Microalbuminuria in essential hypertension

Urinary excretion of albumin exceeds normal values in 10 to 25% of patients with essential hypertension. The lever of albuminuria is highly correlated with arterial pressure, and more closely with ambulatory arterial pressure . The interaction between albuminuria and arterial pressure is enhanced by overweight, smoking, protein intake, insulin resistance, lipid abnormalitie s, and possibly genotypes of the components of the renin-angiotensin system . The renal mechanisms of microalbuminuria are not well elucidated. Notably , an increase in filtration fraction suggestive of intraglomerular hyperten sion was observed in patients with hyperfiltration. Microalbuminuria may be a marker of diffuse vascular abnormalities predisposing to cardiovascular disease and/or hypertensive renal disease heralding future renal failure, b ut its predictive value needs to be tested in more long-term follow-up stud ies. Antihypertensive treatment has a varied influence on albuminuria; angi otensin-converting enzyme inhibitors may correct this abnormality (at least partially) better than other agents. Curr Opin Nephrol Hypertens 8:359-363 . (C) 1999 Lippincott Williams & Wilkins.