HIGH PREVALENCE OF HYPERTENSIVE RETINOPATHY AND CORONARY HEART-DISEASE IN HYPERTENSIVE PATIENTS WITH PERSISTENT MICROALBUMINURIA UNDER SHORT INTENSIVE ANTIHYPERTENSIVE THERAPY

In 84 patients with insufficiently treated essential hypertension (sys tolic blood pressure greater than or equal to 160 mmHg and/or diastoli c blood pressure greater than or equal to 100 mmHg) and normal renal f unction (creatinine clearance Mean +/- SD = 114 +/- 22 ml/min/1.73 m(2 )) the mean urinary albumin excretion was 39 +/- 19 mg/24h in comparis on to 14 +/- 13 mg/24h (p <0.001) in 10 healthy controls. In 39 of the hypertensive patients albumin excretion was increased (>30 mg/24h uri ne) in a subclinical range (microalbuminuria). After 3 days of effecti ve antihypertensive treatment (systolic blood pressure <150 mmHg and d iastolic blood pressure <90 mmHg) the mean albumin excretion of the mi croalbuminuric patients decreased from 66 +/- 33 mg/24h to 44 +/- 28 m g/24h (p <0.01). 27 of these hypertensive patients showed persistent m icroalbuminuria; in the other 12 patients with primary microalbuminuri a the albumin excretion rate was normal now. In the patients with pers istent microalbuminuria the prevalence of hypertensive retinopathy was 85% in comparison to only 33% in the patients with reversible microal buminuria under intensified antihypertensive treatment (p <0.01) and 3 1% in the patients with primary normoalbuminuria. The prevalence of co ronary heart disease was 11% in the patients with normoalbuminuria and 29% in those with irreversible microalbuminuria (ns). Thus hypertensi ve patients with persistent but not with reversible microalbuminuria u nder short intensive antihypertensive therapy show a statistically sig nificant higher prevalence of hypertensive retinopathy and therefore c an be considered as an indicator of general microvascular damage in es sential hypertension.