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Item #11 

ACE Inhibitor Therapy Does Not Slow Progression of Diabetic Retinopathy

ACE inhibitors do not appear to stop retinopathy from progressing from moderate to severe in type 2 diabetics, according to a recent report.

Previous reports have suggested that ACE inhibitor therapy delays the progression of early diabetic retinopathy, Dr. Mayer B. Davidson and colleagues, from Charles R. Drew University in Los Angeles, note in the November/December issue of the Journal of Diabetes and Its Complications. However, it was unclear if such therapy would also be useful in retarding the progression of more advanced forms of diabetic retinopathy.

In the current study, the researchers assessed the outcomes of 35 normotensive type 2 diabetics with moderate to severe diabetic retinopathy who were randomized to receive enalapril 5 mg/d or multivitamin placebo daily for 2 years. The subjects were examined by an ophthalmologist every 3 months.

Neither group experienced a significant change in blood pressure or in HbA1C levels during the study, the authors point out.

Although the planned study duration was 2 years, the trial was terminated after an average of 7.2 months when it became apparent that enalapril therapy probably did not slow disease progression. By that time, roughly equal numbers of patients in each group had progressed to proliferative DR, macular edema, or had developed sustained proteinuria.

It is possible that treatment with higher doses of enalapril would have produced a beneficial effect, the authors note. "Perhaps larger studies using higher doses of ACE inhibitors in normotensive patients...are needed over longer periods of time to see any effect of ACE inhibitors on DR," they add.

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