A recent study published in Hypertension touts the value of checking for microalbuminuria as an important part of cardiovascular risk assessment. Microalbuminuria was found to be a “powerful” independent risk factor. This prospective observational study was conducted in Spain and included 2835 patients with known hypertension but no known cardiovascular disease. Subjects had a mean age of 55 years and approximately half of them were men. Microalbuminuria was defined in this study as a urine albumin-to-creatinine ratio of >22 mg/g in men and >31 mg/g in women based on spot urine tests. Tests were done at baseline and annually in this study that had a mean duration of 4.7 years. Authors seemed surprised to find that 20% of these hypertensive patients had microalbuminuria at baseline. The researchers tracked the occurrence of both fatal and non-fatal cardiovascular events in all subjects. They found significant prognostic information beyond that provided by commonly used prognosticators such as low-density lipoprotein cholesterol, diabetes, conventional risk factors, standard risk calculator assessment, etc. Patients with the microalbuminuria at baseline had a much lower event-free survival rate that worsened over time. The group with the best event-free survival rate were those who had no microalbuminuria at baseline or at any time during the study. The result of this study complements that of many others that point to the connection between elevations in microalbuminuria, endothelial dysfunction, large-vessel atherosclerosis and consequent heart attack and/or stroke.
Reference: Pascual JM, Rodilla E, Costa JA, et al. Prognostic value of microalbuminuria during antihypertensive treatment in essential hypertension. Hypertension 2014. Published online before print. September 22, 2014. doi: 10.1161/HYPERTENSIONAHA.114.04273