Antihypertensive therapy in diabetics: Focus on microalbuminuria [Antihypertensive Behandlung beim Diabetes: Fokus Mikroalbuminurie]

Microalbuminuria (MAU) is defined as urinary albumin excretion between 30 and 300 mg/24 h or 2-20 mg/mmol creatinine in a spot urine sample. MAU does not only indicate nephropathy, but it is now recognised to reflect generalised vascular endothelial damage and therefore has emerged as a marker of increased cardiovascular risk. Even in "healthy" populations, the prevalence of MAU is 5-7%, due to"lifestyle" factors such as lipid abnormalities and smoking. In diabetics, MAU indicates micro- as well as macroangiopathy and carries a three-fold overall mortality risk. MAU cannot be detected with ordinary dipstick tests. In all diabetics, MAU must be measured at least once a year by using specific assay methods. As a therapeutic end point in diabetics, normalisation of MAU is prognostically as important as lowering blood pressure. This requires antiproteinuric antihypertensives, primarily inhibitors of the renin-angiotensin-aldosterone system. © 2007 Springer Medizin Verlag.