Cardiovascular and renal prognosis in patients with arterial hypertension, type 2 diabetes mellitus and microalbuminuria.

It is known that the presence of microalbuminuria has a high predictive value for the proteinuria of patients with T2DM (Pollak & Sypniewska 2008) and is a negative predictive factor for renal and cardiovascular evolution in patients with T2DM and essential arterial hypertension. Microalbuminuria is a known risk factor both for end-stage renal disease and for cardiovascular mortality and morbidity in general population and also in patients with T2DM and arterial hypertension (Anavekar et al 2004, Pinto-Sietsma et al 2000). Studies performed in Europe, US (United States) and Australia have found a prevalence of microalbuminuria of 5-15% in the general population, approximately 20-30% in diabetic patients and 11-17% in hypertensive patients (Pollak & Sypniewska 2008). A study published in Romania in 2011 reports that the prevalence of microalbuminuria in patients with arterial hypertension and T2DM is 29%, respectively 20% in patients with T2DM without arterial hypertension and 15% in hypertensive patients without T2DM (Bacanu et al 2011). Klausen et al examined 2762 patients without known coronary heart disease pathology and concluded that microalbuminuria was a significant determinant of death and coronary heart Abstract. Diabetes Mellitus is a metabolic disease defined by hyperglycemia, secondary to insulin deficiency both in secretion and activity, which alters the metabolism of carbohydrates, lipids and proteins. Diabetic nephropathy is a microvascular complication of diabetes mellitus defined by an increased excretion of proteins in urine. The early stage is characterized by a mild albumin excretion, named as microalbuminuria or incipient diabetic nephropathy. The screening for diabetic nephropathy should be performed when the diagnosis of diabetes mellitus type 2 is confirmed, because approximately 7% of the patients already have microalbuminuria. Microalbuminuria is a known risk factor for cardiovascular morbidity and mortality and for end-stage renal disease in general population and also in patients with type 2 diabetes mellitus and arterial hypertension. Microalbuminuria is an independent predictor of cardiovascular mortality (cardiovascular diseases, cerebrovascular diseases, peripheral arterial disease) in diabetes mellitus or hypertensive patients in the general population. The microalbuminuria test is recommended as a strategy in stratifying the risk of diabetic and hypertensive patients. Albuminuria is associated with a poor renal and cardiovascular outcome. By reducing the microalbuminuria and the blood pressure values using angiotensin-converting-enzyme inhibitors or angiotensin renin blockers, we can improve the prognostic. The physicians should routinely measure urinary albumin excretion in patients with type 2 diabetes mellitus and hypertension and aggressively treat the modifiable risk factors, such as high glycemic values, cholesterol and blood pressure, in order to suppress the microalbuminuria and thus to prevent the renal and cardiovascular adverse effects.