Abstract
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.
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References
Mogensen CE et al. Microalbuminuria an early marker of renal involvement in diabetes Uremia Invest 1985–86 9: 85–95
Deckert T et al. Microalbuminuria. Implications for micro- and macrovascular disease Diabetes Care 1992 15: 1181–1191
Mogensen CE . Microalbuminuria predicts clinical proteinuria and early mortality in maturity onset diabetes N Engl J Med 1984 310: 356–360
Damsgaard EM et al. Microalbuminuria is a predictor of increased mortality in elderly people Br Med J 1990 300: 297–300
Yudkin JS, Jackson CA . Microalbuminuria as predictor of vascular disease in non-diabetic subjects Lancet 1988 ii: 530–533
Jensen JS et al. Arterial hypertension, microalbuminuria, and risk of ischemic heart disease Hypertension 2000 35: 898–903
Parving HH . Microalbuminuria in essential hypertension and diabetes mellitus J Hypertens 1996 14 (Suppl 2): S89–S93
Marre M, Bouhanick B, Berrut G . Microalbuminuria In: Brenner D (ed) Current Opinion in Nephrology and Hypertension Current Science: Philadelphia 1994 pp 558–5638
Hömer D, Fliser D, Klimm HP, Ritz E . Albuminuria in normotensive and hypertensive individuals attending office of general practitioners J Hypertens 1996 14: 655–660
Redon J et al. Factors related to the presence of microalbuminuria in essential hypertension Am J Hypertens 1994 7: 801–807
Cirillo M et al. Pulse pressure and isolated systolic hypertension: association with albuminuria Kidney Int 2000 58: 1211–1218
Crippa G . Usefulness and limits of ambulatory blood pressure monitoring Ann Ital Med Int 2000 15: 63–69
Crippa G et al. Blood pressure variation and regulation in man In: Velasco M, Hernandez R (eds) New Advances in Cardiovascular Physiology and Pharmacology Elsevier Science: Amsterdam 1988 pp 19–24
Cuspidi C et al. Prevalence of target organ damage in treated hypertensivepatients: different impact of clinic and ambulatory blood pressure control J Hypertens 2000 18: 803–809
Bigazzi et al. Increased thickness of the carotid artery inpatients with essential hypertension and microalbuminuria J Hum Hypertens 1995 9: 827–833
Agrawal B, Berger A, Wolf K, Luft FC . Microalbuminuria screening by reagent strips predicts cardiovascular risk in hypertension J Hypertens 1996 14: 223–228
Jensen JS et al. Microalbuminuria in arterial hypertension: relation to cardiovascular disease and antihypertensive agents J Hum Hypertens 1997 11: 727–732
Pedrinelli P et al. Microalbuminuria and endothelial dysfunction in essential hypertension Lancet 1994 344: 14–18
Rostand SG et al. Renal insufficiency in treated essential hypertension N Engl J Med 1989 320: 684–686
Erley CM, Holzer M, Kramer BK, Risler T . Renal haemodynamics and organ damage in young hypertensivepatients with different plasma renin activities after ACE inhibition Nephrol Dial Transplant 1992 7: 216–220
Mattei P et al. Microalbuminuria and renal haemodynamics in essential hypertension Eur J Clin Invest 1997 27: 755–760
Berrut G et al. Loss of the nocturnal decline in blood pressure in subjects with essential hypertension and microalbuminuria Blood Press Monit 1996 1: 469–473
Welton PK, Klag MJ . Hypertension as a risk factor for renal disease: review of clinical and epidemiological evidence Hypertension 1989 13 (Suppl I): I19–I17
Redon J . Renal protection by antihypertensive drugs: insight from microalbuminuria studies J Hypertens 1998 16: 2091–2100
Dworkin LD et al. Calcium antagonists and converting enzyme inhibitors reduce renal injury by different mechanisms Kidney Int 1993 43: 808–813
Smith AC, Toto R, Bakris GT . Differential effects of calcium channel blockers on size selectivity of proteinuria in diabetic glomerulopathy Kidney Int 1998 54: 899–904
Persson B et al. Calcium antagonism in essential hypertension: effects on renal haemodynamics and microalbuminuria J Intern Med 1992 231: 247–251
DeQuattro V, Lee DP . Equivalent reduction of proteinuria in hypertensive by either nifedipine GITS or enalapril: disparate effects on neurohormons and ambulatory blood pressure and the influence of salt Cardiology 1997 88 (Suppl 3): 38–42
Crippa G, Sverzellati E, Antoniotti P, Carrara GC . Effect of different antihypertensive drugs on albumin excretion in hypertensivepatients J Cardiovasc Drugs Ther 1999 13: 62 (abstract)
Crippa G et al. Effect of nifedipine on urinary protein excretion in hypertensivepatients Am J Hypertens 1999 12: 116 (abstract)
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Crippa, G. Microalbuminuria in essential hypertension. J Hum Hypertens 16 (Suppl 1), S74–S77 (2002). https://doi.org/10.1038/sj.jhh.1001348
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DOI: https://doi.org/10.1038/sj.jhh.1001348
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