CLINICAL QUESTION

Does blood pressure (BP) control prevent diabetic retinopathy or slow its progression?

EVIDENCE-BASED ANSWER

More intensive BP control in patients with diabetes mellitus and hypertension decreases the incidence of diabetic retinopathy, especially among those with higher BP.¹ There are many definitions for more intensive BP control, from a diastolic BP of less than 75 mm Hg to a BP target of less than 135/75 mm Hg or a systolic BP of less than 120 mm Hg; nonintensive control is typically a systolic BP of less than 140 mm Hg.¹ (Strength of Recommendation [SOR]: A, consistent, good-quality patient-oriented evidence.)

More intensive BP control does not slow the progression of diabetic retinopathy once it has developed. Reduction of BP in normotensive people with diabetes does not prevent or slow diabetic retinopathy. (SOR: B, inconsistent or limited-quality patient-oriented evidence.) Treatment of hypertension increases the risk of hypotension (risk ratio [RR] = 2.04; 95% CI, 1.63 to 2.55).¹ (SOR: A, consistent, good-quality patient-oriented evidence.)