure remain key elements in the prevention and treatment of diabetic retinopathy, and a number of specific metabolic pathways have been identified that may be useful additional targets for therapeutic intervention. Trial data, however, aimed specifically to answer the questions of optimum medical management are limited, so the DIRECT study of renin-angiotensin blockade using oral candesartan 32 mg daily is a welcome addition to our knowledge. This arose from the promising improvement of retinopathy outcomes in the EUCLID study of lisinopril in type I diabetes. In DIRECT, 5 years of candesartan treatment in type I diabetes reduced the incidence of retinopathy by two or more steps (EDTRS) in severity by 18{\%} (P = 0.0508) and, in a post hoc analysis, reduced the incidence of retinopathy by three-step progression by 35{\%} (P = 0.034). In type I diabetes patients there was no effect on progression of established retinopathy. In contrast, in type II diabetes, 5 years of candesartan treatment resulted in 34{\%} regression of retinopathy (P ≤0.009). Importantly, an overall significant change towards less-severe retinopathy was noted in both type I and II diabetes (P0.03). Although there is still no absolute proof that these effects were specific to RAS blockade, or just an effect of lower blood pressure, it is reasonable to conclude that candesartan has earned a place in the medical management of diabetic retinopathy, to prevent the problem in type I diabetes and to treat the early stages in type II diabetes.",
keywords = "candesartan, diabetic retinopathy, EUCLID and RASS studies, Lisinopril, Renin-angiotensin blockade, DIRECT",
author = "A.D. Wright and P.M. Dodson",
year = "2010",
month = "1",
doi = "10.1038/eye.2009.189",
language = "English",
volume = "24",
pages = "1--6",
journal = "Eye",
issn = "0950-222X",
publisher = "Nature Publishing Group",
number = "1",

}

Diabetic retinopathy and blockade of the renin–angiotensin system : new data from the DIRECT study programme. / Wright, A.D.; Dodson, P.M.

In: Eye, Vol. 24, No. 1, 01.2010, p. 1-6.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Diabetic retinopathy and blockade of the renin–angiotensin system

T2 - new data from the DIRECT study programme

AU - Wright, A.D.

AU - Dodson, P.M.

PY - 2010/1

Y1 - 2010/1

N2 - The pathogenesis and medical management of diabetic retinopathy is reviewed. The importance of good control of blood glucose and blood pressure remain key elements in the prevention and treatment of diabetic retinopathy, and a number of specific metabolic pathways have been identified that may be useful additional targets for therapeutic intervention. Trial data, however, aimed specifically to answer the questions of optimum medical management are limited, so the DIRECT study of renin-angiotensin blockade using oral candesartan 32 mg daily is a welcome addition to our knowledge. This arose from the promising improvement of retinopathy outcomes in the EUCLID study of lisinopril in type I diabetes. In DIRECT, 5 years of candesartan treatment in type I diabetes reduced the incidence of retinopathy by two or more steps (EDTRS) in severity by 18% (P = 0.0508) and, in a post hoc analysis, reduced the incidence of retinopathy by three-step progression by 35% (P = 0.034). In type I diabetes patients there was no effect on progression of established retinopathy. In contrast, in type II diabetes, 5 years of candesartan treatment resulted in 34% regression of retinopathy (P ≤0.009). Importantly, an overall significant change towards less-severe retinopathy was noted in both type I and II diabetes (P0.03). Although there is still no absolute proof that these effects were specific to RAS blockade, or just an effect of lower blood pressure, it is reasonable to conclude that candesartan has earned a place in the medical management of diabetic retinopathy, to prevent the problem in type I diabetes and to treat the early stages in type II diabetes.

AB - The pathogenesis and medical management of diabetic retinopathy is reviewed. The importance of good control of blood glucose and blood pressure remain key elements in the prevention and treatment of diabetic retinopathy, and a number of specific metabolic pathways have been identified that may be useful additional targets for therapeutic intervention. Trial data, however, aimed specifically to answer the questions of optimum medical management are limited, so the DIRECT study of renin-angiotensin blockade using oral candesartan 32 mg daily is a welcome addition to our knowledge. This arose from the promising improvement of retinopathy outcomes in the EUCLID study of lisinopril in type I diabetes. In DIRECT, 5 years of candesartan treatment in type I diabetes reduced the incidence of retinopathy by two or more steps (EDTRS) in severity by 18% (P = 0.0508) and, in a post hoc analysis, reduced the incidence of retinopathy by three-step progression by 35% (P = 0.034). In type I diabetes patients there was no effect on progression of established retinopathy. In contrast, in type II diabetes, 5 years of candesartan treatment resulted in 34% regression of retinopathy (P ≤0.009). Importantly, an overall significant change towards less-severe retinopathy was noted in both type I and II diabetes (P0.03). Although there is still no absolute proof that these effects were specific to RAS blockade, or just an effect of lower blood pressure, it is reasonable to conclude that candesartan has earned a place in the medical management of diabetic retinopathy, to prevent the problem in type I diabetes and to treat the early stages in type II diabetes.

KW - candesartan

KW - diabetic retinopathy

KW - EUCLID and RASS studies

KW - Lisinopril

KW - Renin-angiotensin blockade

KW - DIRECT

UR - http://www.scopus.com/inward/record.url?scp=75449093415&partnerID=8YFLogxK

UR - http://www.nature.com/eye/journal/v24/n1/abs/eye2009189a.html

U2 - 10.1038/eye.2009.189

DO - 10.1038/eye.2009.189

M3 - Article

C2 - 19648902

AN - SCOPUS:75449093415

VL - 24

SP - 1

EP - 6

JO - Eye

JF - Eye

SN - 0950-222X

IS - 1

ER -