Blood Pressure Medicine May Help Eye Disease

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Effect of candesartan on progression and regression of retinopathy in type 2 diabetes (DIRECT-Protect 2): a randomized placebo-controlled trial, by Anne Katrin Sjølie and colleagues. The Lancet 372:1385–1393, 2008

What is the problem and what is known about it so far?

Diabetic eye disease is the leading cause of blindness among people of working age. Nearly 40% of people with type 2 diabetes have some degree of eye disease when they are diagnosed with diabetes. Lowering blood glucose and blood pressure can help prevent worsening of eye disease, and laser therapy is helpful for some types of eye problems. Research is needed to find out whether medicines that are used to treat other diabetes complications may also be helpful for eye disease.

Why did researchers do this particular study?

The researchers wanted to find out whether the blood pressure medicine candesartan, which reduces the risk of kidney and heart disease, could help patients with diabetic eye disease.

Who was studied?

The study included 1,905 adults with type 2 diabetes and mild to moderate diabetic eye disease from more than 300 health centers around the world. Participants did not have kidney problems and either had normal blood pressure or high blood pressure that was treated.

How was the study done?

Participants were prescribed either candesartan or a "dummy" pill. The participants were then tested for worsening of or improvement in their eye disease over 4 years.

What did the researchers find?

Worsening of eye disease was somewhat less for those taking candesartan than for those taking the dummy pills. Those who took candesartan were more likely to have improvements in their eye disease. Improvements were greater for those who started the trial with mild eye disease and less for those whose eye disease was already more advanced.

What are the limitations of the study?

Because of the design of the study, researchers could not tell whether improvements in eye disease were linked to improvements in blood pressure or were unrelated to blood pressure control.

What are the implications of the study?

Treatment with the medicine candesartan may improve mild to moderate eye disease for people with type 2 diabetes.

FOR MORE INFORMATION

Eye complications of diabetes

Diabetes and high blood pressure

ADA Guide to Diabetes Complications