Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Journal of Nephrology
Published in: Journal of Nephrology 6/2016

01-12-2016 | Review

Microalbuminuria in primary hypertension: a guide to optimal patient management?

Authors: Francesca Viazzi, Francesca Cappadona, Roberto Pontremoli

Published in: Journal of Nephrology | Issue 6/2016

Login to get access

Abstract

Accurate assessment of the global risk profile is considered a prerequisite for the optimal management of hypertensive patients. In particular, the evaluation of subclinical organ damage, namely left ventricular hypertrophy, peripheral atherosclerosis and renal function, plays a key role in optimizing therapeutic targets and strategy in individual patients. Urine albumin excretion is a low-cost, easy-to-use test and a powerful predictor of cardiovascular diseases. The search for albuminuria has, therefore, become routine in the evaluation of hypertensive patients. Moreover, albuminuria has been shown to be associated with early signs of extra-renal organ damage such as left ventricular hypertrophy, and carotid atherosclerosis. Under effective antihypertensive treatment, changes in subclinical organ damage over time, especially regression of left ventricular hypertrophy, are paralleled by modification of risk status and may serve as intermediate endpoints for treatment. More recently, changes in albuminuria have also been proposed to reflect changes in the risk of cardiovascular events. If this is confirmed by large well-designed studies, microalbuminuria may not simply be regarded as a risk predictor but become itself an independent target for treatment.
Literature
1.
Viazzi F, Leoncini G, Parodi D, Ratto E, Vettoretti S, Vaccaro V, Parodi A, Falqui V, Tomolillo C, Deferrari G, Pontremoli R (2005) Impact of target organ damage assessment in the evaluation of global risk in patients with essential hypertension. J Am Soc Nephrol 16(Suppl 1):S89–S91CrossRefPubMed
2.
Devereux RB, Alderman MH (1993) Role of preclinical cardiovascular disease in the evolution from risk factor exposure to development of morbid events. Circulation 88:1444–1455CrossRefPubMed
3.
Leoncini G, Ratto E, Viazzi F, Conti N, Falqui V, Parodi A et al (2008) Global risk stratification in primary hypertension: the role of the kidney. J Hypertens 26:427–432CrossRefPubMed
4.
Leoncini G, Sacchi G, Viazzi F, Ravera M, Parodi D, Ratto E, Vettoretti S, Tomolillo C, Deferrari G, Pontremoli R (2002) Microalbuminuria identifies overall cardiovascular risk in essential hypertension: an artificial neural network-based approach. J Hypertens 20:1315–1321CrossRefPubMed
5.
Pedrinelli R, Dell’Omo G, di Bello V, Pontremoli R, Mariani M (2002) Microalbuminuria, an integrated marker of cardiovascular risk in essential hypertension. J Hum Hypertens 16:79–89CrossRefPubMed
6.
Pontremoli R (1996) Microalbuminuria in essential hypertension–its relation to cardiovascular risk factors. Nephrol Dial Transpl 11:2113–2115CrossRef
7.
Viazzi F, Leoncini G, Ratto E, Vaccaro V, Tomolillo C, Falqui V, Parodi A, Conti N, Deferrari G, Pontremoli R (2006) Microalbuminuria, blood pressure load, and systemic vascular permeability in primary hypertension. Am J Hypertens 19:1183–1189CrossRefPubMed
8.
