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. 2010:2010:106384.
doi: 10.1155/2010/106384. Epub 2010 Jun 10.

Effect of trandolapril on regression of retinopathy in hypertensive patients with type 2 diabetes: a prespecified analysis of the benedict trial

Piero Ruggenenti  1 , Ilian Iliev, Marco Filipponi, Stefano Tadini, Annalisa Perna, Maria Ganeva, Bogdan Ene-Iordache, Paolo Cravedi, Roberto Trevisan, Antonio Bossi, Giuseppe Remuzzi
Affiliations

Effect of trandolapril on regression of retinopathy in hypertensive patients with type 2 diabetes: a prespecified analysis of the benedict trial

Piero Ruggenenti et al. J Ophthalmol. 2010.

Abstract

Background. The effect of angiotensin converting enzyme inhibitors (ACEi) on regression of retinopathy in type 2 diabetics is still ill defined. Methods. We compared the incidence of retinopathy regression in 90 hypertensive type 2 diabetics randomized to at least 3-year blinded ACEi with trandolapril (2 mg/day) or non-ACEi therapy who had preproliferative or proliferative retinopathy at baseline. Results. Over a median (interquartile range) follow-up period of 35.8 (12.4-60.7) months, retinopathy regressed in 27 patients (30.0%). Regression occurred in 18 of 42 patients (42.9%) on ACEi and in 9 of 48 (18.8%) on non-ACEi therapy (adjusted for predefined baseline covariates HR (95% CI): 2.75 (1.18-6.42), P = .0193). Concomitant treatment with or without Non-Dihydropyridine Calcium Channel Blockers (ndCCBs) did not appreciably affect the incidence of retinopathy regression. Conclusions. Unlike ndCCB, ACEi therapy may have an additional effect to that of intensified BP and metabolic control in promoting regression of diabetic retinopathy.

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Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Fundus photographs showing pre-proliferative changes (a) at baseline in a patient who had a regression of eye lesions after three years of trandolapril therapy (b). This picture provides a comprehensive example of three typical lesions, microaneurysms (MA), hemorrages (E), and hard exudates (HE, that may regress in type 2 diabetic patients on ACE inhibitor therapy combined to intensified metabolic and blood pressure control, as in the BENEDICT trial.
Figure 3
Figure 3
Cumulative incidence of patients with retinal involvement at baseline who achieved regression of diabetic retinopathy according to randomization to ACEi therapy YES or NO (a) or to ndCCB therapy YES or NO (b).
See this image and copyright information in PMC

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