Hypertension microalbuminuria

Depression and Diabetes Mellitus. Patients with chronic medical illness have a high prevalence of major depressive disorder [59], Depression may be three times more prevalent in the diabetic population when compared with its occurrence in nondiabetic individuals [60], In addition, microalbuminuria, hypertension, and hyperinsulinemia are another three independent risk factors for cardiac disease in non-insulin-dependent diabetes mellitus (NIDDM) [61], Nosadini et al. showed that peripheral insulin resistance, hypertension, microalbuminuria, and lipid abnormalities are associated with NIDDM [61], Further, Helkala et al. determined that cognitive and memory dysfunction are associated with NIDDM and explored the disease s relationship with depression, metabolic control, and serum lipids. The results showed that the NIDDM patients had impaired control of their learning processes [62], Obviously, future research examining the causal relationship of depression to the onset on diabetes and the effect of depression on the natural course of diabetes is needed [60]. 

Mogensen CE, Neidam S, Tikkanen I, Oren S, Viskoper R, Watts RW, et al. Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes the candesartan and lisinopril microalbuminuria (CALM) study. BMJ 2000 321 1440-4,... 

Thiazolidinedio-nes or PPAR-y agonists Rosiglitazone, pioglitazone Binding on the PPAR-y, it aetivates the transcription of speeifie genes of lipid metabolism Sensitivity to insulin, anti-inflammatory effects and amelioration of hypertension, microalbuminuria and hepatic steatosis Severe liver failure, death and increased cardiac risk... 

Reduction in risk of Ml, stroke, and death from cardiovascular causes - In patients 55 years of age or older at high risk of developing a major cardiovascular event because of a history of coronary artery disease, stroke, peripheral vascular disease, or diabetes that is accompanied by at least 1 other cardiovascular risk factor (eg, hypertension, elevated total cholesterol levels, low FIDL levels, cigarette smoking, documented microalbuminuria). 

Also contraindicated for the treatment of hypertension in patients with the following conditions Type 2 diabetes with microalbuminuria serum creatinine greater than 2 mg/dL in males or greater than 1.8 mg/dL in females Ccr less than 50 mL/min concomitant use of potassium supplements or potassium-sparing diuretics (amiloride, spironolactone, or triamterene). 

The CARDS randomized 2838 people with Type 2 diabetes plus retinopathy, microalbuminuria, hypertension, or smoking and no history of macrovascular disease to receive either ator-vastatin or placebo. Atorvastatin reduced the combined... 

Many investigators have shown heightened sympathetic nerve activity observed in plasma norepinephrine or microneurography in patients with ESRD in cross-sectional studies [20, 21], These observations show renal injury or ESRD is a consequence of hypertension and obesity, however, most of previous studies regarding the relationships between sympathetic nerve activity and renal function have investigated proteinuria or microalbuminuria as a maker for renal injury. Few investigations have simultaneously taken into account... 

In type 1 diabetes, diabetic nephropathy follows a predictable course from onset of diabetes to the onset of microalbuminuria to frank nephropathy to end-stage renal disease or death. Microalbuminuria (a tiny amount of protein in the urine) develops 10-14 years after onset of diabetes. Without treatment, clinical nephropathy follows within 5 years, and severe renal impairment leading to end-stage renal failure develops approximately 5 years later. Hypertension develops in association with microalbuminuria and progresses with diabetic nephropathy, further damaging the kidneys. Once end-stage renal disease (ESRD) is reached, the toxins in the body can no longer be cleared by the kidneys and, unless treated by dialysis, can build up to fatal levels. 

Although there is still debate about its significance, mildly increased excretion (20 to 300mg/L) of albumin, so-called microalbuminuria (more correctly termed minimal albuminuria or paucialhuminuria), appears to be a predictor of future development of clinical renal disease in patients with hypertension or diabetes mellitus. It is important to remember that tubular and postrenal causes of albuminuria may also be present in association with these disorders. 

Agewall S, Wikstrand J, Ljungman S, Fagerberg B. Usefulness of microalbuminuria in predicting cardiovascular mortality in treated hypertensive men with and without diabetes meUitus, Risk Factor Intervention Study Group. Am J Cardiol 1997 80 164-9. 

Patients with hypertension may develop damage to either the renal tissue (parenchyma) or the renal arteries. Chronic kidney disease presents initially as microalbuminuria (30-299 mg albumin in a 24-hour urine collection) that can progress to macroalbuminuria and overt kidney failure. The rate of kidney function deterioration is accelerated when both hypertension and diabetes are present. Once patients have an estimated glomerular filtration rate (GFR) of less than 60 mL/m per minute or macroalbuminuria, they have chronic kidney disease, and the risk of cardiovascular disease and progression to severe chronic kidney disease increases. Strict BP control to a goal of less than 130/80 mm Hg can slow the decline in kidney function. This strict control often requires two or more antihypertensive agents. 

Although not a quantitative measure of renal function, urinary microalbuminuria has been identified as an early marker of renal disease in patients with diabetic nephropathy and numerous other conditions, such as hypertension and obesity. Patients with microalbuminuria (30 to 300 mg/day) on at least two occasions or overt albuminuria (>300 mg/day) should begin to receive pharmacotherapy. For children, microalbuminuria is considered present if albumin excretion exceeds 0.36 mg/kg per day, and overt albuminuria has been defined as an excretion rate that exceeds 4 mg/kg per day. The urinary albumin creatinine ratio is also an accurate predictor of 24-hour proteinuria, a marker of renal disease. Guidelines for monitoring indicate that a urine albumin creatinine ratio of >30 mg/g places the patient at increased risk of developing diabetic nephropathy and is an indication for the initiation of pharmacotherapeutic intervention. Microalbuminuria has also been suggested as a risk factor for renal dysfunction among patients with essential hypertension. ... 

Valensi P, Assayag M, Busby M, et al. Microalbuminuria in obese patients with or without hypertension. Int J Obes Relat Metab Disord 1996 20 574-579. 

Berrut G, Bouhanick B, Fabbri P, et al. Microalbuminuria as a predictor of a drop in glomerular filtration rate in subjects with non-insulin-dependent diabetes mellitus and hypertension. Clin Nephrol 1997 48 92-97. 

Mimran A, Ribstein J, DuCailar G. Is microalbuminuria a marker of early intrarenal vascular dysfunction in essential hypertension Hypertension 1994 23 1018-1021. 

Diabetic patients with or without hypertension who demonstrate persistent microalbuminuria despite intensive insulin therapy should have their ACEI or ARB dose titrated to achieve maximal suppression of urinary albumin excretion to halt or slow CKD progression. 

---