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Doody's Review ServiceReviewer: John F. Moran, MD (Loyola University Stritch School of Medicine)
Description: This text is about blood pressure measurement techniques, circadian variation, and ambulatory blood pressure monitoring written by 21 authors. It is divided into three sections on techniques, circadian variation, and ambulatory blood pressure monitoring.
Purpose: The purpose is to review approximately 15 years of data on ambulatory blood pressure monitoring and its usefulness. There is a big section on circadian rhythm, which is included in this text. This material is not generally covered in other books on hypertension.
Audience: This book is readable and intended for any practitioner who deals with hypertensive patients. The use of ambulatory blood pressure monitoring is increasingly important because of "white coat hypertension," as well as antihypertensive drug selection. The authors presented a credible text.
Features: The first part of the book has to do with the techniques for out of office blood pressure monitoring, the importance of daytime activities, night time measurements, caffeine, talking, blood pressure measurements taken in the home vs. the clinic, are all reviewed. There are also sections on the effect of ambulatory blood pressure monitoring related to the patient's posture, his mood, his work. There are also important variations with blood pressure taken in the season of the year, as well as gender. There is an interesting section on the history of ambulatory blood pressure monitoring, which has been around for perhaps 30 years, but has only recently become somewhat more widely used. There is an excellent review on circadian rhythm, which goes beyond circadian rhythm into ultraradian and infraradian rhythms, as well as seasonal rhythms. There is a good review of the circadian rhythm importance with acute myocardial infarction, unstable angina, sudden cardiac death, and cerebral vascular accidents. There is a brief review on blood coagulation related to circadian rhythms, as well as the importance of the sympathetic nervous system, the renin angiotensin aldosterone system, and sodium and potassium concentrations. A short chapter on chronopharmacology shows the importance of drug selection when treating hypertensive patients. Throughout the text there are several references to the hypertensive "dippers" and hypertensive "non-dippers". Finally, new antihypertensive drug development will have to take into consideration ambulatory blood pressure monitoring and circadian rhythms.
Assessment: This is clearly an addition to the literature, which takes a different path than many of the hypertensive text books that are currently available. This text falls short in the management of hypertension, simply because there is not enough data on drug usage for hypertensive patients, which takes into account circadian rhythms. This text is a worthwhile addition to the medical literature.