Regression of albuminuria: latest evidence for a new approach.
OBJECTIVE
To review the latest studies on antihypertensive strategies in the treatment of microalbuminuria, in order to highlight the association of microalbuminuria with hypertension and type 2 diabetes, the evidence for microalbuminuria as a risk factor for target-organ damage and mortality, and the prognostic significance of regression of microalbuminuria.


METHODS
Randomized controlled trials in patients with hypertension, type 2 (non-insulin-dependent) diabetes mellitus and microalbuminuria, with changes in albumin excretion rate (AER) as a primary outcome measure.


RESULTS
Antihypertensive treatment is the most effective method for reducing microalbuminuria. Although microalbuminuria regression is related to reduction in blood pressure, antihypertensive drugs acting on the renin-angiotensin system have an antiproteinuric effect that is additional to that of blood pressure reduction. The combination of these agents with diuretics, even when used in low doses, may further reduce AER in these patients.


CONCLUSIONS
Blockade of the renin-angiotensin system with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers is a most effective means of treating microalbuminuria and preventing its progression to overt nephropathy and, perhaps, the associated cardiovascular disease. The effect of this strategy may be improved further with the use, as first-line treatment, of a combination of angiotensin-converting enzyme inhibitor and diuretic.
Viberti
Giancarlo
G
Department of Diabetes, Endocrinology and Internal Medicine, Guy's, King's and St Thomas' School of Medicine, 5th Floor, Thomas Guy House, King's College London Guy's Hospital, London SE1 9RT, UK. giancarlo.viberti@kcl.ac.uk
D000419:Albuminuria / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D012084:Renin-Angiotensin System / Q000187:drug effects; D014481:United States / Q000453:epidemiology
D000959:Antihypertensive Agents