Managing vascular risk in hypertension with a focus on microalbuminuria: attitude and practices.

INTRODUCTION: Elevated blood pressure is a principal risk factor for cardiovascular and renal diseases. Early detection and adequate treatment of hypertension are essential components in the primary prevention of these end-stage events. Microalbuminuria is recognised as an early marker of renal disease and increased cardiovascular risk. Screening alerts physicians to implement timely intervention strategies to delay disease progression and minimise consequent complications. Although the value and significance of microalbuminuria screening has been widely documented, its use is still suboptimal. METHODS: Survey forms were sent to randomly-selected general practitioners in Singapore to capture their self-reported attitudes and practices regarding microalbuminuria screening in the management of hypertension. RESULTS: Results from this survey revealed that microalbuminuria screening was practised by 88 percent of the physicians surveyed; however, only 56 percent of hypertensive patients without risk factors were screened. Quantitative analysis of urine samples was the preferred screening method of 90 percent of the physicians surveyed. CONCLUSION: A concerted effort should be made to address the lack of public awareness on the importance of screening for microalbuminuria. Continuing medical education should also emphasise the usefulness of surrogate markers in the therapeutic prevention of end-organ damage in hypertensive patients. There is also a need to form a consensus guideline on microalbuminuria screening, to aid in the standardisation of practice.

Microalbuminuria prevalence study in hypertensive patients with type 2 diabetes mellitus in Singapore.

INTRODUCTION: Microalbuminuria is a marker of increased cardiovascular morbidity and mortality. It represents the earliest clinical evidence of diabetic nephropathy. Its early detection allows for implementation of individually-tailored cardiovascular risk reduction management programmes. Despite this, information on the prevalence of microalbuminuria in hypertensive patients with type 2 diabetes mellitus in Singapore is limited. METHODS: The Microalbuminuria Prevalence Study (MAPS) assessed the prevalence of macroalbuminuria and microalbuminuria in consecutively-screened hypertensive adult patients with type 2 diabetes mellitus in ten Asian countries. This paper presents the results of a sub-analysis of data from patients in Singapore. RESULTS: Singapore contributed seven percent of the overall enrolment into MAPS; a total of 499 patients were enrolled and 388 constituted the per-protocol population (patients with bacteriuria and haematuria were excluded). Overall, the prevalence of diabetic kidney disease was high. In our study population, 23.5 percent of patients had macroalbuminuria (95 percent confidence interval [CI] 21.3-25.6), and 48.5 percent of patients had microalbuminuria (95 percent CI 45.9-51.0). Only 28.1 percent (95 percent CI 25.8-30.4) of patients were normoalbuminuric. Associated factors were poor glycaemic control and poor blood pressure control. CONCLUSION: The high prevalence (72 percent) of microalbuminuria and macroalbuminuria found in hypertensive patients with type 2 diabetes mellitus in Singapore is a cause for concern. These findings highlight the need to screen for microalbuminuria and better manage hypertensive patients with type 2 diabetes mellitus, if we are to avoid a major increase in end-stage renal disease.

An alarmingly high prevalence of diabetic nephropathy in Asian type 2 diabetic patients: the MicroAlbuminuria Prevalence (MAP) Study.

AIM/HYPOTHESIS: Microalbuminuria represents the earliest clinical evidence of diabetic nephropathy and is a marker of increased cardiovascular morbidity and mortality. Its early detection allows the implementation of individualised and aggressive intervention programmes to reduce cardiovascular risk factors. There is limited information on the prevalence of microalbuminuria among hypertensive type 2 diabetic patients in Asia. METHODS: This cross-sectional epidemiological study aimed to assess the prevalence of microalbuminuria and macroalbuminuria among consecutively screened hypertensive type 2 diabetic adult patients in 103 centres in 10 Asian countries or regions. Predictive factors for microalbuminuria and macroalbuminuria were characterised using a stepwise logistic regression model. RESULTS: A total of 6,801 patients were enrolled and 5,549 patients constituted the per-protocol population (patients with bacteriuria and haematuria were excluded). The prevalence of microalbuminuria was 39.8% (39.2-40.5; 95% CI) and the prevalence of macroalbuminuria was 18.8% (18.2-19.3; 95% CI). Only 11.6% of the patients had systolic and diastolic blood pressure below the 130/80 mm Hg target. In the multivariate analyses, the predictive factors for the presence of microalbuminuria were age, BMI, systolic blood pressure and ethnic origin. The highlighted predictive factors for the presence of macroalbuminuria were age, sex, ethnic origin, BMI, duration of diabetes, presence of diabetic complications, intake of diuretics, intake of calcium channel blockers, diastolic and systolic blood pressure. CONCLUSIONS/INTERPRETATION: The high prevalence (58.6%) of micro or macroalbuminuria observed in these patients is alarming and indicates an impending pandemic of diabetic cardiovascular and renal diseases in Asia with its potential economic consequences.