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Secondary forms of hypertension are not uncommon in clinical prac tice, but they are often overlooked or forgotten by clinicians in many fields of medicine. Dr. George Mansoor' s volume on Secondary Hyper tension is an important contribution to the field of clinical hypertension and vascular diseases, since it brings up to date the numerous diagnostic and therapeutic advances in the evaluation for secondary types of hyper tension. In the past, textbooks usually stated that an etiology could be determined in less than 5% of patients presenting with newly diagnosed hypertension. We now know this is far too low a proportion (e.g., pri mary hyperaldosteronism alone may account for hypertension in 5% of patients presenting with chronic elevations in blood pressure). Secondary Hypertension has been thoughtfully organized into chap ters evaluating screening and diagnosis, as well as medical and/or sur gical intervention of the well-known etiologies of secondary hypertension in adults and children. Additional coverage is given to such exogenous or lesser appreciated causes of secondary hypertension as obstructive sleep apnea and drugs. These sections make this book novel because in the past little attention has been paid to the effects of noncar diac drugs that interfere with antihypertensive therapy or to exogenous substances that might induce refractory hypertension.
- Sales Rank: #5043958 in Books
- Brand: Brand: Humana Press
- Published on: 2004-03-03
- Original language: English
- Number of items: 1
- Dimensions: 9.21" h x .81" w x 6.14" l, 2.75 pounds
- Binding: Hardcover
- 352 pages
- Used Book in Good Condition
From The New England Journal of Medicine
The introduction states that the aim of this book is to provide "the essential clinical, diagnostic and treatment aspects of secondary hypertension." These topics are covered by succinct and authoritative overviews that provide an agreeable balance between evidence-based medicine and skilled clinical experience. (Figure) Appropriately, the first two chapters deal with refractory and iatrogenic hypertension. Resistance to treatment, or the exclusion of obvious factors that could cause resistance, is among the most important reasons for starting diagnostic maneuvers to detect secondary forms of hypertension. Even though the two chapters overlap somewhat, they cover the most important problems, and the uncertainties in the definition of refractory hypertension simply reflect the present state of clinical practice. In my opinion, an experienced practitioner may make a diagnosis of refractory hypertension only after a patient has been treated with the right combination of three drugs for at least one month and after the possibilities of nonadherence to treatment and misleading blood-pressure measurements have been excluded. Hypertension secondary to renal disease is also clearly described. The most controversial issue is the treatment of renovascular hypertension. The few randomized trials comparing revascularization with medical therapy are too small to serve as the basis for making a meaningful choice between the two treatments. In the absence of convincing trials, the good results obtained with angioplasty in fibromuscular dysplasia favor this treatment for renovascular hypertension as well. In the case of atherosclerotic renal-artery stenosis, the decision is more difficult. Clinical practice and anecdotal observation point to a subgroup of patients who may benefit from revascularization with stenting to reduce the progression of either renal-artery stenosis or renal failure (particularly when there is stenosis in both kidneys). The procedure may also be used to lower blood pressure in patients already receiving a multidrug combination or to treat patients with coronary heart disease, cardiac insufficiency, or hypertensive encephalopathy. The clinical problems associated with disorders of the adrenal cortex receive a well-balanced review. I personally prefer magnetic resonance imaging over computed tomography for the detection of morphologic adrenal abnormalities and the use of eplerenone over spironolactone for the treatment of primary aldosteronism (to prevent the side effects of spironolactone). The ratio of plasma aldosterone to plasma renin activity, which is still not widely used in screening for primary aldosteronism, is thoroughly discussed. I particularly appreciated the chapter on nonprimary aldosteronism for its concise descriptions of all the monogenic or mendelian forms of hypertension. Patients with these forms of the disease share an abnormality in sodium transport across the renal tubuli. In the much more common "primary," or "essential," hypertension, subtle abnormalities in renal pathways for sodium transport may also be involved. In patients who have paroxysmal hypertension, palpitations, nervousness, tremor, excessive sweating, pallor, or erythema (together or in various combinations), it is not easy to distinguish between pseudopheochromocytoma due to short-term activation of the sympathetic nervous system in response to stressful stimuli (of which not all patients are aware) and the much less frequent classic pheochromocytoma. The two chapters dealing with this problem are very well written, with discussions that are neat and to the point. Careful clinical evaluation and simple algorithms are needed to avoid unnecessary tests to make the diagnosis of secondary forms of hypertension in children and adolescents. The chapter dealing with this topic is very useful, as is the one entitled "Sleep Apnea and Hypertension," which covers important aspects of the association between breathing disorders during sleep and hypertension, a connection that is not well recognized in clinical practice. Since arterial hypertension affects about 30 percent of the people in industrialized countries, this book should be in the library of primary care physicians, internists, and specialists in nephrology, cardiology, and endocrinology. Giuseppe Bianchi, M.D.
Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
Review
From the reviews:
"The book covers renovascular, endocrine, and pulmonary causes of secondary hypertension and its treatments. It is well written and easy to read with an exhaustive index. The book provides historical and contemporary information on each subject. A unique aspect of this book is the attention given to surgical therapy using excellent figures. This is an excellent book for several reasons. First, it is compact and readable, with up-to-date information from several medical specialties, obviating the need for multiple larger books to gather this information. Second, it offers a comprehensive literature review providing a historical perspective in each subject area. Finally, the infrastructure of the book (tables, figures, index) is clear and complete." -Doody's Health Sciences Book Review Journal
"...this book should be in the library of primary care physicians, internists, and specialists in nephrology, cardiology, and endocrinology." -The New England Journal of Medicine
"...a comprehensive reference...timely and well worth reading by doctors involved in hypertension management...an excellent and informative volume and highly recommended for physicians involved in the management of hypertensive disorders..." - Clinical and Experimental Pharmacology and Physiology
"...the book provides an outstanding review of hypertension." - The Annals of Pharmacology
"Over 17 chapters written by specialists in the field, reexamine the classical aetiologies of secondary hypertension in light of the current knowledge but also address the effects of non-cardiac drugs and obstructive sleep apnoea. … We strongly recommend this excellent work which is of great value not only for students but also for all physicians interested in a better management and treatment of patients with refractory hypertension." (Victor Legrand, Acta Cardiologica, April, 2005)
"Secondary Hypertension: Clinical Presentation, Diagnosis and Treatment is a timely volume on this important subject. … This book updates various medical conditions that contribute to hypertension and summarizes the clinical features … . will be of great value not only to physicians involved in hypertension research and in undergraduate and postgraduate medical education (which includes most pediatric nephrologists), but also to internists in practice. The price is right, and I recommend a copy of this book in each medical library." (Manju Chandra, Pediatric Nephrology, Vol. 21, February, 2006)
From the Back Cover
Our knowledge of secondary hypertension has grown significantly in recent years with the introduction of new diagnostic tools, biochemical tests, and drugs. In Secondary Hypertension: Clinical Presentation, Diagnosis, and Treatment, world-renowned researchers and clinicians critically evaluate and summarize the latest ideas about the screening, diagnosis, and medical/surgical treatment of secondary hypertension in adults and children. Drawing on a variety of medical disciplines-including nephrology, endocrinology, internal medicine, and pediatrics-the book's authors review the critical scenarios that should prompt a search for secondary forms of hypertension and discuss appropriate testing for these uncommon disorders. Additional coverage is given to exogenous or such less-appreciated causes of secondary hypertension as obstructive sleep apnea, primary aldosteronism, renovascular hypertension, and the effects of noncardiac drugs.
Comprehensive and up-to-date, Secondary Hypertension: Clinical Presentation, Diagnosis, and Treatment is an indispensable guide for physicians seeking the special knowledge and expertise needed to diagnose and treat the many varieties of secondary hypertension in adults and children.
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By Rainford J Wilks
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