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Cited by 116Retinal Diseases and TreatmentsDiabetes Management and ResearchChronic Kidney Disease and Diabetes

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

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Gallego, P. H., Craig, M. E, Hing, S., Donaghue, K. C·2008·BMJ
DOI 10.1136/bmj.a918PMC PMC2526183
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Abstract

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) microg/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 microg/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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  • Patients diagnosed with kidney disease are at higher risk for poor visual outcomes.

    “Patients diagnosed with kidney disease, hypertension, and covered under Medicaid insurance are at higher risk for poor visual outcomes13–24.”

    From Autonomous AI-assisted diabetic retinopathy screening at primary care is associated with increased presentation to eye care by at risk patients (2026) · cites this paper as [14]

    The Longitudinal analysis and Systolic and diastolic blood pressure and retinopathy sections report that higher albumin excretion predicted retinopathy in adolescents with type 1 diabetes. That supports a kidney-related association, but the study does not establish that patients diagnosed with kidney disease generally have a higher risk of poor visual outcomes; its measured outcome was retinopathy, not vision loss. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Patients diagnosed with hypertension are at higher risk for poor visual outcomes.

    “Patients diagnosed with kidney disease, hypertension, and covered under Medicaid insurance are at higher risk for poor visual outcomes13–24.”

    From Autonomous AI-assisted diabetic retinopathy screening at primary care is associated with increased presentation to eye care by at risk patients (2026) · cites this paper as [14]

    The Discussion reports that higher blood pressure predicted early retinopathy in adolescents with type 1 diabetes, and the Cox proportional hazard regression section reports higher retinopathy risk at or above the 90th blood-pressure centile. The paper does not establish the broader claim that patients diagnosed with hypertension have worse visual outcomes generally: it studied blood-pressure measurements and early retinopathy in a specific population, not hypertension diagnoses or vision loss. Page numbers were not provided in the copy. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Patients covered under Medicaid insurance are at higher risk for poor visual outcomes.

    “Patients diagnosed with kidney disease, hypertension, and covered under Medicaid insurance are at higher risk for poor visual outcomes13–24.”

    From Autonomous AI-assisted diabetic retinopathy screening at primary care is associated with increased presentation to eye care by at risk patients (2026) · cites this paper as [14]

    The Clinical characteristics section reports an association between blood pressure and retinopathy in adolescents with type 1 diabetes, but does not address insurance coverage. Searches for Medicaid, insurance coverage, and socioeconomic status found no passage linking Medicaid to visual outcomes in our copy; page numbers were not provided for these passages. (LLM, conf=0.74)

    Experimental — accuracy not yet measured

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Cites

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Research works printed but not linked: 31

