53. MICROALBUMINURIA IN PATIENTS WITH ESSENTIAL HYPERTENSION. CARDIOVASCULAR AND RENAL IMPLICATIONS

INTRODUCTION The availability of methods to quantitate small amounts of urinary albumin excretion non detectable by the albustix, has allowed early recognition of renal disease in several pathological conditions, such as diabetes mellitus and essential hypertension. The term microalbuminuria indicates amounts of urinary albumin excretion above the 95% confidence interval of the normal population, but below amounts detectable by semiquantitative methods (30-300 mgl24 hours or 20-200 /lglmin) [1,2,3]·Several studies have indicated that microalbuminuria is a marker of glomerular damage, and predicts the development of overt proteinuria and progressive renal failure in patients with insulin-dependent diabetes mellitus (100M) [4,5,6,7,8] and non-insulin-dependent diabetes mellitus (NIDOM) [9,10]. In both 100M and NIDOM patients, microalbuminuria also predicts cardiovascular morbidity and mortality [11,12,13,14]. Treatment of hypertension and administration of angiotensin-converting enzyme inhibitors, even in normotensive patients are of benefit in arresting the progression of diabetic renal disease both in 100M [15,16,17,18,19] and NIDOM patients [20,21,22]. Some evidence also indicates that microalbuminuria may predict cardiovascular events and perhaps early renal damage in patients with essential hypertension. The purpose of this manuscript is to review the incidence of microalbuminuria and its relationship with blood pressure levels and cardiovascular risk factors in patients with essential hypertension. Moreover, we will discuss the evidence supporting the role of microalbuminuria in predicting