Hypertension May Worsen the Risk of Diabetic Retinopathy Among Patients with T2D

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New research suggests hypertension may increase the risk of diabetic retinopathy among patients with type 2 diabetes (T2D).¹

The data, presented at the 83rd Scientific Sessions of the American Diabetes Association (ADA 2023), showed the cumulative incidence of diabetic retinopathy among normotensive and hypertensive were 49% and 73%, respectively, after a median follow-up of approximately 5 years.

“An effective strategy of diabetic retinopathy screening is recommended for patients coexisting with hypertension,” wrote the investigative team, led by Nguyen Nhat Nam, MD, from the department of endocrinology in the faculty of medicine at the University of Medicine and Pharmacy at Ho Chi Minh City.

The leading cause of blindness among working-age adults, diabetic retinopathy is projected to affect approximately 16 million people with diabetes in the US by 2050, and approximately 160 million globally.² A sight-treatening complication of diabetes, the investigative team suggests hypertension may worsen diabetic retinopathy risk due to additional vascular damage. Led by Nam, the team investigatived whether hypertension could increase the 10-year incidence of diabetic retinopathy in patients with T2D.¹

The retrospective cohort included ≥400 patients with T2D who were free of diabetic retinopathy at baseline and completed ≥1 further clinic visit between 1997 - 2008, and were followed up with for 10 years. Investigators performed face-to-face interviews to collect baseline characteristics, including age, gender, duration of diabetes, comorbidities, and complications. Patients were categorized into normotension or hypertension based on the clinician’s diagnosis obtained from the medical record.

Retinal photographs were taken annually following current guidelines. The Kaplan-Meier curve was used to estimate the cumulative incidence of diabetic retinopathy, stratified by normotensive or hypertensive status. The log rank test was used to compare the distribution of time until the occurrence of diabetic retinopathy in 2 groups (a P-value of <0.05 was considered statistically significant).

Of the 415 patients included in the study, the characteristics data showed a mean age of 54 years, 124 males (30%), and a mean body mass index (BMI) of 24. Patients had a mean diiabetes duration of 1 year, an HbA1c of 7.92%, and an estimated glomerular filtration rate of 82.04 ml/min/1.73m².

After a median follow-up, the cumulative incidences of diabetic retinopathy among normotesnive and hypertensive participants were 49% (95% CI, 36 - 60) and 73% (95% CI, 67% - 78%), respectively. They showed a significant difference in the risk of new-onset diabetic retinopathy among groups (P <.001). Investigators noted the 2 Kaplan-Meier curves occurred early in the 1st year after recruiting.

“Hypertension could further increase the risk of diabetic retinopathy among T2D patients,” wrote the investigative team.

References

1. Nam NN, Khue NT. Hypertension Aggravated the Risk of Diabetic Retinopathy over 10 Years. Poster presentation at the 83rd Scientific Sessions of the American Diabetes Association. June 23 – 26, 2023.
2. Saaddine JB, Honeycutt AA, Narayan KMV, Zhang X, Klein R, Boyle JP. Projection of Diabetic Retinopathy and Other Major Eye Diseases Among People With Diabetes Mellitus: United States, 2005-2050. Arch Ophthalmol. 2008;126(12):1740–1747. doi:10.1001/archopht.126.12.1740