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

Wu AYT, Low LP
Correspondence: Dr Akira Y T Wu, akirawu@pacific.net.sg

ABSTRACT
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.

Keywords: cardiovascular risk factor, health screening, hypertension, microalbuminuria, renal disease
Singapore Med J 2009; 50(10): 976-981