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Ronald Klein, MD, MPH; Chelsea E. Myers, MS; Barbara E. K. Klein, MD, MPH; Bernard Zinman, MD; Robert Gardiner, MD; Samy Suissa, PhD; Alan R. Sinaiko, MD; Sandra M. Donnelly, MDCM; Paul Goodyer, MD; Trudy Strand, RN; Michael Mauer, MD

Arch Ophthalmol. 2010;128(2):198-205. doi:10.1001/archophthalmol.2009.391

Objective  To examine the relationship of blood pressure (BP) and use of angiotensin-receptor blocker or angiotensin-converting enzyme inhibitor to retinal vessel diameter in normotensive, normoalbuminuric persons with type 1 diabetes mellitus.

Methods  In a randomized, controlled clinical trial, clinic and 24-hour ambulatory BPs were measured in persons with type 1 diabetes mellitus and gradable fundus photographs both at baseline (n = 147) and at 5-year follow-up (n = 124). Retinal arteriole and venule diameters were measured by a computer-assisted technique. Individual arteriole and venule measurements were combined into summary indexes that reflect the average retinal arteriole (central retinal arteriole equivalent [CRAE]) and venule (central retinal venule equivalent [CRVE]) diameter of an eye, respectively.

Results  While controlling for age, study site, glycosylated hemoglobin level, and ambulatory pulse rate, the daytime ambulatory systolic (–0.29-µm effect per 1 mm Hg; P = .02), daytime ambulatory diastolic (–0.44-µm effect per 1 mm Hg; P = .04), nighttime ambulatory systolic (–0.27-µm effect per 1 mm Hg; P = .03), and 24-hour ambulatory systolic (–0.31-µm effect per 1 mm Hg; P = .03) BPs were cross-sectionally associated with a smaller CRAE. While controlling for age, study site, glycosylated hemoglobin level, ambulatory pulse rate, and baseline CRAE, no BP measure was associated with a change in CRAE or CRVE during 5 years of follow-up. Treatment with losartan potassium or enalapril maleate was not associated with a statistically significant change in CRAE or CRVE.

Conclusion  Angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker therapy does not affect retinal arteriole or venule diameter in normotensive persons with type 1 diabetes mellitus.

Trial Registration  clinicaltrials.gov Identifier: NCT00143949

Author Affiliations: Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison (Drs R. Klein and B. E. K. Klein and Ms Myers); Departments of Medicine, Samuel Lunenfeld Research Institute, Mount Sinai Hospital (Dr Zinman), and St Michaels Hospital (Dr Donnelly), University of Toronto, Toronto, Ontario, Canada; Departments of Medicine (Drs Gardiner and Suissa), Epidemiology and Biostatistics (Drs Suissa and Goodyer), and Pediatrics (Dr Goodyer), McGill University, Montreal, Quebec, Canada; and Department of Pediatrics, University of Minnesota, Minneapolis (Drs Sinaiko and Mauer and Ms Strand).

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