Study suggests enalapril, losartan may slow retinopathy in patients with type 1 diabetes.

According to a study published July 2 in the New England Journal of Medicine, “two blood-pressure medicines slowed the pace of eye damage from type 1 diabetes, without providing protection against kidney injury from the disease.” Specifically, “the drugs, Merck & Co.’s Cozaar [losartan] and Biovail Corp.’s Vasotec [enalapril], reduced the likelihood that patients’ eye damage would worsen over five years by 70 percent and 65 percent compared with a placebo.” The two “drugs play a part in blocking the body’s renin- angiotensin system that raises blood pressure and, in people with diabetes, may contribute to damage to the kidneys and the eyes.”

For the study, researchers from the University of Minnesota “included 285 people who had been treated for type 1 diabetes for an average of 11 years,” HealthDay (7/1, Edelson) explained. “Participants were assigned to take daily doses of a placebo…or either enalapril or losartan.” Approximately five years later, the investigators found that “detailed measurements of kidney function showed no difference in the damage seen in the three groups.” However, “eye damage was reduced by 65 percent among the participants taking enalapril and by 70 percent among those who took losartan, compared with people in the placebo group.” The authors said that the study data “support starting this therapy in people who have early diabetic eye changes,” except in “women of child-bearing age,” because “both drugs can cause fetal damage.”

Medscape (7/1, Barclay) reported, “Independently of changes in blood pressure, the odds of progression of retinopathy by at least two steps was 65 percent lower with enalapril vs. placebo…and 70 percent lower with losartan vs. placebo.” The authors of an accompanying editorial called “the retinopathy results ‘very encouraging,’ but” recommended “additional research before enalapril or losartan could be used for retinopathy prevention in clinical practice.”

MedPage Today (7/1, Phend) pointed out that the study’s “findings challenge the widely accepted belief that inhibition of the renin-angiotensin system in patients with diabetes counteracts both early and advanced stages of nephropathy, according to” the accompanying editorial. The editorialists stated that “inhibition of the renin-angiotensin system should not be considered for normotensive patients with type 1 diabetes and normoalbuminuria,” and said that “use of ACE inhibitors and ARBs should be questioned for microalbuminuria in patients with type 1 or type 2 diabetes, ‘since evidence of prevention of early decline in renal function is limited.'”

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2 Responses

  1. Very good post. Hope to see a lot more great posts in the near future.

  2. Keep up the good work, bookmarked and referred a few friends.

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