ALBUMINURIA AND TRANSFERRINURIA IN ESSENTIAL-HYPERTENSION - EFFECTS OF ANTIHYPERTENSIVE THERAPY

The objectives of this study were to evaluate the effects of an ACE in hibitor (fosinopril) and a calcium antagonist (amlodipine) on the urin ary albumin and transferrin excretion and their relationship to the bl ood pressure in essential hypertension. Twenty-four never-treated pati ents (mean age, 46.4 +/- 8.9 years) with a diastolic blood pressure be tween 90 and 114 mm Hg and normal renal function, randomly received am lodipine or fosinopril and, if the diastolic blood pressure was not no rmalized, doxazosin was added to the therapy. Twenty-four-hour ambulat ory blood pressure monitoring and 24-h urine collection for albumin an d transferrin measurements were performed before and after 3 and 6 mon ths of therapy. Diastolic blood pressure was normalized in 23 patients (96%). Before treatment, microalbuminuria was present in 50% of patie nts. In the amlodipine and fosinopril group, antihypertensive therapy significantly decreased blood pressure and, only in the fosinopril gro up, albuminuria, Transferrinuria did not change significantly in both groups. Fosinopril lowered albuminuria in all patients, whereas amlodi pine only in half of patients, Albuminuria, but not transferrinuria, w as significantly correlated to the ambulatory blood pressure. This cor relation was more pronounced for systolic than for diastolic pressure. In essential hypertensive patients with normal renal function, a high prevalence of microalbuminuria can be observed. Albuminuria appears t o correlate with ambulatory blood pressure, particularly with systolic pressure. Intrarenal hemodynamic changes seem to play a more importan t role than systemic blood pressure decrease in the reduction of album inuria. Transferrinuria does not seem a useful marker to follow-up non diabetic hypertensive patients with early signs of glomerular dysfunct ion.