MICROALBUMINURIA - FROM DIABETES AND HYPERTENSION TO CARDIOVASCULAR RISK Increased urinary albumin excretion has been shown to be an important determinant of cardiovascular risk. This relationship was initially evident in diabetes. Soon it was detected that also in patients with essential hypertension high albuminuria predicted future cardiovascular events. By definition microalbuminuria corresponds to an albumin excretion rate of 20 to 200 ug/ min (30 to 300 mg/day) or an albumin to creatinine ratio (mg/mmol) of 2.5 to 25 in males and 3.5 to 35 in females. Microalbuminuria and reduced glomerular filtration rate may be markers of different pathologic processes. They represent respectively, the spectrum of renal vascular manifestations from systemic endothelial dysfunction (microvascular disease) to systemic atherosclerosis (macrovascular disease). Although measurement of albuminuria is important to determine the individual´s risk, much more important is the use the albuminuria level to appropriately targeted therapy and thereby to change the longterm risk for cardiovascular disease. Several studies have consistently shown that lowering of albuminuria with these drugs translates to a reduction of cardiovascular risk. Drugs intervening in the renin - angiotensin - aldosterone system reduce albuminuria. Several other drugs, such as vitamin D receptor activators, endothelin antagonists, and monocyte ‒ chemoactive - protein -1 inhibitor have been shown to reduce albuminuria on top of renin - angiotensin - aldosterone system intervention.