Role of blood pressure in development of early retinopathy in adolescents with type 1 diabetes: prospective cohort study.
OBJECTIVE
To examine the relation between blood pressure and the development of early retinopathy in adolescents with childhood onset type 1 diabetes.


METHODS
Prospective cohort study.


METHODS
Diabetes Complications Assessment Service at the Children's Hospital at Westmead, Sydney, Australia.


METHODS
1869 patients with type 1 diabetes (54% female) screened for retinopathy with baseline median age 13.4 (interquartile range 12.0-15.2) years, duration 4.9 (3.1-7.0) years, and albumin excretion rate of 4.4 (3.1-6.8) microg/min plus a subgroup of 1093 patients retinopathy-free at baseline and followed for a median 4.1 (2.4-6.6) years.


METHODS
Early background retinopathy; blood pressure.


RESULTS
Overall, retinopathy developed in 673 (36%) participants at any time point. In the retinopathy-free group, higher systolic blood pressure (odds ratio 1.01, 95% confidence interval 1.003 to 1.02) and diastolic blood pressure (1.01, 1.002 to 1.03) were predictors of retinopathy, after adjustment for albumin excretion rate (1.27, 1.13 to 1.42), haemoglobin A(1c) (1.08, 1.02 to 1.15), duration of diabetes (1.16, 1.13 to 1.19), age (1.13, 1.08 to 1.17), and height (0.98, 0.97 to 0.99). In a subgroup of 1025 patients with albumin excretion rate below 7.5 microg/min, the cumulative risk of retinopathy at 10 years' duration of diabetes was higher for those with systolic blood pressure on or above the 90th centile compared with those below the 90th centile (58% v 35%, P=0.03). The risk was also higher for patients with diastolic blood pressure on or above the 90th centile compared with those below the 90th centile (57% v 35%, P=0.005).


CONCLUSIONS
Both systolic and diastolic blood pressure are predictors of retinopathy and increase the probability of early retinopathy independently of incipient nephropathy in young patients with type 1 diabetes.
Gallego
Patricia Herold
PH
Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia.
Craig
Maria E
ME
Hing
Stephen
S
Donaghue
Kim C
KC
D000293:Adolescent; D000419:Albuminuria / Q000150:complications; D001794:Blood Pressure / Q000502:physiology*; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000503:physiopathology* / Q000652:urine; D003925:Diabetic Angiopathies / Q000150:complications / Q000503:physiopathology* / Q000652:urine; D003928:Diabetic Nephropathies / Q000150:complications / Q000503:physiopathology / Q000652:urine; D003930:Diabetic Retinopathy / Q000150:complications / Q000503:physiopathology* / Q000652:urine; D004812:Epidemiologic Methods; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology* / Q000652:urine; D008297:Male