Hallan SI, Matsushita K, Sang Y, Mahmoodi BK, Black C, Ishani A, Kleefstra N, Naimark D, Roderick P, Tonelli M, Wetzels JF, Astor BC, Gansevoort RT, Levin A, Wen CP, Coresh J, Chronic Kidney Disease Prognosis Consortium (2012) Age and association of kidney measures with mortality and end-stage renal disease. JAMA 308:2349–2360CrossRefPubMedPubMedCentral
9.
Savarese G, Dei Cas A, Rosano G, D’Amore C, Musella F, Mosca S et al (2014) Reduction of albumin urinary excretion is associated with reduced cardiovascular events in hypertensive and/or diabetic patients. A meta-regression analysis of 32 randomized trials. Int J Cardiol 172:403–410CrossRefPubMed
10.
Devereux RB, de Simone G, Roman MJ (1997) Relations of left ventricular geometry and function to prognosis in hypertension. Adv Exp Med Biol 432:1–12CrossRefPubMed
11.
Vlachopoulos C, Xaplanteris P, Aboyans V, Brodmann M, Cífková R, Cosentino F, De Carlo M, Gallino A, Landmesser U, Laurent S, Lekakis J, Mikhailidis DP, Naka KK, Protogerou AD, Rizzoni D, Schmidt-Trucksäss A, Van Bortel L, Weber T, Yamashina A, Zimlichman R, Boutouyrie P, Cockcroft J, O’Rourke M, Park JB, Schillaci G, Sillesen H, Townsend RR (2015) The role of vascular biomarkers for primary and secondary prevention. A position paper from the European Society of Cardiology Working Group on peripheral circulation: endorsed by the Association for Research into Arterial Structure and Physiology (ARTERY) Society. Atherosclerosis 241:507–532CrossRefPubMed
12.
Viazzi F, Parodi D, Leoncini G, Vettoretti S, Ratto E, Vaccaro V, Ravera M, Tomolillo C, Bezante GP, Del Sette M, Deferrari G, Pontremoli R (2004) Optimizing global risk evaluation in primary hypertension: the role of microalbuminuria and cardiovascular ultrasonography. J Hypertens 22:907–913CrossRefPubMed
13.
Mancia G, Fagard R, Narkiewicz K, Redo´n J, Zanchetti A, Bo¨hm M, Task Force Members et al (2013) ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013(31):1281–1357CrossRef
14.
Viazzi F, Leoncini G, Pontremoli R (2013) Global cardiovascular risk assessment in the management of primary hypertension: the role of the kidney. Int J Hypertens 2013:542646CrossRefPubMedPubMedCentral
15.
Pontremoli R, Leoncini G, Viazzi F, Ratto E, Vaccaro V, Falqui V, Parodi A, Conti N, Tomolillo C, Deferrari G (2006) Evaluation of subclinical organ damage for risk assessment and treatment in the hypertensive patient: role of microalbuminuria. J Am Soc Nephrol 17:S112–S114CrossRefPubMed
16.
Devereux RB, Agabiti-Rosei E, Dahlöf B, Gosse P, Hahn RT, Okin PM, Roman MJ, Pierdomenico SD, Lapenna D, Cuccurullo F (2008) Regression of echocardiographic left ventricular hypertrophy after 2 years of therapy reduces cardiovascular risk in patients with essential hypertension. Am J Hypertens 21:464–470CrossRef
17.
Devereux RB, Agabiti-Rosei E, Dahlöf B, Gosse P, Hahn RT, Okin PM, Roman MJ (1996) Regression of left ventricular hypertrophy as a surrogate end-point for morbid events in hypertension treatment trials. J Hypertens Suppl 14:S95–S101CrossRefPubMed
18.
Muiesan ML, Salvetti M, Rizzoni D, Castellano M, Donato F, Agabiti-Rosei E (1995) Association of change in left ventricular mass with prognosis during long-term antihypertensive treatment. J Hypertens 13:1091–1095CrossRefPubMed
19.
Leoncini G, Viazzi F, Pontremoli R (2010) Overall health assessment: a renal perspective. Lancet 375:2053–2054CrossRefPubMed
20.
