Microalbuminurie bij essentiële hypertensie: van beperkte betekenis voor het aanwijzen van patiënten met een hoog risico voor complicaties

– Microalbuminuria is usually defined as a urinary albumin excretion of 30-300 mg24 h (i.e. 20-200 µgmin) measured, in view of the short-term variation of 15-30, in at least 2 out of 3 urine samples. An alternative definition is: an albumincreatinine ratio of 2-20 mgmmol creatinine. -Microalbuminuria is an indicator of an enhanced risk of chronic kidney failure and cardiovascular disease in diabetic patients and of cardiovascular disease in the elderly general population.

– It is not known whether these relationships exist in essential hypertension as well.

– In essential hypertension there is, however, a relationship between microalbuminuria and endothelial dysfunction, impaired regulation of renal haemodynamics and an increased risk of left ventricular hypertrophy and hypertensive retinopathy.

– By screening for microalbuminuria a group of patients can be distinguished who have a relatively high risk for the presence of complications of hypertension. It is not certain, however, that more intensive treatment of such patients (e.g. with ACE inhibitors) is useful.

– Consequently, for the time being, screening of patients with esssential hypertension for microalbuminuria is of little practical importance.