Hypertension and Organ Damage by Giuliano Tocci

Author:Giuliano Tocci
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Low estimated glomerular filtration rate by creatinine clearance by Cockcroft–Gault formula (<60 ml/min).

Dosage of microalbuminuria at a 24-h urine sample: 30–300 mg/24 h

Urine albumin–creatinine ratio [UACR] at morning urine sample: male >22; female >31 mg/g creatinine

In this patient, the presence of microalbuminuria was able to modify her global cardiovascular risk profile from moderate to high, which had important clinical consequences. Indeed, the presence of renal organ damage may help physicians in choosing among different antihypertensive drug classes and adopting the most effective antihypertensive therapy at appropriate dosages and/or combination, according to compelling indications from current hypertension guidelines [1]. For example, the therapeutic choice for this patient was a combination therapy based on the angiotensin receptor blocker irbesartan, which has demonstrated beneficial effects on cardiovascular morbidity and mortality in hypertensive patients with microalbuminuria [5–7].

In the preliminary evaluation of the patient, the main goal of the therapeutic strategy was focused on the proper assessment of individual global cardiovascular risk profile. In a subsequent step, the discovery of renal organ damage induced an up-titration of pharmacological strategy throughout the adoption of antihypertensive drug classes with proven benefits on regression of microalbuminuria, beyond BP lowering efficacy [5–7].

During the follow-up evaluation of this hypertensive patient with microalbuminuria, repeated evaluations of renal parameters may provide indirect evidence of the therapeutic effectiveness of antihypertensive therapy, by demonstrating the regression of renal impairment, a phenomenon that has been associated to a reduced risk of cardiovascular, cerebrovascular and renal complications [5–7].

Take-Home Messages

Microalbuminuria is a relatively common condition in hypertensive patients at different cardiovascular risk profile, with or without diabetes.

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