Does treatment for hypertension protect against retinopathy?

1. Does treatment for hypertension protect against retinopathy? Skaraborgs Diabetesregister (SDR) ten years follow up Grete Garberg, MD Skaraborg Hospital

2. Background I Diabetic retinopathy main reason for visual impairment in working ages, patients fear ”blindness” Important to prevent Type 2 diabetes retinopathy not unusual at diagnosis Screening is effective to detect retinopathy makes treatment possible before symptoms evolve

3. Background II Screening in Skaraborg from late 1980 patients in ages < 70 years Skaraborgs Diabetes Register (SDR) 1991-2004 clinical data and data on morbidity and mortality Patients type 2 (+0=undefined)diagnosed 1996-1998 the basis of this study

4. Population 2007-2010 1258 (305 dead ) 877 < 70 yrs at baseline 381 ≥70 yrs at baseline (118 dead ) (187 dead ) 765 104 8 403 2 6 type 2 type 1 undefined type 2 type 1 undefined SDR cohort 1996-1998 SDR=Skaraborgs diabetesregister

5. Methods Data from retinal screening close to diagnosis and after 5 and 10 years From screening records retinopathy, maculopathy, laser treatment, visual acuity and other reasons for visual impairment From Skaraborgs Diabetes Register HbA1c, body mass index (BMI), blood pressure (BP) and antihypertensive treatment

6. Results I a Diabetic retinopathy in all patients (type 1+2+0) *Before 01/01/99, ** Before 01/01/03, *** Before 10/08/09, § last examination

7. Results I Diabetic retinopathy in patients type 0+2 <70 years at baseline *Before 01/01/99, ** Before 01/01/03, *** Before 10/08/09, § last examination

8. Results summary I Frequency of screening 83% (639/773) of patients <70 years at diagnosis screened some time during follow-up HbA1C at diagnosis Mean value 6,66% Visual acuity 96% (527/548) >0.5 at the last recorded examination

9. HbA1C at diagnosis

10. Results IIaHbA1C in 1996-1998

11. Results IIbHbA1C and time to retinopathy

12. Results IIcHbA1C and time to maculopathy

13. Results IId BMI in 96-98 and retinopathy

14. Results IIeBMI in 96-98 and maculopathy

15. Results IIIaBlood pressure and hypertension Systolic blood pressure <130 mmHg Associated with less retinopathy Systolic blood pressure >130 mmHg Further increase in systolic blood pressure not associated with more retinopathy. Blood pressure at baseline Not associated with retinopathy or maculopathy Hypertension treatment at baseline Associated with less retinopathy

16. Results IIIbAntihypertensive treatment and retinopathy

17. Results IIIcAntihypertensive treatment and maculoopathy

18. Conclusions I Relatively few patients with visual impairment Retinopathy increases rapidly after 10 years duration

19. Conclusions II • HbA1C level at diagnosis seems to predict risk for retinopathy and maculopathy • BMI at diagnosis does not affect development of retinopathy

20. Conclusions III • Antihypertensive treatment regardless of BP level associated with • lower frequency of retinopathy • lower frequency of maculopathy

21. Thank you for your attention! Questions or comments?

22. Thanks for contribution from • R&D Centre, Skaraborg Hospital, financing • Bo Berger, PhD • Kristina A Boström,Supervisor; PhD, R&D Centre Skaraborg Primary Care • Monica Lövestam Adrian, Suprervisor; PhD, Eye Clinic, Lund University Hospital • Salmir Nasic, Statistician, Skaraborg Hospital • Ann Segerblom, Research Assistent, R&D Centre Skaraborg Primary Care