Differing effects of antihypertensive agents on urinary albumin excretion

Increased urinary albumin excretion is a good predictor of future progression of renal disease in patients with both insulin-dependent and non-insulin-dependent diabetes mellitus. In addition, it is an independent predictor of cardiovascular morbidity and mortality in patients with essential hypertension. Whether urinary albumin excretion represents a prognostic indicator for progressive renal dysfunction in patients with normal blood pressure, or essential hypertension and normal renal function, remains to be determined. In patients with diabetic renal disease, urinary albumin excretion is a good predictor for the future development of renal injury, and an effort has thus been made to study the success of antiproteinuric therapies in delaying progression of renal injury. Some antihypertensive agents have demonstrated abilities to reduce urinary albumin excretion either with or without a reduction in systemic arterial pressure. Whether the abilities of these drugs to protect renal function is related to their antihypertensive effects or antiproteinuric effects, or both, is unknown. This review will explore the influence of different antihypertensive agents on urinary albumin excretion in patients with and without essential hypertension, as well as in patients with nondiabetic and diabetic renal disease.