Blood Pressure Monitoring in Cardiovascular Medi-cine and Therapeutics is one in a series of texts titled Contemporary Cardiology. The focus of the present volume is on the circadian fluctuations of the cardiovascular system. It is intended for a readership of cardiologists, internists, endocrinologists, and nephrologists, as well as nurse practitioners, physician assistants, and others involved in the care of the hypertensive patient.
The book is divided into 3 major sections. The 1st reviews techniques for out-of-office blood-pressure monitoring. The limitations of blood-pressure evaluation in the physician's office are examined, and various types of home blood-pressure monitors are discussed. The importance of interpreting data within the context of behavioral and environmental factors is underscored as the essential distinction between disease and adaptive physiologic response. Dr. White critically reviews the advantages and limitations of ambulatory monitoring, together with the economic issues surrounding it.
The 2nd section of the book is its most scientific: it examines the circadian variations of the cardiovascular system. The major neurohormonal systems responsible for rhythmic hemodynamic oscillations are reviewed, and their relationship to the circadian variability of myocardial infarction, sudden cardiac death, and stroke is discussed. An entire chapter in this section is devot-ed to the evaluation of heart rate as an independent predictor of cardiovascular morbidity and mortality. Another focuses on the close interaction between the sympathetic and renin-angiotensin-aldosterone systems and the effects of these systems upon circadian variation.
Finally, the 3rd section reviews important practical considerations regarding antihypertensive therapy, including the dependence of drug kinetics and dosing intervals upon the circadian variability of the cardiovascular system. The book concludes with a chapter that focuses on current and future use of ambulatory blood-pressure monitoring both in clinical practice and investigation.
Notwithstanding some redundancy, this book provides an excellent, comprehensive analysis of circadian variability in the hypertensive patient. It also highlights the mounting evidence in favor of ambulatory monitoring and self-monitoring of blood pressure to more accurately discern blood-pressure trends. Hyper-tension remains a ubiquitous disease with independent risk for cardiovascular morbidity and mortality, despite decades of research and advances in pharmacology. Therefore, strategies to identify suboptimally controlled or widely variable blood pressure have a potential for great impact. This publication provides a practical framework for understanding hemodynamic variability and underscores the role of out-of-office blood-pressure monitoring in tailoring therapy to achieve 24-hour control.