Effect of antihypertensive treatment on qualitative estimates of microalbuminuria

We tested the utility of qualitative microalbuminuria (MAU) screening in an office practice setting, in assessing the response of MAU to drug treatment. We enrolled general practitioners throughout Germany, who obtained histories, physical examinations, and routine laboratory values as clinically indicated on > 6000 non-treated hypertensive, nondiabetic patients. MAU was measured with an albumin-sensitive, immunoassay test strip. The patients were then assigned to monotherapy by their physicians with carvedilol, angiotensin-converting enzyme (ACE) inhibitors, beta blockers, calcium channel blockers, diuretics, and other single regimens in an open-label fashion. The goal was diastolic pressure < 90 mm Hg or at least a 10 mm Hg decrease in systolic (S) and diastolic blood pressure (DBP). The patients' mean age was 57 years and 51% were men. The mean known hypertension duration was 69 months. MAU was present in 37% of men and 34% of women. All regimens lowered BP. All regimens caused large numbers of MAU patients to revert by 3 months. MAU reversal occurred in patients less than 65 years as well as in those 65 years or older. Multiple regression analysis indicated that systolic and DBP reduction, duration of hypertension, and body size were most associated with MAU reversal. Thus, MAU determinations reverted to negative with antihypertensive treatment in many patients. BP reduction was the single most important variable in reversing MAU. All drug regimens were effective. We conclude that qualitative MAU detection is useful not only for screening, but also for follow-up nondiabetic patients with hypertension in an office practice setting.