  1. Nordwall M, Hyllienmark L, Ludvigsson J. Early diabetic complications in a population of young patients with type 1 diabetes mellitus despite intensive treatment. J Pediatr Endocrinol 2006;19:45-54.
  2. Agardh CD, Agardh E, Torffvit O. The association between retinopathy, nephropathy, cardiovascular disease and long-term metabolic control in type 1 diabetes mellitus: a 5 year follow-up study of 442 adult patients in routine care. Diabetes Res Clin Pract 1997;35:113-21.
  3. Klein R, Klein BE, Moss SE, Cruickshanks KJ. The Wisconsin epidemiologic study of diabetic retinopathy: XVII. The 14-year incidence and progression of diabetic retinopathy and associated risk factors in type 1 diabetes. Ophthalmology 1998;105:1801-15.
  4. Marshall G, Garg SK, Jackson WE, Holmes DL, Chase HP. Factors influencing the onset and progression of diabetic retinopathy in subjects with insulin-dependent diabetes mellitus. Ophthalmology 1993;100:1133-9.
  5. Rassam SM, Patel V, Kohner EM. The effect of experimental hypertension on retinal vascular autoregulation in humans: a mechanism for the progression of diabetic retinopathy. Exp Physiol 1995;80:53-68.
  6. Patel V, Rassam S, Newsom R, Wiek J, Kohner E. Retinal blood flow in diabetic retinopathy. BMJ 1992;305:678-83.
  7. Alibrahim E, Donaghue KC, Rogers S, Hing S, Jenkins AJ, Chan A, et al. Retinal vascular caliber and risk of retinopathy in young patients with type 1 diabetes. Ophthalmology 2006;113:1499-503.
  8. Norgaard K, Feldt-Rasmussen B, Deckert T. Is hypertension a major independent risk factor for retinopathy in type 1 diabetes? Diabet Med 1991;8:334-7.
  9. Guillausseau PJ, Massin P, Charles MA, Allaguy H, Guvenli Z, Virally M, et al. Glycaemic control and development of retinopathy in type 2 diabetes mellitus: a longitudinal study. Diabet Med 1998;15:151-5. [Correction in Diabet Med 1998;15:709.]
  10. Larsson LI, Alm A, Bergenheim T, Lithner F, Bergstrom R. Retinopathy in diabetic patients aged 15-50 years in the county of Umea, Sweden. Acta Ophthalmol Scand 1999;77:430-6.
  11. Taylor RH, Jones HS, Dodson PM, Hamilton AP, Kritzinger EE. Diabetic eye disease: a natural history study. Eye 1997;11:547-53.
  12. Cignarelli M, De Cicco ML, Damato A, Paternostro A, Pagliarini S, Santoro S, et al. High systolic blood pressure increases prevalence and severity of retinopathy in NIDDM patients. Diabetes Care 1992;15:1002-8.
  13. Roy MS. Diabetic retinopathy in African Americans with type 1 diabetes: the New Jersey 725: II. Risk factors. Arch Ophthalmol 2000;118:105-15.
  14. Wan Nazaimoon WM, Letchuman R, Noraini N, Ropilah AR, Zainal M, Ismail IS, et al. Systolic hypertension and duration of diabetes mellitus are important determinants of retinopathy and microalbuminuria in young diabetics. Diabetes Res Clin Pract 1999;46:213-21.
  15. Estacio RO, McFarling E, Biggerstaff S, Jeffers BW, Johnson D, Schrier RW. Overt albuminuria predicts diabetic retinopathy in Hispanics with NIDDM. Am J Kidney Dis 1998;31:947-53.
  16. Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy: III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Arch Ophthalmol 1984;102:527-32.
  17. Taplin CE, Craig ME, Lloyd M, Taylor C, Crock P, Silink M, et al. The rising incidence of childhood type 1 diabetes in New South Wales, 1990-2002. Med J Aust 2005;183:243-6.
  18. Fleiss JL. Statistical methods for rates and proportions. 2nd ed. New York: Wiley, 1981.
  19. Eross J, Kreutzmann D, Jimenez M, Keen R, Rogers S, Cowell C, et al. Colorimetric measurement of glycosylated protein in whole blood, red blood cells, plasma and dried blood. Ann Clin Biochem 1984;21:477-83.
  20. National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents. Update on the 1987 task force report on high blood pressure in children and adolescents: a working group report from the national high blood pressure education program. Pediatrics 1996;98:649-58.
  21. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000;320:1240-3.
  22. Zeger SL, Liang KY, Albert PS. Models for longitudinal data: a generalized estimating equation approach. Biometrics 1988;44:1049-60. [Correction in Biometrics 1989;45:347.]
  23. Kernell A, Dedorsson I, Johansson B, Wickstrom CP, Ludvigsson J, Tuvemo T, et al. Prevalence of diabetic retinopathy in children and adolescents with IDDM: a population-based multicentre study. Diabetologia 1997;40:307-10.
  24. Klein BE, Klein R, Moss SE, Palta M. A cohort study of the relationship of diabetic retinopathy to blood pressure. Arch Ophthalmol 1995;113:601-6. [Correction in Arch Ophthalmol 1996;114:109.]
  25. Strippoli GF, Craig M, Schena FP, Craig JC. Antihypertensive agents for primary prevention of diabetic nephropathy. J Am Soc Nephrol 2005;16:3081-91.
  26. Chaturvedi N, Sjolie AK, Stephenson JM, Abrahamian H, Keipes M, Castellarin A, et al. Effect of lisinopril on progression of retinopathy in normotensive people with type 1 diabetes: EURODIAB controlled trial of lisinopril in insulin-dependent diabetes mellitus. Lancet 1998;351:28-31.
  27. Matthews DR, Stratton IM, Aldington SJ, Holman RR, Kohner EM, UKP DS Group. Risks of progression of retinopathy and vision loss related to tight blood pressure control in type 2 diabetes mellitus: UKPDS 69. Arch Ophthalmol 2004;122:1631-40.
  28. Patel A, Group AC, MacMahon S, Chalmers J, Neal B, Woodward M, et al. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007;370:829-40.
  29. Danser AH, Derkx FH, Admiraal PJ, Deinum J, de Jong PT, Schalekamp MA. Angiotensin levels in the eye. Investigative Ophthalmol Vis Sci 1994;35:1008-18.
  30. American Diabetes Association. Treatment of hypertension in adults with diabetes. Diabetes Care 2002;25:199-201.
  31. Schrier RW, Estacio RO, Esler A, Mehler P. Effects of aggressive blood pressure control in normotensive type 2 diabetic patients on albuminuria, retinopathy and strokes. Kidney Int 2002;61:1086-97.

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Authors
Gallego, P. H., Craig, M. E., Hing, S., & Donaghue, K. C.
Affiliations
  • Children's Hospital at Westmead (AU)
  • The University of Sydney (AU)
Corresponding author
Donaghue, K. C
ORCID
Venue
BMJ
Publisher
BMJ
Published
2008-08-26
Volume
337
Issue
aug26 1
Pages
a918-a918
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.a918
PMC
PMC2526183
OpenAlex
W2126737185
Cited by
116
References
0
Citations by year
2026: 3 · 2025: 1 · 2024: 2 · 2023: 4 · 2022: 3 · 2021: 7 · 2020: 6 · 2019: 8 · 2018: 5 · 2017: 7 · 2016: 11 · 2015: 5 · 2014: 7 · 2013: 5 · 2012: 13
FWCI
9.79
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • BMJ (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
Topics
  • Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
Keywords
type 1 diabetes, diabetic retinopathy, blood pressure, systolic blood pressure, diastolic blood pressure, adolescents, urinary albumin excretion rate, diabetic nephropathy, retinopathy risk factors, HbA1c, diabetes duration, retinopathy screening
MeSH terms
Adolescent, Albuminuria, Blood Pressure, Child, Diabetes Mellitus, Type 1, Diabetic Angiopathies, Diabetic Nephropathies, Diabetic Retinopathy, Epidemiologic Methods, Female, Fluorescein Angiography, Humans, Hypertension, Male

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