MICROALBUMINURIA - A MARKER OF CARDIOVASCULAR RISK AND ORGAN DAMAGE IN ESSENTIAL-HYPERTENSION

Microalbuminuria (Mi) is thought to reflect diffuse vascular damage an d to predict cardiovascular morbidity and mortality in essential hyper tension, although its pathogenesis remains to be fully elucidated. The relationship between microalbuminuria and several cardiovascular risk factors and target organ damage was evaluated in a large cohort of un treated essential hypertensive patients. Albuminuria was measured as t he albumin to creatinine ratio in three non consecutive first morning urine samples. Cardiac damage was evaluated by ECG and retinal vascula r changes by direct ophtalmoscopy. Ln a subgroup of 23 patients with M i and in a control group of 22 normoalbuminurics, selected from the en tire cohort of patients and carefully matched for age, gender, body ma ss index (BMI) and duration of disease, we also measured left ventricu lar mass index by M-B mode echocardiography, common carotid wall thick ness by high resolution US-scan, and renal vascular resistances by US- doppler of interlobar arteries. K-means cluster analysis performed on the entire cohort of patients showed that microalbuminuria is associat ed with the presence of an unfavorable risk profile and target organ d amage. Furthermore, microalbuminuric hypertensive patients have a larg er left ventricular mass index, increased intima media thickness of ca rotid arteries and higher intrarenal vascular resistances as compared to a well matched group of normoalbuminuric patients. We conclude that in essential hypertension increased urinary albumin excretion can be useful to identify patients for whom more aggressive preventive strate gies and/or additional treatment measures are advisable.