Treating patients with hypertension induced albuminuria
Albuminuria is a renal disease that is found to be independently associated with cardiovascular and renal problems without any links to diabetes. In latest ESC/ESH guidelines, microalbuminuria has been related to hypertension-mediated organ damages. While studying its effects and treatment, it was suggested to include albumin-to-creatinine ratio in the routine workup evaluation of the hypertensive patient. Changes in albuminuria were considered to moderate prognostic value in routine evaluations. ACEIs and ARBs were prescribed in maximum tolerated doses due to its effect on renal hemodynamic and glomerular structure.
While the ACEIs and ARBs had some effect on the results, the new CCBs generation used in addition to the RAAS blockades had promising results. T-type and N-type CCB generations were preferred for treatment when available.
Researchers have also investigated the effects of different classes of antihypertensive drugs which, regardless of having a similar antihypertensive effect in other cases, had completely different effect on albuminuria with regards to each other. Hence, it was also advised that patients should use different antihypertensive drugs if their goal is to reduce albuminuria whilst maintaining blood pressure.
If the patient is affected with resistant hypertension, the use of thiazide or thiazide like diuretic is advised along with the use of a combination of RAAS blockers and different antihypertensive drugs. A multifactorial and early antialbuminuric treatment is suggested for patients even when albuminuria values are below the cut-off value for microalbuminuria. Along with treatment, low-salt intake is also advised for all hypertensive patients, especially those with albuminuria.
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