Regardless of having a similar antihypertensive effect, different antihypertensive drug classes have a
different effect on albuminuria.Patients with albuminuria will usually need more than one drug to achieve blood
pressure control, particularly if the aim is also to reduce albuminuria.Albuminuria is independently associated
with cardiovascular and renal risk regardless of diabetes status. The recent ESC/ESH guidelines listed microalbuminuria
among the hypertension-mediated organ damages. Albumin-to-creatinine ratio was suggested to be
included in the routine workup for evaluation of every hypertensive patient and changes in albuminuria were
considered to have moderate prognostic value.
Because of its specific effects on renal hemodynamic and glomerular structure, the ACEIs and ARBs should be
prescribed in maximum tolerated doses. The MRAs can be considered in uncontrolled hypertensive patients. The
CCBs can be used in addition to the RAAS blockade. Data on antialbuminuric effect of the new CCBs generation
(T-type and N-type channel blockers) is promising and they might be preferential CCBs when available. In the
case of resistant hypertension, thiazide or thiazide-like diuretic has to be added into the combination with RAAS
blockers and other antihypertensive drugs. Low-salt intake has to be recommended for all hypertensive patients,
particularly those with albuminuria.
A multifactorial and early antialbuminuric approach should be started early even when albuminuria values are
below the cut-off value for microalbuminuria.
Keywords: Arterial hypertension, Microalbuminuria, Proteinuria, Cardiovascular disease, Target organ damage, RAAS-inhibition, Angiotensin converting enzyme inhibitors, Calcium channel blockers, Angiotensin ii receptor blockers, Mineralocorticoid receptor antagonist, thiazide-like diuretic
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