Ronald J. Portman, Jonathan M. Sorof, Julie R. Ingelfinger, eds.
492 pp. Totowa, NJ: Humana Press; 2004. $145.00. ISBN 1-58829-385-8
Hypertension remains one of the most important risk factors for cardiovascular disease. An increasing accumulation of evidence has shown that pediatric hypertension has a significant impact on adult cardiovascular disease as it tracks into adulthood and is a risk factor for continued adult hypertension. Pediatric hypertension also directly causes end-organ damage, primarily left ventricular hypertrophy, and is associated with early atherosclerotic changes. A new textbook, Pediatric Hypertension, is a timely and worthwhile reference for any clinician or clinical researcher interested in this area because it provides a comprehensive review of what is known about childhood blood pressure based on scientific data. Equally important, it also provides insight on what is still unknown and identifies areas that require further investigation. This multiauthor survey covers the entire spectrum of pediatric hypertension in 27 chapters that are divided into 4 sections: regulation of blood pressure; assessment of blood pressure including measurement, normative data, and epidemiology; definitions, predictors, and risk factors for essential and secondary hypertension and hypertension in specific populations; and evaluation and management of pediatric hypertension.
In general, the chapters are well organized, concise, and easy to read and understand. The third section, as is highlighted in the foreword and preface, provides what is novel about this book: It encompasses an in-depth discussion of the impact of genetic and environmental factors on blood pressure regulation and control, including the effects from a specific gene (monogenic) or several genes (polygenic), perinatal programming, cardiovascular reactivity, ethnicity, and social environments. Each of these chapters is well organized, with an introduction that specifically outlines the areas to be covered followed by a discussion of current knowledge based on basic, translational, and clinical studies. The material is presented in a logical and straightforward manner, with results clearly interpreted. Where appropriate, clinical applications or speculation on clinical applicability are given so that the clinician can better incorporate this material into his or her understanding of the pathophysiology of pediatric hypertension. For example, in the chapter on monogenic and polygenic contributions (Chapter 12), the clinical discussion includes a table with clues on when to suspect one of the rare causes of monogenic hypertension.
The chapters that are more clinically focused cover the gamut of pediatric hypertension. Part II focuses on the measurement and assessment of blood pressure, including normative data for both casual and ambulatory blood pressure monitoring. Many of the chapters’ authors also are members of the National High Blood Pressure Education Program (NHBPEP) Working Group on High Blood Pressure in Children and Adolescents, which has recently released the fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adoles-cents.1 These chapters review much of the same information but provide a more in-depth discussion including the historical and scientific bases for the updated recommendations. In particular, the chapter on ambulatory blood pressure methodology and norms (Chapter 6) is useful because this is a relatively new area for pediatric blood pressure monitoring and is only briefly touched on in the new NHBPEP report. The chapter includes information on types of monitors and methods used in ambulatory blood pressure monitoring, the normative reference values including comparison to casual blood pressure values and the current and future clinical utility, and areas where further work needs to be accomplished.
Part IV concentrates on the management and treatment of hypertension in general, whereas specific chapters in Part III focus on the management of specific populations of children (neonates and children with chronic kidney disease and end-stage renal failure). These chapters are organized in an easy-to-follow format for the clinician. Of note, the chapter on pediatric antihypertensive trials (Chapter 26) is innovative because it discusses the different issues surrounding a well-designed clinical trial for new antihypertensive medications in children. It provides insight on how the pediatric process differs from adult trials and what is currently mandated by the US Food and Drug Administration Written Requests.
The one area of this text that could be improved is Part I, Regulation of Blood Pressure in Children. The first chapter, Neurohumoral Regulation of Blood Pressure in Early Development, is densely written, especially for readers without a strong background in cardiovascular physiology. The third chapter, Development of Circadian Time Structure and Blood Pressure Rhythms, reviews broadly the development and establishment of circadian rhythms, but scant information is included about how this relates to blood pressure because there appear to be scant data. This chapter adds little to understanding blood pressure regulation.
For pediatricians, family practitioners, and internists who have interests in the antecedents for cardiovascular disease, this textbook is a welcome addition because it offers the first comprehensive review on this important topic. Pediatric Hypertension has clearly met its editors’ goals, “to provide a catalyst for more interest in pediatric hypertension,” as well as to provide “a guide for the interested clinician or clinical researcher.”