Assessment of urinary albumin excretion might improve cardiovascular outcome in patients with hypertension

This Practice Point commentary discusses a study by Boersma et al. that aimed to investigate whether the efficacy of blood-pressure-lowering agents depends on a patient's level of urinary albumin excretion before initiation of treatment. Boersma et al. reported that the higher baseline albuminuria is in hypertension, the better the relative and absolute risk reductions for cardiovascular events with antihypertensive drugs. Their data also suggested that the cardiovascular protective effect of agents that interfere with the renin–angiotensin–aldosterone system in patients with elevated urinary albumin excretion is better than that of other blood-pressure-lowering agents. Here, the importance of measuring urinary albumin excretion in clinical practice to improve the cardiovascular prognosis of hypertensive patients will be discussed. The many potential pitfalls of this observational study are highlighted and the need for well-designed, large, randomized trials in the area is emphasized.