Edited By William B. White, MD 308 pages . Totowa, NJ ; Humana Press, Inc. ; 2000. $99. ISBN 0896038408
I have been active in the field of blood pressure monitoring, advising self‐measurement to patients, for over 40 years. My involvement in assessing and using automated stationary and ambulatory devices spans over 30 years. The chapters in this book are written by experts and leaders in their areas and expertly edited and contributed to by Dr. White. It was a pleasure to read.
Multiple standardized measurements of blood pressure are necessary for the proper diagnosis and management of hypertension. National and international guidelines, such as those of the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, the American Society of Hypertension, the American College of Cardiology, and the World Health Organization/International Society for Hypertension, now recommend out‐of‐office measurement of blood pressure to assist in the assessment and continuing management of patients with high blood pressure, in the pursuit of improved control rates and better outcomes.
Because of concerns with mercury in the environment, the classic mercury sphygmomanometers are being replaced with aneroid or electronic devices. There have been impressive advances in the past two decades. Large, international databases in adults and children, 10 observational prognostic studies, and several outcome trials have been published. These technologies have come of age. Chips in the electronic devices that record all the blood pressure determinations have addressed concerns regarding errors in self‐determination or transcription of data by patients. They have a memory and mechanism for transmission of the information to a personal computer and/or medical office. All health care providers who treat patients with high blood pressure need to be familiar with the details of the devices, and when and how the procedures should be used and interpreted. For example, an average blood pressure at home of 135/85 corresponds to 140/90 in the medical office. The definition and interpretation of white coat (office‐only) hypertension is discussed in detail. The role of emotional and physical activity in altering blood pressure is illustrated. Devices should be chosen that have been evaluated independently, in a standard fashion, such as recommended by the Association for the Advancement of Medical Instrumentation or British Hypertension Society recommendations. Periodic validation must be done to assure continued reliability and accuracy.
During the last decades, our awareness of the chronobiology of cardiovascular events has increased. For example, the highest numbers of myocardial infarction, stroke, and sudden death occur in the morning hours. In addition to these circadian rhythms, there are weekly and annual rhythms. There are rhythmic variations in the autonomic nervous system, renal function, hormones, biogenic amines, peptides, opioids and much more. Arising from these observations are drug formulations designed to provide the optimum blood levels of therapeutic agents at the appropriate time—the right drug at the right place at the right time [chronotherapeutics]. Data from several trials of these agents are described. These maturing methodologies are presented in detail.
I found only one error—on page 8, the last measurement listed in the Table 3 does not match the discussion in the text.
I found this book to be very informative. It provides one with the current science in a succinct, consistently well written and illustrated fashion that is quickly assimilated for everyday use. There is very little overlap of material. It should be useful for health care providers, both new to and experienced in this field, who are involved in the day‐to‐day care of patients with high blood pressure. It should also be valuable for managed care organizations trying to make their share of the care provided during the 70 million office visits for hypertension more efficient.—Sheldon G. Sheps, MD, Emeritus Professor of Medicine, Division of Hypertension, Mayo Clinic, Rochester, MN