Influence of microalbuminuria in achieving blood pressure goals.
OBJECTIVE
In all individuals with hypertension regardless of diabetes status, microalbuminuria is an independent risk marker for cardiovascular events including myocardial infarction, stroke and other conditions. While blood pressure reduction is important in reducing this marker in individuals with hypertension other factors such as salt intake play an important role in reducing oxidant stress and other factors related to the genesis of microalbuminuria.


RESULTS
Clinical trials demonstrate that drugs interfering with the renin-angiotensin system--angiotensin-converting enzyme inhibitors and angiotensin receptor blockers--should be used as first-line antihypertensive therapy in patients with microalbuminuria because they seem to have a blood pressure-independent antiproteinuric effect. A combination of an angiotensin-converting enzyme inhibitor with an angiotensin receptor blocker or other classes of medications shown to decrease protein excretion, such as nondihydropyridine calcium antagonists or aldosterone receptor blockers, should be considered to decrease albuminuria further; beta-blockers with alpha-blocking properties such as carvedilol have also been shown to reduce microalbuminuria probably secondary to its antioxidant properties.


CONCLUSIONS
This review provides a summary of current evidence regarding the associations of blood pressure with microalbuminuria, the rationale for currently recommended blood pressure goals, and the use of various classes of antihypertensive agents in proteinuric patients.
Duka
Irena
I
Department of Medicine, Hypertensive Diseases Unit, Section of Endocrinology, Diabetes and Metabolism, University of Chicago, Pritzker School of Medicine, Chicago, Illinois, USA.
Bakris
George
G
D000419:Albuminuria / Q000150:complications*; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000209:etiology / Q000652:urine; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology / Q000652:urine; D012307:Risk Factors
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents