Microalbuminuria in essential hypertension: Significance, pathophysiology, and therapeutic implications  Stefano Bianchi, MD, Roberto Bigazzi, MD, Vito M. Campese, MD  American Journal of Kidney Diseases  Volume 34, Issue 6, Pages 973-995 (December 1999) DOI: 10.1016/S0272-6386(99)70002-8 Copyright © 1999 National Kidney Foundation, Inc Terms and Conditions

Fig 1 Mean hourly diastolic blood pressure (DBP) values in patients with essential hypertensive (○) with and (•) without microalbuminuria. (Adapted and reprinted by permission of Elsevier Science from “Diurnal Variation of Blood Pressure and Microalbuminuria in Essential Hypertension” by Bianchi et al, American Journal of Hypertension, Vol 7, pp 23-29, Copyright 1994 by American Journal of Hypertension Ltd.86) American Journal of Kidney Diseases 1999 34, 973-995DOI: (10.1016/S0272-6386(99)70002-8) Copyright © 1999 National Kidney Foundation, Inc Terms and Conditions

Fig 2 Urinary albumin excretion in healthy subjects and in patients with essential hypertension with (dippers) and without a normal decrease in blood pressure at night (nondippers). The differences between dippers and nondippers were significant (P < 0.001). (Reprinted by permission of Elsevier Science from “Diurnal Variation of Blood Pressure and Microalbuminuria in Essential Hypertension” by Bianchi et al, American Journal of Hypertension, Vol 7, pp 23-29, Copyright 1994 by American Journal of Hypertension Ltd.86) American Journal of Kidney Diseases 1999 34, 973-995DOI: (10.1016/S0272-6386(99)70002-8) Copyright © 1999 National Kidney Foundation, Inc Terms and Conditions

Fig 3 Serum levels of lipoproteins in 76 normotensive healthy subjects, 87 patients with essential hypertension and normal UAE and 64 hypertensive patients with microalbuminuria. *Values in patients with microalbuminuria were significantly (P <0.01 by ANOVA) greater than in hypertensive patients with normal UAE and normotensive healthy subjects. (Reprinted with permission.158) American Journal of Kidney Diseases 1999 34, 973-995DOI: (10.1016/S0272-6386(99)70002-8) Copyright © 1999 National Kidney Foundation, Inc Terms and Conditions

Fig 4 Plot shows correlation between insulin AUC and UAE in hypertensive and normotensive subjects combined. (Reprinted with permission from Bianchi S, Bigazzi R, Valtriani C, Chiapponi I, Sgherri G, Baldari G, Natali A, Ferranini E, Campese VM: Elevated serum insulin levels in patients with essential hypertension and microalbuminuria. Hypertension, Vol 23, pp 681-687.201) American Journal of Kidney Diseases 1999 34, 973-995DOI: (10.1016/S0272-6386(99)70002-8) Copyright © 1999 National Kidney Foundation, Inc Terms and Conditions

Fig 5 Thickness of the media intima carotid artery in hypertensive patients with normal UAE (normo), microalbuminuria (micro), and normotensive healthy subjects (controls). The difference between patients with microalbuminuria and normal UAE was significant (P < 0.01) (Reprinted with permission.158) American Journal of Kidney Diseases 1999 34, 973-995DOI: (10.1016/S0272-6386(99)70002-8) Copyright © 1999 National Kidney Foundation, Inc Terms and Conditions

Fig 6 Bar graphs showing incidence of coronary heart disease deaths in elderly nondiabetic subjects with and without microalbuminuria (Micro-A; urinary albumin/urinary creatinine >3.22 mg/mmol), with and without hyperinsulinemia (Hyper-Ins; fasting insulin >114 pmol/L), and with and without simultaneous presence of microalbuminuria and hyperinsulinemia. The average follow-up was 3.5 years. *P > 0.05. #P > 0.001 (Adapted and reprinted with permission from Kuusisto J, Mykkanen L, Pyorealea K, Laakso M: Hyperinsulinemic microalbuminuria. A new risk indicator for coronary heart disease. Circulation, Vol 9, pp 831-837.270) ▪, with; 2, without. American Journal of Kidney Diseases 1999 34, 973-995DOI: (10.1016/S0272-6386(99)70002-8) Copyright © 1999 National Kidney Foundation, Inc Terms and Conditions

Fig 7 UAE before and 4 and 8 weeks after treatment with enalapril, nitrendipine, diuretics, or atenolol. *P < 0.01. (Reprinted with permission.291) American Journal of Kidney Diseases 1999 34, 973-995DOI: (10.1016/S0272-6386(99)70002-8) Copyright © 1999 National Kidney Foundation, Inc Terms and Conditions