Issn Print: 0263-6352

Publication Date: 2000/08/01


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Hypertension in Practice

Pierre François Plouin

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Excerpt

The number of books devoted to hypertension is considerable: the virtual library amazon.com offers no less than 635 different publications on the topic. This abundant production can be divided into three categories. First, there are popular accounts that are intended for the hypertensive patient and his or her relatives. Second, there are ambitious textbooks that encompass most aspects of clinical hypertension and hypertension research and are exhibited on the bookshelves of many academics, notably of hypertension specialists who have contributed a chapter. They are seldom consulted because chapters from the most enthusiastic authors are published months or years after they were written because of the delay imposed by less compliant contributors. The information contained within is therefore outdated as soon as the book is published. The third category is that of textbooks intended for busy practitioners. They are likely to be used not only by practitioners, residents and students, but also by academics looking for a concise summary or convenient illustrations when preparing a lecture.
The third edition of Hypertension in Practice by DG Beevers and GA MacGregor belongs to the last category. It is a 286-page textbook with a convenient 16-page index. It is divided into four sections: 1) Causes and consequences of hypertension, 2) Investigation, 3) Management and 4) Hypertension in special circumstances, including hypertension in diabetes, in children, in the elderly and in pregnancy. This new edition is justified by the emergence of new drugs (e.g. the angiotensin II receptor antagonists), the resolution of some controversies (e.g. calcium channel antagonists for cardiovascular prevention) and more specifically by the implications from recently published long-term outcome trials. The chapter entitled The benefits of anti-hypertensive treatment that summarizes clinical trials from the historical trial of Hamilton et al. (1964) to the HOT trial (1998) is a model of precision and clarity. It is complemented by a list of major US, Scandinavian and European ongoing trials.
The authors claim that ‘This book is designed to be read rather than referred to and the reader has to accept that this is our interpretation of the world literature and of current opinions together with our largely documented experience based on the management of thousands of patients’. Indeed, some personal views on investigation (e.g. the suggestion to perform a renal arteriogram in patients not controlled by two drugs) or treatment (the use of beta-blockers ‘is declining and we do not recommend them for routine first-line therapy’) may be questioned. These few questionable points weigh little in the face of the unity of style and the pedagogic skills that emerge from all parts of the book. This is a patient-oriented, practical handbook. Examples are the denunciation of dangerous myths (‘severe hypertension is a more important hazard to health than mild hyper-tension’, ‘hypertension is characterized by symptoms’ etc.) in the Hypertension and cardiovascular risk section; the table reporting the salt content of some common foods relative to sea water; and convenient diagrams for starting antihypertensive drug treatment or assessing children with high blood pressure.
Hypertension in Practice is an interesting, well-illustrated and up-to-date summary of what is important for hypertension management. It will fulfil the needs of most residents and practitioners and will be useful to many practising and academic cardiologists.

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