Published 26 August 2008, doi:10.1136/bmj.a918
Cite this as: BMJ 2008;337:a918

Research

Role of blood pressure in development of early retinopathy in adolescents with type 1 diabetes: prospective cohort study

¹ Institute of Endocrinology and Diabetes, Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia, ² Discipline of Paediatrics and Child Health, University of Sydney, NSW 2006, Australia, ³ School of Women’s and Children’s Health, University of New South Wales, Sydney NSW 2052

Objective To examine the relation between blood pressure and the development of early retinopathy in adolescents with childhood onset type 1 diabetes.

Design Prospective cohort study.

Setting Diabetes Complications Assessment Service at the Children’s Hospital at Westmead, Sydney, Australia.

Participants 1869 patients with type 1 diabetes (54% female) screened for retinopathy with baseline median age 13.4 (interquartile range 12.0-15.2) years, duration 4.9 (3.1-7.0) years, and albumin excretion rate of 4.4 (3.1-6.8) µg/min plus a subgroup of 1093 patients retinopathy-free at baseline and followed for a median 4.1 (2.4-6.6) years.

Main outcome measures Early background retinopathy; blood pressure.

Results Overall, retinopathy developed in 673 (36%) participants at any time point. In the retinopathy-free group, higher systolic blood pressure (odds ratio 1.01, 95% confidence interval 1.003 to 1.02) and diastolic blood pressure (1.01, 1.002 to 1.03) were predictors of retinopathy, after adjustment for albumin excretion rate (1.27, 1.13 to 1.42), haemoglobin A_1c (1.08, 1.02 to 1.15), duration of diabetes (1.16, 1.13 to 1.19), age (1.13, 1.08 to 1.17), and height (0.98, 0.97 to 0.99). In a subgroup of 1025 patients with albumin excretion rate below 7.5 µg/min, the cumulative risk of retinopathy at 10 years’ duration of diabetes was higher for those with systolic blood pressure on or above the 90th centile compared with those below the 90th centile (58% v 35%, P=0.03). The risk was also higher for patients with diastolic blood pressure on or above the 90th centile compared with those below the 90th centile (57% v 35%, P=0.005).

Conclusions Both systolic and diastolic blood pressure are predictors of retinopathy and increase the probability of early retinopathy independently of incipient nephropathy in young patients with type 1 diabetes.

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This article has been cited by other articles:

• Gardner, T. W., Gabbay, R. A. (2009). Diabetes and Obesity: A Challenge for Every Ophthalmologist. Arch Ophthalmol 127: 328-329 [Full text]  
• (2008). Elevated BP Predicts Development of Retinopathy in Adolescents with Type 1 Diabetes. JWatch General 2008: 5-5 [Full text]  
• Dunger, D. B, Marcovecchio, M L., Chiarelli, F. (2008). Complications of type 1 diabetes in adolescents. BMJ 337: a770-a770 [Full text]  

Rapid Responses:

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Effects of Blood Pressure and Retinal Arteriolar Caliber on Diabetic Retinopathy Risk – A Conceptual Paradox

Ning Cheung, et al.
bmj.com, 19 Sep 2008 [Full text]

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