Microalbuminuria, or a urinary albumin excretion rate of 30 to 300 mg/24 hours, is an independent predictor of cardiovascular disease (CVD) in hypertensive patients (1), and is thought to be the consequence of generalized endothelial damage along the vascular tree, including the glomerulus (2).

Microalbuminuria accompanied by subclinical inflammation in essential hypertension has been found to correlate with metabolic abnormalities, identifying a high cardiovascular risk patient subset, whereas microalbuminuria without subclinical inflammation has been associated with a relatively better metabolic profile (3).

Levels of inflammatory markers are increased in hypertensive patients, and the linearity of these associations may explain why CVD risk is increased in those with high-normal blood pressure. The relationship between hypertension and subclinical inflammation has been described as a chicken-egg phenomenon, as hypertension may promote inflammatory reactions in the vasculature, and inflammation can lead to the development of hypertension by affecting the endothelium.

Adiponectin is a fat tissue-derived protein that controls insulin sensitivity and has potential antiatherogenic properties. Further, reduced plasma levels of adiponectin have been associated with an increased risk of coronary artery disease (4), and there is cross-sectional data to suggest that hypoadiponectinemia is a risk factor for the development of hypertension (5). Adiponectin and C-reactive protein (CRP) levels are negatively related in patients with coronary heart disease (6) and in healthy subjects (7).

In a study published in The American Journal of Cardiology, Dr. Tsioufis and colleagues investigated the interrelationships of microalbuminuria with high-sensitivity CRP (hs-CRP) and adiponectin in men with essential hypertension (8). The findings of this study suggest that the albumin:creatinine ratio reflects widespread vascular dysfunction, that contributes in the progression of renal and cardiovascular atherosclerotic disease.

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After viewing this presentation the participant will be able to discuss:

- The clinical significance of microalbuminuria in hypertensive subjects
- The interrelationships of microalbuminuria with CRP and adiponectin in the setting of essential hypertension
- The role of adiponectin in the progression of atherosclerotic hypertensive disease
- The inflammatory component of hypertension and the link of CRP with increased cardiovascular risk

1. Pedrinelli R, Dell'Omo G, Di Bello V, Pontremoli R, Mariani M.Microalbuminuria, an integrated marker of cardiovascular risk in essential hypertension J Hum Hypertens. 2002 Feb;16(2):79-89.

2. Deckert T, Feldt-Rasmussen B, Borch-Johnsen K, Jensen T, Kofoed-Enevoldsen A.Albuminuria reflects widespread vascular damage. The Steno hypothesis. Diabetologia. 1989 Apr;32(4):219-26.

3. Pedrinelli R, Dell'Omo G, Di Bello V, Pellegrini G, Pucci L, Del Prato S, Penno
G.Low-Grade Inflammation and Microalbuminuria in Hypertension Arteriosclerosis, Thrombosis, and Vascular Biology. 2004;24:2414.

4. Kumada M, Kihara S, Sumitsuji S, Kawamoto T, Matsumoto S, Ouchi N, Arita Y,
Okamoto Y, Shimomura I, Hiraoka H, Nakamura T, Funahashi T, Matsuzawa Y; Osaka
CAD Study Group. Coronary artery disease.Association of hypoadiponectinemia with coronary artery disease in men. Arteriosclerosis, Thrombosis, and Vascular Biology. 2003;23:85.

5. Yoshio Iwashima; Tomohiro Katsuya; Kazuhiko Ishikawa; Noriyuki Ouchi; Mitsuru Ohishi; Ken Sugimoto; Yuxiao Fu; Masaharu Motone; Kouichi Yamamoto; Akiko Matsuo; Koji Ohashi; Shinji Kihara; Tohru Funahashi; Hiromi Rakugi; Yuji Matsuzawa; Toshio Ogihara Hypoadiponectinemia Is an Independent Risk Factor for Hypertension Hypertension. 2004;43:1318.

6. Noriyuki Ouchi, MD, PhD; Shinji Kihara, MD, PhD; Tohru Funahashi, MD, PhD; Tadashi Nakamura, MD, PhD; Makoto Nishida, MD, PhD; Masahiro Kumada, MD; Yoshihisa Okamoto, MD; Koji Ohashi, MD; Hiroyuki Nagaretani, MD; Ken Kishida, MD, PhD; Hitoshi Nishizawa, MD, PhD; Norikazu Maeda, MD; Hideki Kobayashi, MS; Hisatoyo Hiraoka, MD, PhD; Yuji Matsuzawa, MD, PhDReciprocal Association of C-Reactive Protein With Adiponectin in Blood Stream and Adipose Tissue Circulation. 2003;107:671.

7. Matsushita K, Yatsuya H, Tamakoshi K, Wada K, Otsuka R, Zhang H, Sugiura K,
Kondo T, Murohara T, Toyoshima H.Inverse association between adiponectin and C-reactive protein in substantially healthy Japanese men Atherosclerosis. 2006 Sep;188(1):184-9.

8. Tsioufis C, Dimitriadis K, Chatzis D, Vasiliadou C, Tousoulis D, Papademetriou
V, Toutouzas P, Stefanadis C, Kallikazaros I.Relation of Microalbuminuria to Adiponectin and Augmented C-Reactive Protein Levels in Men With Essential Hypertension Am J Cardiol. 2005 Oct 1;96(7):946-51.