Blood pressure control for diabetic retinopathy

摘要: Background Diabetic retinopathy is a common complication of diabetes and leading cause visual impairment blindness. Research has established the importance blood glucose control to prevent development progression ocular complications diabetes. Simultaneous pressure been advocated for same purpose, but findings reported from individual studies have supported varying conclusions regarding benefit interventions on pressure. Objectives The primary aim this review was summarize existing evidence effect or reduce levels among diabetics incidence diabetic retinopathy, preservation acuity, adverse events, quality life, costs. A secondary compare classes anti-hypertensive medications with respect outcomes. Search methods We searched number electronic databases including CENTRAL as well ongoing trial registries. We last 25 April 2014. also reviewed reference lists articles reports selected inclusion. In addition, we contacted investigators trials potentially pertinent data. Selection criteria We included in randomized controlled (RCTs) which either type 1 2 participants, without hypertension, were assigned randomly intense versus less control, usual care no intervention pressure, different agents placebo. Data collection analysis Pairs authors independently titles abstracts manual searches full text any document that appeared be relevant. assessed risk bias outcomes review. extracted data characteristics, cost-effectiveness at annual intervals after study entry whenever provided published other documents available trials. Main results We 15 RCTs, conducted primarily North America Europe, had enrolled 4157 9512 ranging 16 2130 participants trials. 10 one group more received placebo. three trials, compared control. remaining two care. Five diabetics, diabetics. Six sponsored entirely by pharmaceutical companies, seven partial support government-sponsored grants institutional support. Study designs, populations, interventions, lengths follow-up (range nine years) varied Overall, low moderate. For outcomes, downgraded due inconsistency imprecision estimates differing characteristics participants. For five 4 5 years treatment follow-up; four combined outcome over time interval. Among 3 retinopathy; during 4- 5-year period. One participated (or secondary) targeted review. The these intensive (estimated ratio (RR) 0.80; 95% confidence interval (CI) 0.71 0.92) RR 0.78; CI 0.63 0.97). The (point estimate closer than point progression, overlapped 1; estimated 0.88; 0.73 1.05). proliferative clinically significant macular edema moderate severe loss best-corrected acuity did not pressure: RRs CIs 0.95 (0.83 1.09) 1.06 (0.85 1.33), respectively, follow-up. Findings within subgroups (type diabetics; normal baseline those elevated levels) similar overall findings. The event most often (7 trials) death, yielding an 0.86 (95% 0.64 1.14). Hypotension trials; 2.08 1.68 2.57). Other events single trials. Authors' conclusions Hypertension well-known factor several chronic conditions lowering proven beneficial. supports beneficial preventing up years. However, lack such slow considered review, along relatively modest incidence, weakens conclusion intervening solely retinopathy.