Hypertension leads to target organ damage not only through the effect of increased haemodynamic load, but also through increased angiotensin II expression, decreased nitric oxide production and an enhanced subclinical inflammatory process.

Microalbuminuria, or slightly elevated urinary albumin excretion (UAE), has been shown prospectively to be an independent predictor of ischemic heart disease, and it also increases the risk associated with established risk factors such as arterial hypertension (1). How is microalbuminuria linked to increased cardiovascular disease (CVD) risk? According to a review published in the American Journal of Hypertension, microalbuminuria constitutes the renal manifestation of a generalized vascular endothelial dysfunction that probably underlies the link between increased UAE and CVD risk (2). The term "inflammatory microalbuminuria" is now used to describe a state that strongly correlates with metabolic abnormalities, identifying a high cardiovascular risk patient subset (3).

How does microalbuminuria relate to levels of different inflammatory markers such as hs-CRP, IL-18 and sCD40L in the setting of newly diagnosed untreated essential hypertension? This was investigated in a study published by Dr. Tsioufis and colleagues (4), and the findings of this study suggest activation of different inflammatory pathways 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 effect of inflammatory activation in the progression of hypertensive target organ damage
- The clinical significance of microalbuminuria in hypertensive subjects
- The interrelationships of microalbuminuria with CRP, IL-18 and sCD40L in the setting of essential hypertension
- The role of IL-18 and sCD40L in diffuse atherosclerosis and cardiovascular events

1. Knut Borch-Johnsen; Bo Feldt-Rasmussen; Svend Strandgaard; Marianne Schroll; Jan Skov Jensen Urinary Albumin Excretion: An Independent Predictor of Ischemic Heart Disease Arteriosclerosis, Thrombosis, and Vascular Biology. 1999;19:1992-1997.

2. Tsioufis C, Dimitriadis K, Antoniadis D, Stefanadis C, Kallikazaros I.Inter-Relationships of microalbuminuria with the other surrogates of the atherosclerotic cardiovascular disease in hypertensive subjects Am J Hypertens. 2004 May;17(5 Pt 1):470-6.

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. Tsioufis C, Dimitriadis K, Taxiarchou E, Vasiliadou C, Chartzoulakis G,
Tousoulis D, Manolis A, Stefanadis C, Kallikazaros I.Diverse Associations of Microalbuminuria With C-Reactive Protein, Interleukin-18 and Soluble CD 40 Ligand in Male Essential Hypertensive Subjects Am J Hypertens. 2006 May;19(5):462-6.