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Hermann Haller tells about the significant health risks – including renal disease, myocardial infarction and stroke – which are going undetected across Europe because doctors are not testing their patients who have hypertension for microalbuminuria. He discusses the findings of a European Society of Hypertension survey revealing widespread ignorance among general practitioners, cardiologists and diabetologists.
Milan, Italy – Significant health risks – including renal disease, myocardial infarction and stroke – are going undetected across Europe because doctors are not testing their patients who have hypertension for microalbuminuria (MAU) – attendees at the European Meeting on Hypertension heard.
“Microalbuminurea is still undervalued as a risk factor and diagnostic tool,” said Prof. Hermann Haller, MD, Director of the Department of Nephrology and Hypertension at Hannover Medical School, after presenting his findings from a computer assisted questionnaire survey conducted in France, Germany, Italy, Spain and the UK.
“I think that physicians should understand that microalbuminuria is not only a risk factor, but also a diagnostic tool for renal and cardiovascular damage,” he said, noting that the survey found serious shortcomings in the way MAU is assessed.
The investigators asked 1,700 GPs, diabetologists and cardiologists a series of questions and calculated scores from the responses given, and found that – despite being the most frequently used test for renal function carried out in patients with hypertension – MAU assessment is only done in about half of all cases: 42% and 48% of patients are tested by GPs and cardiologists respectively, and still only 54% of patients seeing diabetologists.
And when MAU is detected, according to Dr Haller, organ damage is already likely to be present in most patients with hypertension or diabetes. What’s more, the study also found there was widespread ignorance about the relationship between MAU and damage to organs other than the kidney, and even that around 10 per cent of doctors thought the test was not needed: “Because proteinuria already provides enough information,” these doctors replied.
It was also important to educate doctors, Dr Haller thought, about the correct way to sample urine for such testing. 24-hour collections were unnecessary, he noted: MAU assessment should be done with a “first morning void sample”, which the questionnaire revealed was understood by fewer than 60 per cent of the doctors.
In the question session after his talk at the conference in Milan, Dr Haller was asked if doctors should test for MAU routinely straight after a diagnosis of diabetes or hypertension – reflecting some of the uncertainty which persists even among clinicians attending such a big hypertension congress as the Milan meeting.
Dr Haller’s reply was precise, and emphatic: “When you assess the patient after diagnosis of diabetes of hypertension you should know about MAU, and then test at yearly intervals in order to find out which patients actually have changes in their microvasculature,” he said.