A slightly elevated urinary albumin excretion rate (UAER) is a predictor of atherosclerotic cardiovascular disease. The mechanism is unknown, but moderate office blood pressure elevation has been demonstrated as part of a clustering of known atherosclerotic risk factors in subjects with elevated UAER. Because 24-hour ambulatory blood pressure is a superior predictor of hypertensive target organ involvement, we aimed to investigate blood pressure profile in clinically healthy subjects with elevated UAER. Ambulatory blood pressure monitoring was performed with a portable recorder in 27 subjects with an elevated UAER (>6.6 microg/min, overnight urine collection) and 46 normoalbuminuric control subjects. Mean+/-SD systolic and diastolic ambulatory blood pressures (24-hour) were significantly higher in subjects with elevated UAER than in normoalbuminuric controls (134+/-12 versus 128+/-11 mm Hg and 78+/-7 versus 75+/-6 mm Hg, P<0.05), as were systolic and diastolic blood pressure loads [median (range): 42% (6 to 94%) versus 23% (1 to 89%) and 20% (0 to 68%) versus 6% (0 to 62%), P<0.05]. The circadian variation of blood pressure was normal in subjects with elevated UAER. However, the increased urinary loss of albumin could not be solely related to the higher blood pressure. In conclusion, apparently healthy subjects with elevated UAER had slightly but significantly higher 24-hour systolic and diastolic blood pressure levels in addition to increased blood pressure loads but normal circadian variation. The demonstrated differences in blood pressure may offer a partial explanation for the association between elevated urinary albumin excretion and atherosclerotic cardiovascular risk.