“We will never again have such a large study in diabetic retinopathy,” observed Dr. Kristian Hanssen, an independent commentator and professor of medicine at Aker University Hospital in Oslo. He suggested that it probably doesn't matter whether patients use an ARB or an ACE inhibitor; maintaining a low blood pressure—possibly as low as 120/80 mm Hg—is what's important.
“The take-home message is ARBs or ACE inhibitors are indicated in patients with risk of progression into retinopathy,” Dr. Hanssen said. They should also be considered in those patients with existing eye disease. The study data, together with those from other large-scale studies, should be used to create a “risk engine” to help clinicians diagnose retinopathy in their patients.
Dr. Sjolie, Dr. Chaturvedi, and Dr. Bilous disclosed receiving honoraria to attend DIRECT steering committee meetings from the study program's sponsors, AstraZeneca and Takeda. Dr. Hanssen reported no conflicts of interest.
'ARBs or ACE inhibitors are indicated in patients with risk of progression into retinopathy.' DR. HANSSEN