title: Microalbuminuria and cardiovascular risk assessment in primary hypertension: should threshold levels be revised?
abstract: BACKGROUND
  Urinary albumin excretion and left ventricular mass are related to each other and to the risk of cardiovascular events in patients with primary hypertension. We aimed to identify a lower threshold for albuminuria that might improve detection of patients with left ventricular hypertrophy (LVH) and cost-effectiveness in cardiovascular risk assessment.
  
  
  METHODS
  Albuminuria and left ventricular mass index were assessed in 448 untreated, nondiabetic patients with primary hypertension. The impact that lower albuminuria cut-off levels might have on detecting LVH was evaluated with regard to test cost and sensitivity. This was done by a diagnostic algorithm consisting of albuminuria evaluation followed by echocardiography in the presence of normoalbuminuria.
  
  
  RESULTS
  The area under the ROC curve of albuminuria in predicting LVH was 0.73. Using a lower albumin to creatinine ratio threshold than what is recommended by the guidelines (ie, 11.5 mg/g), the sensitivity and specificity of albuminuria in identifying patients with LVH was 39% and 92%, respectively, which translated to positive and negative predictive values of 76% and 69%, respectively. When considering only patients without electrocardiographically detected LVH, routine screening for albuminuria, followed by echocardiography in the presence of albuminuria <or = 11.5 mg/g, allowed us to decrease the number of echocardiograms by 23%.
  
  
  CONCLUSIONS
  Adopting a lower threshold to define microalbuminuria could prove to be cost-effective for assessing cardiovascular risk in hypertensive patients.
authors.affiliation: Department of Cardio-Nephrology, Azienda Ospedaliera Universitaria San Martino, Genoa, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Ratto
authors.forename: Giovanna
authors.initials: G
authors.lastname: Leoncini
authors.forename: Francesca
authors.initials: F
authors.lastname: Viazzi
authors.forename: Valentina
authors.initials: V
authors.lastname: Vaccaro
authors.forename: Angelica
authors.initials: A
authors.lastname: Parodi
authors.forename: Valeria
authors.initials: V
authors.lastname: Falqui
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Bezante
authors.forename: Cinzia
authors.initials: C
authors.lastname: Tomolillo
authors.forename: Giacomo
authors.initials: G
authors.lastname: Deferrari
authors.forename: Roberto
authors.initials: R
authors.lastname: Pontremoli
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000175:diagnosis*; D001794:Blood Pressure; D002319:Cardiovascular System / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012680:Sensitivity and Specificity