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Urinary albumin excretion, endothelial dysfunction and cardiovascular risk: study in Bartter's/Gitelman's syndromes and relevance for hypertension

Journal of Human Hypertension volume 21, pages 904–906 (2007)Cite this article

Increased urinary albumin excretion in uncomplicated hypertension has been associated recently with impaired vascular reactivity (nitric oxide (NO)-dependent and -independent vasodilation)1 and increased levels of adhesion molecules,2 thereby suggesting that endothelial dysfunction is responsible for the increased cardiovascular (CV) risk associated with albuminuria.1, 2 In light of these reports, we have used our human model of vascular tone control, Bartter's/Gitelman's syndromes (BS/GS) patients who have biochemical and hormonal characteristics typical of hypertension, yet normotension/hypotension, hyporesponsiveness to pressors and have reduced vascular resistance,3, 4, 5 to assess the urinary albumin/creatinine ratio (UACR) as a potential marker of endothelial dysfunction. We found that UACR in BS/GS did not differ from healthy subjects, contrary to that found in hypertensive patients, thereby indirectly providing further support for the fact that increased UACR reflects endothelial dysfunction and its associated increased CV risk.

Microalbuminuria (urinary albumin excretion of 30–300 mg/24 h or 20–200 mg/min) in patients with essential hypertension predicts the decline of renal function and is associated with target organ damage and increased risk of adverse CV events,6, 7 while the reduction of microalbuminuria with antihypertensive treatment is accompanied by a decrease in CV risk. The recent association found in hypertensive subjects between increased urinary albumin excretion and impaired vascular reactivity (NO-dependent and -independent vasodilation)1 and greater levels of adhesion molecules2 points toward a potential mechanism linking the increased albuminuria with CV risk via the early induction of endothelial dysfunction.1, 2 The possibility of confirming this mechanism could come from the study of a human model for vascular tone and structure regulation, which has biochemical and hormonal characteristics typical of hypertension, yet hyporesponsive to pressors and has reduced vascular resistance and normotension/hypotension, such as BS/GS.3, 4, 5

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Authors and Affiliations

  1. Department of Clinical and Experimental Medicine, Clinica Medica 4, University of Padova, Padova, Italy

    L A Calò, P Palatini, A Semplicini & A C Pessina

  2. Department of Nutrition, University of California, Davis, CA, USA

    P A Davis

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  1. L A Calò
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  2. P A Davis
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  3. P Palatini
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  4. A Semplicini
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  5. A C Pessina
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Correspondence to L A Calò.

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Calò, L., Davis, P., Palatini, P. et al. Urinary albumin excretion, endothelial dysfunction and cardiovascular risk: study in Bartter's/Gitelman's syndromes and relevance for hypertension. J Hum Hypertens 21, 904–906 (2007). https://doi.org/10.1038/sj.jhh.1002231

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