Microalbuminuria as a predictive factor for cardiovascular events

We tested the hypothesis that microalbuminuria screening in a general pract ice setting would identify high-risk nondiabetic hypertensive patients, and we measured microalbuminuria response to drug treatment. General practitio ners were enrolled who had collected medical histories and performed physic al examinations and routine laboratory tests in more than 11,000 untreated hypertensive, nondiabetic patients. Microalbuminuria was measured with an a lbumin-sensitive immunoassay test strip. The patients' mean age was 57 year s, 51% were men, and mean duration of hypertension was 69 months. Twenty-fi ve percent of patients had coronary artery disease (CAD), 17% had left vent ricular hypertrophy (LVH), 5% had had a stroke, and 6% had peripheral vascu lar disease (PVD). Microalbuminuria was present in 32% of men and 28% of wo men. In patients with microalbuminuria, 31% had CAD, 24% had LVH, 6% had ha d a stroke, and 7% had PVD. In patients without microalbuminuria, all of th ese rates were significantly lower: 22%, 14%, 4%, and 5%, respectively (p < 0.001). Furthermore, in patients with CAD, LVH, stroke, or PVD, microalbum inuria was significantly greater than in patients who did not have these co mplications (p < 0.001). A multiple stepwise regression analysis with micro albuminuria as the dependent variable showed microalbuminuria depended on t he following factors, in order of importance: systolic blood pressure, reti nopathy, CAD, diastolic blood pressure, and LVH (all p < 0.0001). A multipl e stepwise regression analysis with each of the concomitant diseases as the dependent variable showed that microalbuminuria was an independent and sig nificant variable for each of the conditions. The patients were assigned to monotherapy with either angiotensin-converting enzyme (ACE) inhibitors, be ta-blockers, calcium antagonists, or diuretics. All of the drugs reduced mi croalbuminuria, although the beta-blocker carvedilol was superior (p < 0.05 ). We concluded microalbuminuria is an important risk factor that can be in fluenced by treatment.