Microalbuminuria in essential hypertension: Significance, pathophysiology,and therapeutic implications

Some patients with essential hypertension manifest greater than normal urin ary albumin excretion (UAE), The significance of this association, which is the object of this review, is not well established. Hypertensive patients with microalbuminuria manifest greater levels of blood pressure, particular ly at night, and higher serum levels of cholesterol, triglycerides, and uri c acid than patients with normal UAE, Levels of high-density lipoprotein ch olesterol, on the other hand, were lower in patients with microalbuminuria than in those with normal UAE, Patients with microalbuminuria manifested gr eater incidence of insulin resistance and thicker carotid arteries than pat ients with normal UAE, After a follow-up of 7 years, we observed that 12 ca rdiovascular events occurred among 54 (21.3%) patients with microalbuminuri a and only two such events among 87 patients with normal UAE (P < 0.0002), Stepwise logistic regression analysis showed that UAE, cholesterol: level, and diastolic blood pressure were independent predictors of the cardiovascu lar outcome. Rate of creatinine clearance from patients with microalbuminur ia decreased more than that from those with normal UAE, In conclusion, thes e studies suggest that hypertensive individuals with microalbuminuria manif est a variety of biochemical and hormonal derangements with pathogenic pote ntial, which results in hypertensive patients having a greater incidence of cardiovascular events and a greater decline in renal function than patient s with normal UAE, (C) 1999 by the National Kidney Foundation, Inc.