Book Review

Abstract

The Kidney and Hypertension Edited by George L. Bakris 233 pages . New York, NY ; Martin Dunitz ; 2004 $99.95 . ISBN 841842702 The rates of end-stage renal disease have been at epidemic levels for decades in the United States. The disparities associated with kidney disease are very significant, with African Americans being five times more likely to develop end-stage renal disease. Most alarming are the increasing disease rates, such that medicine will not be able to keep pace with the $80,000-plus annual costs for dialysis. Hypertension is a major factor associated with the risk of kidney disease progression, and it is essential that clinicians understand the blood pressure (BP)—kidney relationship and its impact on adverse health outcomes. Complicating the transfusion of the information from research to practice are the multiple aspects of the hypertension–kidney disease relationship and the changing risk profiles of the population. Bakris has edited a comprehensive multiauthored book that seeks to inform residents, fellows, and junior faculty of the current clinical concepts regarding hypertension and kidney disease. The text addresses the appropriate measurement of BP, hypertension detection, understanding of risk associated with elevated BP, mechanisms of disease, and hypertension treatment strategies based on evidence-based medicine. Specific emphasis and focus are dedicated to the issues of salt retention, action of the renin-angiotensin system, overactivity of the sympathetic nervous system, renal artery stenosis, and the resistant nature of hypertension in patients with renal disease. The book has three major sections. The first section deals with assessment, epidemiology, BP measurement, microalbuminuria, proteinuria, systolic BP, and secondary hypertension. The second section focuses on general treatment with special considerations for risk reduction, BP treatment goals, the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, treatment of elevated lipids, and hypertension urgencies. The third section addresses the treatment of high-risk patients, including patients with diabetes, African Americans and South and East Asians, pregnant patients with hypertension, children with hypertension, and BP in dialysis patients. The book has the characteristics inherit to many multiple-author texts. In particular, writing styles and relevance vary by author. The number of references included at the end of each chapter range from 9 to 74. As with many such publications, the time needed for coordinating the writing assignments, edits, rewrites, and synthesis to one document seems to have delayed the publication such that current relevant references are not included. In the case of this book, several citations refer to the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI), rather than the current JNC 7 guidelines. On the other hand the text is well indexed and structured, demonstrating an extensive review process by the editor. The book is easy to read and follow. Sections and topics of special interest to the reader are quickly identified and located. The book offers a useful resource for the intended audience, i.e., residents, fellows, and junior faculty who need to understand the impact and clinical considerations of the hypertension–kidney relationship in the patient population and, most importantly, the need for early diagnosis and aggressive treatment of hypertension to successfully reduce the population burden of kidney disease.—Daniel T. Lackland, DrPH, Department of Biometry and Epidemiology, Medical University of South Carolina, Charleston, SC