OBJECTIVES: About 80% of individuals with type 2 diabetes (T2D) also experience hypertension. The relationship between antihypertensive drugs and the risk of sight-threatening diabetic retinopathy (STDR) is not well-established. This study investigates the relationship between the use of angiotensin receptor blockers (ARBs) and the risk of STDR in T2D patients, compared with angiotensin-converting enzyme inhibitors (ACEis).

METHODS: This new-user comparative effectiveness study involved adults (≥18 years) with T2D who were prescribed ACEis and ARBs as recorded in the Clinical Practice Research Datalink (a UK primary care database) from January 1, 2000, to June 30, 2022. The main outcome was the incidence of STDR. Competing risk Cox proportional hazard regression models were used to determine the crude and adjusted hazard ratios (aHR) of STDR incidence.

RESULTS: The study included 356,944 new ACEis users (mean [SD] age: 64.2 [12.8] years; 199,246 [56%] male) and 172,424 new ARBs users (66.9 [11.7] years; 87,386 [50.7%] male). Over a median follow-up of 5.5 years, the incidence of STDR was 19.2 per 1,000 person-years in the ARBs group and 16.1 per 1,000 person-years in the ACEis group. The crude HR was 1.07 (95% CI 1.05 to 1.09) and the aHR was 1.02 (1.00 to 1.04), which indicates no significant difference in the risk of STDR between ACEis and ARBs in T2D patients

CONCLUSIONS: The findings suggest no significant difference in the risk of STDR between the use of ACEis and ARBs in individuals with T2D.