Medicine And Books

Hypertension for the Clinician

BMJ 1995; 311 doi: (Published 04 November 1995) Cite this as: BMJ 1995;311:1237
  1. R D S Watson, consultant cardiologist
  1. City Hospital NHS Trust, Birmingham

    J Ian S Robertson, Stephen G Ball W B Saunders, pounds sterling30, pp320 ISBN 0 7020 1812 0

    It is clearly in the publishers' interest to promote a textbook of hypertension to the widest possible readership, but the authors may have set themselves an overambitious task in aiming to “provide, in succinct form, severally for the primary care physician, the postgraduate student, and the hospital specialist.”

    One has to ask whether a book of 320 pages could reasonably cover the disparate problems encountered in general practice and hospital. The primary care team will ask numerous practical questions. At what age is screening for hypertension worth while, and how often should it be repeated? What is the best means of assessing the cardiovascular risk in individual patients, and which measurements other than blood pressure need to be included? What is the likely benefit from antihypertensive treatment in both men and women at different ages? The answers to these questions are not readily found in Hypertension for the Clinician.

    For a hospital based physician, particularly one in training, the text fulfils its purpose well. It provides a clear background of the pathophysiology of hypertension, and helpfully discusses current views concerning the investigation and treatment of various problems, particularly renovascular disease. In places the emphasis is a little surprising. Two or three pages only are given to a description of blood pressure measurement, but there are separate chapters--admittedly short--on porphyria, endothelin-producing tumours and angiotensinogen-producing tumours. Topical aspects such as ambulatory blood pressure recording and the fetal origins of cardiovascular disease are mentioned only in passing.

    Clinical management in practice often differs considerably from that described in textbooks, and these differences become particularly apparent in the important question of whether antihypertensive treatment should be started. Particularly in general practice this often assumes a greater role than a search for an underlying cause for hypertension. Detection of hypertensive organ damage is often critical in making thisdecision.

    Whichever tests are selected should be defensible in terms of both cost and effectiveness. Many physicians accept that the role of the chest radiograph is limited in this respect and it is slightly surprising that it continues to be recommended as a routine investigation. On the other hand, the authors are enthusiastic about ultrasound and advocate echocardiography both renal and cardiac as highly desirable in the initial assessment of the hypertensive patient. There is certainly a role for these investigations but the logistics of cardiology and radiology services having to cope with large numbers of unselected requests is quite daunting.

    I much admire the clarity of the prose and willingness of the authors to deal with some contentious issues. One of the book's particular strengths is its overview of the major therapeutic trials of antihypertensive treatment, which indicates well the important gaps that remain in our knowledge as well the progress achieved to date. I certainly recommend the book for hospital libraries. Whether it will prove valuable for general practitioners remains uncertain.--R D S WATSON, consultant cardiologist, City Hospital NHS Trust, Birmingham

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