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Urinary albumin excretion: lowering the threshold of risk in hypertension.

During the past few years, a subtle increase in urinary albumin excretion (UAE) not detectable by routine methods, microalbuminuria, has become a prognostic marker for cardiovascular and/or renal risk in diabetic and nondiabetic subjects. Consequently, microalbuminuria assessment is now recommended in a risk stratification strategy not only in diabetic subjects but also for hypertension management. Microalbuminuria is defined as UAE from 30 to 300 mg/24 hours or equivalent amounts using timed overnight or spot urine samples (Table). The definition comes from studies that have established its value as a marker of risk for nephropathy in diabetic subjects. When the potential prognostic value of microalbuminuria on cardiovascular disease was being assessed in diabetic and nondiabetic populations, the threshold value pointing to an increment of risk was largely below the UAE value of 30 mg/24 hours regardless of the population studied.1 Dammsgard2 in an elderly population demonstrated that subjects with timed overnight UAE >7.5 μg/min had a higher mortality rate than those with lower values. Borch-Johnsen3 found, in a population-based cohort of 2085 consecutive subjects, the relative risk of ischemic heart disease associated with an spot urine albumin/creatinine ratio of only >0.65 mg/mmol was 2.3 when adjusted …