Hypertension: Companion to Brenner & Rector’s The Kidney

Abstract

The basic premise leading to the publication of Hypertension: Companion to Brenner & Rector’s The Kidney is that the explosion of clinical and basic science data impacting on the practice of nephrology can no longer be contained within the confines of a manageable two-volume text. To supplement the base text (Brenner & Rector’s The Kidney ), four additional volumes have been published to cover the areas of hypertension, dialysis and transplantation, acid-base and electrolyte disorders, and therapy in nephrology and hypertension. In Hypertension: Companion to Brenner & Rector’s The Kidney, Oparil and Weber divide their text into 10 general sections covering, in order: history, pathophysiology, target organ damage, diagnosis, treatment—general considerations, lifestyle modifications, pharmacological treatment, comorbid conditions—special considerations, individual drug classes, and secondary hypertension. Treatment issues are given the largest portion of the text. The book deals largely with essential hypertension; less than 100 pages are given to secondary hypertension. This distribution is appropriate given the importance of essential hypertension as a major public health problem, but it will disappoint readers looking for extensive coverage of the rare and unusual. This is not necessarily the best resource for information on hypertension due to adrenal abnormalities or rarer endocrine syndromes. It is, however, a useful and fascinating work that dwells on the most important cause of hypertension. Because of the organization presented, a considerable amount of duplication exists throughout the book. Topics are considered and reconsidered, but each time from a significantly different perspective. Drugs are discussed as individual agents (in terms of dose response relationships) and single agents in combination (in relation to comorbid conditions, effectiveness in clinical trials, and consideration of target organ disease). The text also describes numerous aspects of the pathophysiology of hypertension. Genetics, the sympathetic and parasympathetic nervous system, stress and the environment, each of the significant hormones and autocoids, and vascular biological influences are all given their due. There is no attempt to summarize or to arrive at a “holistic” understanding. The reader is left to absorb the data and integrate it. This is not a fault, though. There is a wealth of information, and the individual presentations are often brilliant. The pathophysiology section can be read as a whole or mined for information. The effect is as if the reader attended a series of seminars or read a collection of individual essays. One finishes with an appreciation of the complexity of the problem and the knowledge that one has access to a data source that considers all points of view. Particularly useful and unique chapters are those reviewing the nature of outcomes, the characteristics of trials, the discussion of the current guidelines, and the analysis of current prescribing practices in different nations. Although this is a multiauthored book, the quality of the writing is consistently good throughout. There is liberal use of classic and original graphs. An amazing amount of data is provided by means of carefully designed tables. The most remarkable of these are found in a series that presents the currently available data on angiotensinogen polymorphism in population groups. Forty-eight studies are reviewed in five tables. One cannot imagine a more succinct or exhaustive treatment of the topic. The references throughout are current and extensive. There is no doubt that Hypertension: Companion to Brenner & Rector’s The Kidney greatly extends the coverage of its subject relative to the parent textbook. It can either be used to complement The Kidney or to stand alone as a reference. Although it could be used as a single source clinical text, it has less basic utility to the novice than Clinical Hypertension by Norman Kaplan. It is an excellent, enjoyable book and much better suited as a reference, a guide to further study, and a source for the teaching physician.