Book Review

Pediatric and Adolescent Hypertension

N Engl J Med 1993; 328:1579-1580May 27, 1993

Article

Pediatric and Adolescent Hypertension
Edited by Jennifer M.H. Loggie. 416 pp., illustrated. Boston, Blackwell Scientific, 1992. $149.95. ISBN: 0-86542-097-1

Over the past two decades, there has been heightened interest in the subject of blood pressure and hypertension in infants, children, and adolescents. This interest has been stimulated by a number of factors, prominent among which are the realization that essential hypertension and atherosclerosis probably have their origins in childhood and the recommendations of the American Academy of Pediatrics and the Task Force on Blood Pressure Control in Children that blood pressure be measured as a part of routine anticipatory guidance starting at an early age (two to three years). Over the past several decades, a number of important advances have been made. These include technological advances that have improved the ease and reliability of blood-pressure measurement, better definition of normal blood pressures in children of different ages and sizes, increased knowledge of the causes of hypertension in children, greater understanding of pathophysiologic mechanisms of high blood pressure, the development of more reliable and less invasive imaging studies, and the availability of a number of more specific therapeutic agents. Despite the heightened interest and major advances, few books have been published that address the problem of hypertension in infants and children, and none of those that are available are comprehensive or recent. This relatively comprehensive book therefore fills a real need.

The first part of the book concerns the physiology of blood-pressure regulation. These chapters are succinct and adequately referenced, and they provide a balanced overview of the topic. The next section of the book deals with the mechanics of blood-pressure measurement in infants and children, normal blood pressures, epidemiologic factors, an overview of causes of hypertension, and a general approach to management. Next, in the middle of the book, are four chapters devoted to pharmacologic agents. There are several chapters on essential hypertension, followed by sections devoted to secondary forms of hypertension in children, including hypertension due to renal parenchymal lesions, chronic renal insufficiency, renovascular hypertension, coarctation, and catecholamine-producing tumors. The well-written chapter on radiologic evaluation has a large number of clear figures of imaging abnormalities. The book then reviews blood pressure and hypertension in young athletes, hypertension during pregnancy, hypertension in newborn infants, and hypertension in blacks. Finally, there are discussions of the management of hypertensive emergencies, vascular pathology, and prognosis.

This multiauthored book is balanced and clearly written. The numerous tables and figures are well done and useful. Anyone treating hypertension in children will be delighted with the extensive information on doses, mechanisms of action, metabolism-elimination, half-life, peak action, duration of action, dose intervals, dosage adjustment in renal failure, effect of dialysis, and common side effects of drugs.

There is some duplication, notably in the two chapters about renal parenchymal lesions associated with hypertension, one written by pediatric nephrologists and the other by urologists. A somewhat different division of responsibility in terms of coverage of the various parenchymal lesions would have prevented some of the duplication. Tables defining severe hypertension in all age groups appear in three different chapters, and all cite the same reference.

This well-written book should be in the libraries of pediatric nephrologists, pediatric cardiologists, fellows in pediatric nephrology and pediatric cardiology, pediatric specialists in ambulatory medicine and adolescent medicine, pediatric generalists with an interest in hypertension, and internists with an interest in adolescent patients. The book should be readily available to pediatric and family-practice house officers, medical students, neonatologists, practicing general pediatricians, and family-practice physicians who see adolescents and children in their practices.

L. Leighton Hill, M.D.
Texas Children's Hospital, Houston, TX 77030