MICROALBUMINURIA AS A MARKER OF VASCULAR DAMAGE IN HYPERTENSION - INFLUENCE OF BLOOD-PRESSURE AND METABOLIC PATTERNS

It has long been shown that in diabetes mellitus, microalbuminuria pre dicts the development of nephropathy and is associated with a high pre valence of cardiac and vascular disease. In on diabetic hypertensive p atients, a prevalence of microalbuminuria ranging form 14% to 40% has been observed. Among the studies performed in hypertensive patients, t his frequency of microalbuminuria increases with the degree of hyperte nsion, and microalbuminuric hypertensive patients had higher rates of cardiac and vascular disease. Indeed, in our studies, microalbuminuria was associated with higher blood pressure levels, both clinic and 24h mean-, and with a slighter nocturnal decrease in blood pressure. More over, it was accompanied by higher values of body mass index and left ventricular mass as well as by increased prevalence of retinopathy. In hypertensive patients with central obesity, microalbuminuria correlat ed with BMI and fasting IRI/glucose ratio. Injury to endothelial cells is associated with increased secretion of the von Willebrand Factor ( vWF) levels reflect endothelial injury in patients with microalbuminur ia, inasmuch as elevated vWF levels were closely related to an increas ed urinary albumin excretion rate. The linkage between microalbuminuri a and endothelial injury is an attractive explanation for atherosclero tic cardiovascular disease, because changes in carotid artery thicknes s in microalbuminuric hypertensives have also been observed. Interesti ngly, significant correlations have been reported between carotid arte ry thickness, microalbuminuria and plasma lipid abnormalities. These d ata suggest that the assay of microalbuminuria may be useful in the fo llow-up of cardiovascular and renal changes in arterial hypertension. (C) 1997, Medikal Press.