Weir MR (2007) Effects of renin-angiotensin system inhibition on end-organ protection: can we do better? Clin Ther 29:1803–1824CrossRefPubMed
21.
Klingbeil AU, Schneider M, Martus P, Messerli FH, Schmieder RE (2003) A meta-analysis of the effects of treatment on left ventricular mass in essential hypertension. Am J Med 115:41–46CrossRefPubMed
22.
Keen H, Chlouverakis C (1963) An immunoassay method for urinary albumin at low concentrations. Lancet 2:913–914CrossRefPubMed
23.
Mogensen CE (1971) Urinary albumin excretion in diabetes. Lancet 11(2):601–602CrossRef
24.
Parving HH, Rossing N, Jensen HA (1974) Increased metabolic turnover rate and transcapillary escape rate of albumin in essential hypertension. Circ Res 35:544–552CrossRefPubMed
25.
Viberti GC, Hill RD, Jarrett RJ, Argyropoulos A, Mahmud U, Keen H (1982) Microalbuminuria as a predictor of clinical nephropathy in insulin-dependent diabetes mellitus. Lancet 26(1):1430–1432CrossRef
26.
Viazzi F, Leoncini G, Conti N, Tomolillo C, Giachero G, Vercelli M et al (2010) Combined effect of albuminuria and estimated glomerular filtration rate on cardiovascular events and all-cause mortality in uncomplicated hypertensive patients. J Hypertens 28:848–855CrossRefPubMed
27.
Viazzi F, Leoncini G, Conti N, Tomolillo C, Giachero G, Vercelli M et al (2010) Microalbuminuria is a predictor of chronic renal insufficiency in patients without diabetes and with hypertension: the MAGIC study. Clin J Am Soc Nephrol 5:1099–1106CrossRefPubMedPubMedCentral
28.
Viazzi F, Pontremoli R (2016) Albuminuria: the kidney message on cardio-vascular health. J Hypertens 34:399–401CrossRefPubMed
29.
Pontremoli R, Leoncini G, Viazzi F, Parodi D, Vaccaro V, Falqui V, Parodi A, Vettoretti S, Ratto E, Deferrari G (2005) Role of microalbuminuria in the assessment of cardiovascular risk in essential hypertension. J Am Soc Nephrol 16(Suppl 1):S39–S41CrossRefPubMed
30.
Tylicki L, Puttinger H, Rutkowski P, Rutkowski B, Horl WH (2006) Smoking as a risk factor for renal injury in essential hypertension. Nephron Clin Pract 103:c121–c128CrossRefPubMed
31.
Pedrinelli R, Giampietro O, Carmassi F, Melillo E, Dell’Omo G, Catapano G, Matteucci E, Talarico L, Morale M, De Negri F et al (1994) Microalbuminuria and endothelial dysfunction in essential hypertension. Lancet 2(344):14–18CrossRef
32.
Alberti FG, Zimmet PZ (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 15:539–553CrossRefPubMed
33.
Viazzi F, Pontremoli R (2014) Blood pressure, albuminuria and renal dysfunction: the ‘chicken or egg’ dilemma. Nephrol Dial Transpl 29:1453–1455CrossRef
34.
Matsushita K, Coresh J, Sang Y, Chalmers J, Fox C, Guallar E, Jafar T, Jassal SK, Landman GW, Muntner P, Roderick P, Sairenchi T, Schöttker B, Shankar A, Shlipak M, Tonelli M, Townend J, van Zuilen A, Yamagishi K, Yamashita K, Gansevoort R, Sarnak M, Warnock DG, Woodward M, Ärnlöv J; CKD Prognosis Consortium (2015) Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes: a collaborative meta-analysis of individual participant data. Lancet Diabetes Endocrinol 3:514–525
35.
Liu C, Chen H, Liu C, Fu C, Zhang H, Yang H, Wang P, Wang F, Chen S, Ma Q (2014) Combined application of eGFR and albuminuria for the precise diagnosis of stage 2 and 3a CKD in the elderly. J Nephrol 27:289–297CrossRefPubMed
36.
