lisinopril and Retinal-Diseases

Hypertension causes arteriolar narrowing and rarefaction in the retinal circulation, but the extent to which these changes are reversible by antihypertensive treatment is not well studied. We compared the effect of antihypertensive treatment with a calcium-channel-blocker-based regimen and an angiotensin-converting-enzyme-inhibitor-based regimen on the retinal microvasculature.. Twenty-five patients (17 men, age range 24-71 years) with untreated hypertension were randomized to treatment with an amlodipine-based (n = 12) or lisinopril-based (n = 13) regimen in a double-blind, prospective parallel limb trial for 52 weeks. Measurements of blood pressure and the retinal microvasculature were made at baseline and at the end of the study.. Both the amlodipine-based and lisinopril-based treatments reduced blood pressure to similar extents. Blood pressure reduction was associated with a reduction in arteriolar narrowing, a widening of arteriolar branch angle and an increase in arteriolar density. There were no significant differences between the two treatment regimens.. Antihypertensive treatment is associated with improvement in arteriolar narrowing and rarefaction. Improved microvascular structure may contribute to the beneficial effects of antihypertensive treatment in hypertension.

Topics: Adult; Amlodipine; Antihypertensive Agents; Blood Pressure; Female; Humans; Hypertension; Lisinopril; Male; Microcirculation; Middle Aged; Retinal Diseases; Retinal Vessels; Treatment Outcome

To report the role of retinal hypoxia in development of diabetic macular edema and its management--a new concept.. A 24-year-old diabetic female was seen with bilateral visual blurring for 3 weeks, associated with marked diabetic macular edema, diabetic retinopathy, and non-arteritic anterior ischemic optic neuropathy (NA-AION) in both eyes. She was taking three blood pressure lowering drugs for diabetic neuropathy and nephropathy. Stopping two of those arterial hypotensive drugs, without any of the conventional treatments for diabetic macular edema, resulted in rapid improvement of visual acuity from counting fingers to 20/50 in the right eye, and from 20/80 to 20/25 in the left eye, and complete resolution of macular edema and improvement of retinopathy. Similarly, visual field defects in both eyes improved to almost normal.. The evidence from this diabetic patient suggests that hypoxia caused by fall in perfusion pressure in the retinal capillaries may be playing an important role in the development of diabetic macular edema in some, perhaps many, of these cases.

Topics: Adult; Blood Pressure; Diabetic Nephropathies; Diabetic Retinopathy; Female; Fluorescein Angiography; Follow-Up Studies; gamma-Aminobutyric Acid; Humans; Hypoxia; Insulin; Lisinopril; Macular Edema; Optic Neuropathy, Ischemic; Pregabalin; Proteinuria; Retinal Diseases; Tomography, Optical Coherence; Tramadol; Vision Disorders; Visual Acuity; Visual Field Tests; Visual Fields

Topics: Blood Pressure; Diabetic Retinopathy; Fluorescein Angiography; gamma-Aminobutyric Acid; Humans; Hypoxia; Insulin; Lisinopril; Macular Edema; Optic Neuropathy, Ischemic; Pregabalin; Proteinuria; Retinal Diseases; Retinal Vein Occlusion; Tomography, Optical Coherence; Tramadol; Vision Disorders; Visual Acuity; Visual Fields