Book Review

Hypertension and Renal Disease in the Elderly

N Engl J Med 1993; 328:1206April 22, 1993

Article

Hypertension and Renal Disease in the Elderly
Edited by Manuel Martinez-Maldonado. 358 pp., illustrated. Boston, Blackwell Scientific, 1992. $79.95. ISBN: 0-86542-093-9

In the preface to this book, the editor makes three important points. First, the percentage of people over the age of 65 in Western countries will rise by 8 to 10 percent by the year 2010 and hypertension may affect 50 percent of this population. This means that there will be 15 million more older people with hypertension in the United States in only 17 years. Second, the monumental Systolic Hypertension in the Elderly Program (SHEP) study confirms the value of treating systolic hypertension. I assume that to meet publishing deadlines, the authors could not include the results of this study in their chapters., and third, the author apologizes in advance for “some overlap” in the chapters.

In reviewing this book I was maddened by its disorganization. Chapter 9, “Hypertension in the Elderly: Rationale for Therapy,” discusses not so much the reasons (rationale) for therapy as the drugs used for treatment. In chapter 10, “Clinical Assessment and Management of Mild to Severe Hypertension in the Elderly,” two or three sentences are devoted to secondary forms of hypertension. There is no mention of newer methods for working up suspected renal-artery stenosis (Doppler flow studies, magnetic resonance angiography, captopril renography, and so on). The index refers only to renal-arterial occlusive disease and refers the reader to the chapter on the rationale for treating this condition.

This is clearly not a book to read from cover to cover, but still it is a valuable book that contains hard-to-find information on the elderly. There are academic discussions of a variety of renal physiologic changes (acidification, hemodynamics, neural controls, and others) and nice clinical discussions of infections, atheroembolism, and obstructive uropathy. The concise chapter by Priscilla Kincaid-Smith on the nonpharmacologic treatment of hypertension and that by Harriet Dustan on the pathophysiology of hypertension in the elderly are lovely.

In summary, this uneven and repetitious book is still invaluable as a source of quick readings on a variety of topics related to hypertension and renal derangements in the elderly.

Harold S. Solomon, M.D.
Harvard Medical School, Boston, MA 02115