Microalbuminuria in essential hypertension

• Published in: Journal of human hypertension Vol. 16; no. S1; pp. 74 - 77
• Main Author: CRIPPA, G
• Format: Conference Proceeding Journal Article
• Language: English
• Published: Basingstoke Nature Publishing 01-03-2002; Nature Publishing Group
• Subjects: Albumin; Albuminuria - etiology; Albuminuria - physiopathology; Angiotensin; Angiotensin II; Angiotensin-converting enzyme inhibitors; Antihypertensive Agents - therapeutic use; Antihypertensives; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood pressure; Cardiology. Vascular system; Cardiovascular diseases; Cardiovascular Diseases - etiology; Cardiovascular Diseases - physiopathology; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Coronary artery disease; Diabetes; Diabetes Complications; Diabetes mellitus (insulin dependent); Diabetes mellitus (non-insulin dependent); Diabetes Mellitus - physiopathology; Diabetic nephropathy; Excretion; Heart diseases; Humans; Hypertension; Hypertension - complications; Hypertension - drug therapy; Hypertension - physiopathology; Insulin; Ischemia; Kidney diseases; Kidney Diseases - etiology; Kidney Diseases - physiopathology; Kidneys; Medical sciences; Nephropathy; Patients; Peptidyl-dipeptidase A; Renal insufficiency; Risk Factors; Human; Hypertension; Urinary system disease; Prognosis; Albumin; Cardiovascular disease; Microalbuminuria; Proteinuria
• ISSN: 0950-9240; 1476-5527
• DOI: 10.1038/sj.jhh.1001348

Microalbuminuria (urinary albumin excretion equal to 30-300 mg/24 h) is a reliable indicator of premature cardiovascular mortality in diabetic patients and in the general population. In insulin-dependent and non-insulin-dependent diabetes mellitus microalbuminuria is a marker of initial diabetic nephropathy and predicts the evolution toward renal insufficiency. In essential hypertension the clinical and prognostic role of microalbuminuria is more controversial. While it is a recognised marker of cardiovascular complications and a reliable predictor of ischaemic heart disease, its prognostic value on the risk of progressive renal alterations is still uncertain because no prospective studies, taking microalbuminuria as a selection criterion and renal insufficiency as an end point, are available. Blood pressure control with antihypertensive drugs is accompanied by a reduction in urinary albumin excretion. The favourable effects of antihypertensive agents on microalbuminuria appear to be proportional to blood pressure reduction, but angiotensin-converting enzyme inhibitors and angiotensin-II-receptor antagonists show an additional beneficial effect on urinary albumin excretion. Whether the reduction of microalbuminuria obtained through pharmacological intervention has favourable prognostic implications remain to be demonstrated. However, screening for microalbuminuria is a relatively easy and inexpensive procedure and reveals a potentially treatable abnormality. Thus, considering that microalbuminuria identifies hypertensive subjects at higher risk than standard, urinary albumin excretion should be routinely measured in hypertensive patients and, in the presence of microalbuminuria, antihypertensive treatment should be intensified in order to obtain an optimal blood pressure control.