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(Hypertension. 2005;45:181.)
© 2005 American Heart Association, Inc.

Editorial Commentaries

Reduction in Microalbuminuria

A Biomeasure of Therapeutic Success?

From the University of Maryland Medical Systems, Baltimore.

Correspondence to Matthew R. Weir, University of Maryland Medical Systems, Division of Nephrology, 22 S Greene St, Room N3W143, Baltimore, MD 21201. E-mail mweir@medicine.umaryland.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

As one reviews the epidemiologic evidence linking microalbuminuria as a measure of increased cardiovascular morbidity and mortality, one is struck by the consistency of the data in diabetic and nondiabetic populations.¹ Given that this test is simple to obtain, relatively inexpensive, and provides enormous predictive value relative to many other clinical cardiovascular testing measures, why is it not used more frequently in the general population to screen for cardiovascular disease?

Traditionally in clinical medicine, we have focused on blood pressure, cholesterol, and glucose levels as a means of identifying those patients at risk for cardiovascular disease events. We have also used reduction of these clinical measures as an indicator of therapeutic success. Although there remains some debate as to how intensive the goals should be, in general, lower goals are recommended for those patients with more cardiovascular disease risks. Could longitudinal measurements of urine microalbumin add some objectivity to our estimation of treatment response to high blood pressure, dyslipidemia, or diabetes?

Why is a microvascular abnormality of the blood–urine interface within the glomeruli of the kidneys such a powerful tool for predicting macrovascular events such as stroke and myocardial infarction? This is an intriguing issue to consider. Which comes first? Is the microalbuminuria a reflection of a primary vascular disease, which has affected the kidneys, the brain, the heart and the rest of the circulation? Or might microalbuminuria be a biomeasure for the amount of vascular disease in the body? Although there is not a simple answer to this question, . . . [Full Text of this Article]