La microalbuminuria es un marcador de disfunción vascular generalizada y predictor independiente de riesgo aumentado de morbimortalidad cardiovascular en pacientes con diabetes e hipertensión, así como en la población general. Estudios observacionales y ensayos de intervención, han establecido que incluso niveles bajos de albuminuria se asocian con riesgo aumentado de morbimortalidad cardiovascular y de mortalidad en general, especialmente en poblaciones de alto riesgo como los diabéticos. Parece haber una relación linear entre el grado de excreción urinaria y el riesgo cardiovascular. Hasta ahora no está aclarada la relación entre microalbuminuria y morbimortalidad cardiovascular aumentada, precisándose más estudios que expliquen esa asociación.
Para revertir la microalbuminuria y reducir la excreción urinaria de albúmina, y el riesgo cardiovascular y renal, se necesita una estrategia múltiple. Los ensayos clínicos indican que reducir la proteinuria en pacientes con enfermedad renal crónica, se asocia a menor riesgo de progressión a insuficiencia renal terminal y de episodios cardiovasculares. Muchos de estos ensayos han empleado antihipertensivos que bloquean el sistema renina-angiotensina-aldosterona, e indican que esos fármacos son, en general, más efectivos que otras estrategias para reducir la proteinuria. Varios pequeños estudios sugieren que los calcioantagonistas no dihidropiridínicos son comparables con los inhibidores de la enzima conversora, y más eficaces que los calcioantagonistas dihidropiridínicos para reducir la proteinuria en diabéticos tipo 2 con nefropatía avanzada. La evidencia combinada de los datos epidemiológicos y los estudios de intervención, aconseja establecer la reducción de la proteinuria como una consideración mandatoria para la selección de regímenes antihipertensivos.
Palabras clave
Microalbuminuria
Enfermedad cardiovascular
Hipertensión
Diabetes mellitus
Excreción urinaria de albúmina
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