Book Review

Hypertension in Children: A practical approach

N Engl J Med 1997; 336:1682June 5, 1997

Article

Hypertension in Children: A practical approach
Edited by Leonard G. Feld. 233 pp. Boston, Butterworth–Heinemann, 1997. $50. ISBN: 0-7506-9678-8

Hypertension was once considered almost exclusively the province of internists. However, an extensive body of clinical and epidemiologic research now clearly points to the antecedents of essential hypertension in childhood. With this realization, hypertension has come of age as a problem in pediatric medicine, and all practitioners who treat children must be thoroughly familiar with it. This book should make the task easier.

Individual chapters in Hypertension in Children deal with the technical aspects of blood-pressure measurement, the cause of essential and secondary hypertension, and a step-by-step approach to diagnosis, as well as nonpharmacologic and pharmacologic therapy. Each chapter has a clinical focus and is comprehensive yet concise. There are discussions of techniques and equipment for determining blood pressure in infants and children; ambulatory blood-pressure monitoring; criteria for defining elevated blood pressure in a patient of either sex and any age or height; and a diagnostic approach based on the degree of hypertension.

It should be noted that this book went to press before the 1996 “Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents: A Working Group Report from the National High Blood Pressure Education Program” (Pediatrics 1996;98:649-58), which recommended use of the fifth Korotkoff sound (K5) to determine diastolic blood pressure in children and adolescents, rather than the fourth sound (K4), as cited in Hypertension in Children. For the same reason, the updated percentile tables for height-specific systolic and diastolic blood pressure in children 1 to 17 years of age, not available at the time of publication, do not appear here. Nonetheless, the book does include data based on the use of K5, which do not differ from the data in the task-force update by more than 4 mm Hg and which are identical in many instances. The book offers useful bedside pearls, such as the Gruskin criteria for estimating the upper limits of normal blood pressure at any age. Above all, the point is stressed that one must avoid labeling a child as hypertensive until the diagnosis is firmly established, because of the social and financial consequences of this diagnosis.

The chapters on therapy emphasize nonpharmacologic intervention and practical suggestions for improving compliance. A comprehensive section discusses the main pharmacologic mechanisms and adverse effects of antihypertensive agents and the advantages and disadvantages of each. Brief tables summarize adverse effects, doses, and available dosing forms and provide guidelines for pharmacologic therapy in children with hypertensive emergencies or chronic renal failure. The recommended therapeutic regimens tend to deemphasize the time-honored role of plasma renin activity in determining which drug to use, an approach not all physicians may subscribe to, but a reasonable one nonetheless.

In a separate chapter, the book addresses the roles of obesity and hyperinsulinism, race, oral-contraceptive use, and diabetes mellitus in the pathogenesis of hypertension, and a subsequent chapter discusses common questions about blood pressure in children, such as whether an adolescent with hypertension should be allowed to participate in sports. The information in these pages alone attests to the value of the book.

From pearls to principles, Hypertension in Children is what a ready reference for clinicians should be: accurate and thorough, yet concise and convenient to use. The book should prove to be indispensible to pediatricians and family practitioners alike.

Martin S. Polinsky, M.D.
Temple University School of Medicine, Philadelphia, PA 19140