Michael A. Weber Libri

The availability of new technologies that enable blood pressure to be measured and re­ corded continuously or repetitively during prolonged observation periods has created ex­ citing opportunities for studying the physiology of blood pressure regulation and the characteristics of clinical hypertension. Ambulatory blood pressure monitoring has been based on three types of approach. The first of these has utilized an intra-arterial catheter that allows blood pressure to be meas­ ured directly and continuously during a full 24-hour period. The second approach is based on non-invasive techniques, and utilizes devices capable of automatically inflating conventional arm cuffs and recording blood pressures at pre-set intervals throughout the day. The third, and most simple method, has depended upon semiautomated techniques that require the subject to inflate a cuff at convenient intervals during the period of obser­ vation. During the last few years, concerted research into these differing techniques has exposed their strengths and shortcomings. Overall, however, there has been a growing perception that these approaches to the measurement of blood pressure might add con­ siderably to the information obtained in the doctor's office by the traditional single or casual reading. This book summarizes the state of the art in ambulatory blood pressure monitoring.

Hypertension is now recognized as being far more than a simple elevation of blood pressure. It is a constellation of risk factors that involves neuroendocrine, metabolic and cardiovascular changes. Hypertension is a form of vascular disease, and several factors that influence the structure and function of critical arteries play a pivotal role in explaining hypertension and its natural history. The traditional emphasis on blood pressure control is no longer acceptable. This special issue of the American Journal of Nephrology focuses on some of the contemporary issues that underlie the new, broader understanding of hypertension. It is an excellent update for all those concerned with this complex problem.

There is clear evidence that lowering blood pressure in severe hypertension through drug therapy reduces major cardiovascular events. Recent studies suggest that this benefit may extend to patients with mild to moderate hypertension. However, the potential advantages of medication can be countered by adverse effects, such as increased impotence and metabolic disorders associated with thiazide diuretics. This highlights the need for further investigation into treating mild to moderate hypertension. The ideal medication would target the mechanisms causing elevated blood pressure, prevent counter-regulatory responses, and have minimal side effects, particularly important for younger patients. These considerations were discussed at a symposium titled “Mild Hypertension: Current Controversies and New Approaches” held in Titisee, West Germany, from October 13-15, 1983. The symposium began with an overview of the neural and hormonal regulation of blood pressure in healthy individuals, followed by an exploration of the potential pathophysiological mechanisms in hypertensive patients. Special focus was given to the central nervous system and the peripheral nervous system's activity, as these areas may offer new avenues for effective therapeutic interventions in clinical hypertension. The current management strategies for mild to moderate hypertension were also reviewed.

This companion to Brenner & Rector's "The Kidney" offers detailed coverage of all aspects of hypertension, from basic science to clinical management.