Stephenson, Judith M.; (1994) Nephropathy, retinopathy and blood pressure in insulin dependent diabetes mellitus. Doctoral thesis (M.D), UCL (University College London).

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Abstract

The relation of blood pressure to the renal and retinal complications of insulin dependent diabetes was examined in a cross-sectional analysis of 3250 clinic- attending patients from 31 centres in Europe (the EURODIAB IDDM Complications Study). In addition, the hypothesis that susceptibility to diabetic nephropathy can be identified by a parental history of hypertension was examined. The relation between blood pressure and albumin excretion differed strikingly between patients with and without retinopathy. This original finding has not been reported before. In patients without retinopathy, albumin excretion was low even when blood pressure was high and glycaemic control poor. In patients with retinopathy, albumin excretion increased steeply with blood pressure above the median (120/75 mmHg). Thus albumin excretion tended to be high only in patients with both raised blood pressure and retinopathy. The prevalence of retinopathy increased with blood pressure, but the association was prominent only in patients with raised albumin excretion, in whom proliferative retinopathy was two to three times more frequent when blood pressure was above 105/65 mmHg than below this level. Both blood pressure and albumin excretion were higher in patients reporting a parental history of hypertension than in patients reporting no parental hypertension. However, parental hypertension made no contribution to the relation between blood pressure and albumin excretion independent of blood pressure in the offspring. These data suggest that patients with retinopathy are particularly vulnerable to the effect of raised blood pressure on the kidney. This offers a plausible explanation for the well known observation that nephropathy without retinopathy is rare, while retinopathy without nephropathy is common. The hypothesis that susceptibility to diabetic nephropathy is determined by a genetic disposition to hypertension is not supported by this study. Rather, it is suggested that patients at high risk of nephropathy can be distinguished by the presence of both retinopathy and raised (above median) blood pressure, irrespective of parental hypertension.

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