Should albuminuria be a therapeutic target in patients with hypertension and diabetes?

Conventional risk factors associated with cardiovascular and renal complications of diabetes include hypertension, dyslipidemia, hyperglycemia, and smoking. Recently, albuminuria has also emerged as an important risk factor, as it is independently associated with increased cardiovascular and renal risk. Inhibition of the renin-angiotensin-aldosterone system (RAAS) reduces both blood pressure (BP) and albuminuria, and induced cardiovascular and renal protection is associated with this albuminuria reduction, independent of BP reduction. Based on these results, optimal therapy for patients at risk for type 2 diabetic nephropathy should include BP reduction to <130/80 mm Hg, with the inclusion of a RAAS blocking agent (ie, an angiotensin II receptor blocker) to provide BP control and control of urinary albumin, which should be reduced to <500 mg/d.