Wachtell K, Ibsen H, Olsen MH, Borch-Johnsen K, Lindholm LH, Mogensen CE, Dahlöf B, Devereux RB, Beevers G, de Faire U, Fyhrquist F, Julius S, Kjeldsen SE, Kristianson K, Lederballe-Pedersen O, Nieminen MS, Okin PM, Omvik P, Oparil S, Wedel H, Snapinn SM, Aurup P (2003) Albuminuria and cardiovascular risk in hypertensive patients with left ventricular hypertrophy: the LIFE study. Ann Intern Med 139:901–906CrossRefPubMed
37.
Leoncini G, Viazzi F, Conti N, Baratto E, Tomolillo C, Bezante GP, Deferrari G, Pontremoli R (2009) Renal and cardiac abnormalities in primary hypertension. J Hypertens 27:1064–1073CrossRefPubMed
38.
Pontremoli R, Sofia A, Ravera M, Nicolella C, Viazzi F, Tirotta A, Ruello N, Tomolillo C, Castello C, Grillo G, Sacchi G, Deferrari G (1997) Prevalence and clinical correlates of microalbuminuria in essential hypertension: the MAGIC Study. Microalbuminuria: a Genoa Investigation on Complications. Hypertension 30:1135–1143CrossRefPubMed
39.
Viazzi F, Bonino B, Ratto E, De Cosmo S, Pontremoli R (2014) Early renal abnormalities as an indicator of cardiovascular risk in type 2 diabetes. High Blood Press Cardiovasc Prev 21:257–260CrossRefPubMed
40.
Pontremoli R, Leoncini G, Ravera M, Viazzi F, Vettoretti S, Ratto E, Parodi D, Tomolillo C, Deferrari G (2002) Microalbuminuria, cardiovascular, and renal risk in primary hypertension. J Am Soc Nephrol 13(3):S169–S172CrossRefPubMed
41.
Pontremoli R, Ravera M, Bezante GP, Viazzi F, Nicolella C, Berruti V, Leoncini G, Del Sette M, Brunelli C, Tomolillo C, Deferrari G (1999) Left ventricular geometry and function in patients with essential hypertension and microalbuminuria. J Hypertens 17:993–1000CrossRefPubMed
42.
Pontremoli R, Nicolella C, Ravera M, Viazzi F, Berruti V, Ruello N, Tomolillo C, Bezante GP, Del Sette M, Martinoli C, Sacchi G, Deferrari G (1998) Microalbuminuria is an early marker of target organ damage in essential hypertension. Am J Hypertens 11:430–438CrossRefPubMed
43.
Ravera M, Ratto E, Vettoretti S, Viazzi F, Leoncini G, Parodi D, Tomolillo C, Del Sette M, Maviglio N, Deferrari G, Pontremoli R (2002) Microalbuminuria and subclinical cerebrovascular damage in essential hypertension. J Nephrol 15:519–524PubMed
44.
Pontremoli R, Viazzi F, Martinoli C, Ravera M, Nicolella C, Berruti V, Ruello N, Tomolillo C, Bezante GP, Del Sette M, Derchi LE, Deferrari G (1999) Increased renal resistive index in patients with essential hypertension: a marker of organ damage. Nephrol Dial Transpl 14:360–365CrossRef
45.
Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, de Jong PE, Coresh J, Gansevoort RT (2010) Association of estimated glomerular filtration rate and albuminuria with all- cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet 375:2073–2081CrossRefPubMedPubMedCentral
46.
Ibsen H, Olsen MH, Wachtell K, Borch-Johnsen K, Lindholm LH, Mogensen CE et al (2006) Does albuminuria predict cardiovascular outcomes on treatment with losartan versus atenolol in patients with diabetes, hypertension, and left ventricular hypertrophy? The LIFE study. Diabet Care 29:595–600CrossRef
47.
Tanaka F, Komi R, Makita S, Onoda T, Tanno K, Ohsawa M et al (2016) Low-grade albuminuria and incidence of cardiovascular disease and all-cause mortality in nondiabetic and normotensive individuals. J Hypertens 34:506–512CrossRefPubMed
48.
