NEW YORK (Reuters Health) - In men with uncomplicated essential hypertension, high-normal albuminuria is associated with a more adverse cardiovascular and metabolic risk profile compared with that of hypertensive men with albuminuria of less than 9 µg/minute. According to a group of Italian physicians, this profile may put these men at risk for glomerular hypertension and renal insufficiency.

Dr. Roberto Pedrinelli and colleagues of Universita di Pisa studied 186 men whose blood pressure exceeded 140/90 mm Hg and who exhibited normal glucose tolerance, normal renal function and an overnight urinary albumin excretion (UAE) of no more than 15 µg/minute.

Compared with men in the three lower quartiles for urine albumin, those whose UAE exceeded 9.4 µg/minute exhibited a higher 24-hour blood pressure and more frequent concentric left ventricular hypertrophy (p < 0.001 for trend), the researchers report in the American Journal of Kidney Diseases for July.

Those men in the upper quartile of UAE also exhibited significantly greater body mass index, increased fasting insulin levels, and reduced insulin sensitivity (p < 0.02 for each).

Even though ultrasound showed that all subjects had normal-sized kidneys, those in the high-normal range of albuminuria had significantly higher creatinine clearance, at 141 mg/min versus 105 to 134 mg/min (p < 0.001).

Dr. Pedrinelli's group suggests these data reflect "the existence of a threshold above which a greater perfusion pressure overcomes renal autoregulation and is transmitted to glomeruli."

The investigators add that a greater creatinine clearance rate "is potentially important because hyperfiltration may underlie an augmented glomerular blood flow and hydraulic pressure, conducive to glomerular hypertension and, eventually, renal insufficiency." They recommend a downward shift of the limits for diagnosing microalbuminuria in men with essential hypertension.

Am J Kidney Dis 2002;40:1-8.

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