Albuminuria has been shown to identify patients with an increased cardiovascular risk, and in clinical studies
ACE inhibitors reduce the urinary
protein excretion. It was the primary aim of this intensified monitoring project to determine whether these results can be reproduced in a clinical practice setting. Micro- (2.7-22.6 mg
albumin/mmol
creatinine) or macroalbuminuria (>22.6 mg/mmol) was confirmed by a central laboratory in 598 out of 773 patients with
hypertension who had
albuminuria >50 mg/l on a Micral Test II performed by 147 general practitioners.
Coronary heart disease (prevalence rates 15% in patients with normalbuminuria, 33% in patients with microalbuminuria, and 40% in patients with macroalbuminuria),
heart failure (prevalence rates 19, 29, and 32%, respectively),
left ventricular hypertrophy (prevalence rates 30, 42, and 38%, respectively), and
peripheral vascular disease (prevalence rates 7, 15, and 20%, respectively) were significantly more common in patients with elevated urinary
albumin excretion. 230 patients with microalbuminuria and 202 subjects with macroalbuminuria were treated with the
angiotensin-converting enzyme inhibitor ramipril for 6 months. The treatment significantly lowered mean arterial blood pressure (from a median value of 120 mm Hg, quartiles 113-125 mm Hg, to 103 mm Hg, quartiles 100-109 mm Hg) as well as urinary
albumin excretion (from a median value of 18 mg/mmol
creatinine, quartiles 7.2-54.6 mg/mmol
creatinine, to 6.5 mg/mmol
creatinine, quartiles 1.6-23.1 mg/mmol
creatinine). The treatment efficacy was unaffected by age, body mass index, and smoking status. Patients with
diabetes mellitus type II and
heart failure also had a significant, although less pronounced reduction of
albuminuria. In summary, we conclude that
ramipril is able to reduce the urinary
albumin excretion in a clinical practice setting, as has been shown in clinical studies. However, the treatment response is not completely uniform, as special patient populations seem to be more resistant to
therapy.