Hillege HL, Fidler V, Diercks GF, van Gilst WH, de Zeeuw D, van Veldhuisen DJ, Gans RO, Janssen WM, Grobbee DE, de Jong PE, Prevention of Renal and Vascular End Stage Disease (PREVEND) Study Group (2002) Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population. Circulation 1(106):1777–1782CrossRef
49.
Ibsen H, Olsen MH, Wachtell K, Borch-Johnsen K, Lindholm LH, Mogensen CE et al (2005) Reduction in albuminuria translates to reduction in cardiovascular events in hypertensive patients: Losartan Intervention For Endpoint Reduction in Hypertension study. Hypertension 45:198–202CrossRefPubMed
50.
Bakris GL, Sarafidis PA, Weir MR, Dahlöf B, Pitt B, Jamerson K, Velazquez EJ, Staikos-Byrne L, Kelly RY, Shi V, Chiang YT, Weber MA, ACCOMPLISH Trial investigators (2010) Renal outcomes with different fixed-dose combination therapies in patients with hypertension at high risk for cardiovascular events (ACCOMPLISH): a prespecified secondary analysis of a randomised controlled trial. Lancet 375:1173–1181CrossRefPubMed
51.
Yusuf S, Teo KK, Pogue J, Dyal L, Copland I, Schumacher H, ONTARGET Investigators et al (2008) Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 358:1547–1555CrossRefPubMed
52.
Schmieder RE, Mann JF, Schumacher H, Gao P, Mancia G, Weber MA et al (2011) ONTARGET Investigators. Changes in albuminuria predict mortality and morbidity in patients with vascular disease. J Am Soc Nephrol 22:1353–1364CrossRefPubMedPubMedCentral
53.
Viazzi F, Muiesan ML, Schillaci G, Salvetti M, Pucci G, Bonino B, Signori A, Pontremoli R. Changes in albuminuria and cardiovascular risk under antihypertensive treatment: a systematic review and meta-regression analysis J Hypertens (in press)
54.
Leoncini G, Viazzi F, Conti N, Baratto E, Tomolillo C, Bezante GP, Deferrari G, Pontremoli R (2009) Renal and cardiac abnormalities in primary hypertension. J Hypertens 27:1064–1073CrossRefPubMed
55.
Ratto E, Viazzi F, Bonino B, Gonnella A, Garneri D, Parodi EL, Bezante GP, Derchi LE, Leoncini G, Pontremoli R (2015) Left ventricular dilatation and subclinical renal damage in primary hypertension. J Hypertens 33:605–611CrossRefPubMed
Metadata
Title
Microalbuminuria in primary hypertension: a guide to optimal patient management?
Authors
Francesca Viazzi
Francesca Cappadona
Roberto Pontremoli
Publication date
01-12-2016
Publisher
Springer International Publishing
Published in
Journal of Nephrology / Issue 6/2016
Print ISSN: 1121-8428
Electronic ISSN: 1724-6059
DOI
https://doi.org/10.1007/s40620-016-0335-0

Other articles of this Issue 6/2016

Journal of Nephrology 6/2016 Go to the issue

Original Article

Conservative management of chronic kidney disease stage 5: role of angiotensin converting enzyme inhibitors

Original Article

Podocyturia is significantly elevated in untreated vs treated Fabry adult patients

Original Article

Incremental peritoneal dialysis: a 10 year single-centre experience

Original Article

Metformin modulates apoptosis and cell signaling of human podocytes under high glucose conditions

Original Article

Metformin associated lactic acidosis (MALA): clinical profiling and management

Position Papers and Guidelines

Light chains removal by extracorporeal techniques in acute kidney injury due to multiple myeloma: a position statement of the Onconephrology Work Group of the Italian Society of Nephrology
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits