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MJA • Volume 188 Number 12 • 16 June 2008 689

Hypertension fundamentalsHypertension. A companion to Braunwald’s HeartDisease. Henry R Black and William J Elliott.Philadelphia: Elsevier Saunders, 2007 (xxii + 615 pp,$255.00). ISBN 978 1 4160 3053 9.A T THE CLINICAL INTERFACE little seems to benew in the area of hypertension. Non-pharmaco-logical strategies have been unchanged for decadesand there have been no new drug therapies sincethe advent of the angiotensin receptor blocker class

in the mid to late 1990s. However, much haschanged in the past few years with regard to ourunderstanding of the genetics of hypertension, theunderlying pathophysiology of the condition andrecognition of hypertension as the main risk factordriving cardiovascular morbidity globally. Further-more, a number of new classes of agents are beingdeveloped and indeed (the renin inhibitor class)have been approved in a number of countries outside Australia.For all of these reasons a comprehensive update on new develop-ments in hypertension, anchored by sections on the fundamentalsof knowledge regarding this condition, is clearly warranted.

Is Black and Elliott’s Hypertension: a companion to Braunwald’sHeart Disease the definitive textbook in this regard? It is certainly ahandsome volume with an easy-on-the-eye layout accompanied byappropriate figures, tables and drawings. Its chapters fall alongclassical lines comprising epidemiology, pathophysiology, diagno-sis, risk stratification, treatment, concomitant diseases and man-agement in special populations. Thus, it appears to provide acomprehensive overview of this condition.

To test whether this is in fact the case I consulted a similarpublication, Hypertension: a companion to Brenner and Rector’s TheKidney by Oparil and Weber (interestingly, put out by the samepublishers, Elsevier Saunders). I would have to say that the Blackand Elliott text suffers by comparison. One is struck by the muchmore comprehensive approach by Oparil and Weber in outliningthe pathophysiology of the condition. As well, there is much

greater attention to diet and nutrition, with sixseparate chapters on non-pharmacological manage-ment of the condition. There are also extremelythorough assessments of individual drug trialscontributing to the evidence base of hypertensionmanagement.

Drilling down into my own area of interest (theinterface between hypertension and heart failure),again the Black and Elliott book came across as

somewhat superficial with little discussion on leftventricular hypertrophy (an important disease entityin its own right) and essentially a restating of management strategies for heart failure per se, ratherthan as it specifically pertains to hypertensionpatients.

Despite these reservations, there are particularareas of strength in Black and Elliott’s text. There are

extremely important and sorely needed chapters on hypertensionin special populations and across Third World geographic areas,which underscores the global epidemic we face (expected to reachalmost 50% of the adult population by 2025). Furthermore,chapters on the drug development process in hypertension and afocus on guidelines and their differences across regions also givethe text a comprehensive feel.

Clearly, with sections and chapters of this type, this textbookwill not be for everyone. For the busy general practitionerrequiring guidance as to how best to manage the individualhypertension patient, this is not the book. For others requiring anin-depth review of the fundamentals of hypertension, pathophysi-ology, diagnosis and management, Black and Elliott is a worthyaddition to one’s library (or that of one’s institution). Oparil andWeber may, however, be an even worthier addition!

Henry KrumProfessor, NHMRC Centre of Clinical Excellence in Therapeutics

Monash University, Melbourne, VIC

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