Abstract-Microalbuminuria (an increased urinary albumin excretion that is not detectable by the usual dipstick methods for macroproteinuria) predicts cardiovascular events in essential hypertensive patients. A possible reason for this behavior is that albumin leaks through exaggeratedly permeant glomeruli exposed to the damaging impact of subclinical atherogenesis. To evaluate this possibility, the transcapillary escape rate of albumin (TER alb , the 1-hour decline rate of intravenous 125 I-albumin), a parameter that estimates the integrity of systemic capillary permeability, albuminuria, blood pressure, echocardiographic left ventricular mass, lipids, and body mass index were measured in 73 uncomplicated, glucose-tolerant men with essential hypertension and normal renal function; 53 were normoalbuminuric, and 20 were microalbuminuric. Twenty-one normotensive age-matched male subjects were the controls. TER alb was higher in hypertensives, a behavior explained in part by a positive correlation with blood pressure values, although body mass index, lipids, and left ventricular mass showed no association. Transcapillary albumin leakage values did not differ between normoalbuminuric and microalbuminuric patients and were unrelated to albuminuria. Blood pressure, particularly systolic, and cardiac mass were higher in microalbuminuric patients in whom albuminuria correlated with both cardiovascular variables and indicated the influence of the hemodynamic load on urinary albumin levels. Thus, TER alb , a parameter influenced by the permeability surface area product for macromolecules and the filtration power across the vascular wall, is altered in essential hypertensives. However, this abnormality is dissociated from the amount of albuminuria, which is contrary to the hypothesis that a higher albumin excretion reflects a greater degree of systemic microvascular damage in essential hypertension. (Hypertension. 1999;34:491-495.) Key Words: albuminuria Ⅲ hypertension, essential Ⅲ cardiac mass Ⅲ blood pressure Ⅲ capillary permeability M icroalbuminuria (ie, an abnormal urinary albumin excretion [UAE] in a range not detectable by the usual dipstick methods for urinary protein) is associated with a greater incidence of cardiovascular events in hypertensive patients 1-3 and predicts all-cause and coronary disease morbidity and mortality independently from other cardiovascular risk factors in nondiabetic populations. 4 -7 However, the reasons why a renal parameter behaves as a marker of atherosclerotic cardiovascular disease in hypertension remain obscure. One concept postulates that more albumin leaks through exaggeratedly permeant glomeruli that reflect the systemic damaging impact of subclinical atherogenesis, 8 a process characterized by a diffuse involvement of the entire vascular system. 9 This hypothesis, which was originally formulated to account for the higher cardiovascular morbidity rate in diabetic patients, 8 may also apply to essential hypertensive patients, 10 but no information is available on this issue at th...