title: Association between high-normal albuminuria and risk factors for cardiovascular and renal disease in essential hypertensive men.
abstract: BACKGROUND
  Microalbuminuria (overnight urinary albumin excretion [UAE] > 15 microg/min) is associated with cardiovascular risk factors and predicts morbid events in hypertensive subjects. However, albuminuria is not a dichotomous variable, and a relationship with cardiovascular risk factors may extend below that conventional threshold.
  
  
  METHODS
  We studied 186 never-treated, glucose-tolerant, normalbuminuric (overnight UAE < or = 15 microg/min), essential hypertensive men with normal renal function (serum creatinine < 1.4 mg/dL). Study variables were 24-hour ambulatory blood pressure (BP), cardiac structure and geometry (by echocardiography), body weight, fasting insulin levels, insulin sensitivity (the Homeostasis Model Assessment index), and creatinine clearance (from overnight collections or through the Cockcroft formula) analyzed as a function of ascending urine albumin quartiles (cutoff values, 4.3, 6.3, and 9.4 microg/min; n = 47, 45, 47, and 47, respectively).
  
  
  RESULTS
  As compared with the three bottom fourths, patients with high-normal albuminuria (albumin, 9.4 to 15 microg/min) had a greater 24-hour BP, greater relative wall thickness, more frequent concentric left ventricular hypertrophy, heavier body size, increased fasting insulin levels, reduced insulin sensitivity, and greater creatinine clearance.
  
  
  CONCLUSIONS
  High-normal albuminuria in uncomplicated essential hypertensive men is associated with an adverse cardiovascular and metabolic risk profile. Furthermore, hyperfiltration in the presence of minimally increased albuminuria may underlie an augmented glomerular blood flow and hydraulic pressure conducive to glomerular hypertension and, eventually, renal insufficiency. Overall, these data confirm the appropriateness to shift downward the limits for diagnosing microalbuminuria in essential hypertension, as indicated from previous prospective studies.
authors.affiliation: Dipartimentos Cardio Toracico and Diabetologia, Università di Pisa, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Dell'Omo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Penno
authors.forename: Davide
authors.initials: D
authors.lastname: Giorgi
authors.forename: Vitantonio
authors.initials: V
authors.lastname: Di Bello
authors.forename: Mario
authors.initials: M
authors.lastname: Mariani
authors.forename: Roberto
authors.initials: R
authors.lastname: Pedrinelli
mesh_terms: D000419:Albuminuria / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology* / Q000652:urine; D003404:Creatinine / Q000097:blood / Q000652:urine; D003430:Cross-Sectional Studies; D005544:Forecasting; D018149:Glucose Intolerance; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000503:physiopathology / Q000652:urine; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000503:physiopathology / Q000652:urine; D007328:Insulin / Q000097:blood; D007668:Kidney / Q000098:blood supply / Q000503:physiopathology; D007674:Kidney Diseases / Q000097:blood / Q000209:etiology* / Q000652:urine; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D007328:Insulin; D008055:Lipids; D003404:Creatinine