At the clinical interface little seems to be new in the area of hypertension. Non-pharmacological strategies have been unchanged for decades and there have been no new drug therapies since the advent of the angiotensin receptor blocker class in the mid to late 1990s. However, much has changed in the past few years with regard to our understanding of the genetics of hypertension, the underlying pathophysiology of the condition and recognition of hypertension as the main risk factor driving cardiovascular morbidity globally. Furthermore, a number of new classes of agents are being developed 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 developments in hypertension, anchored by sections on the fundamentals of knowledge regarding this condition, is clearly warranted.

Is Black and Elliott’s Hypertension: a companion to Braunwald’s Heart Disease the definitive textbook in this regard? It is certainly a handsome volume with an easy-on-the-eye layout accompanied by appropriate figures, tables and drawings. Its chapters fall along classical lines comprising epidemiology, pathophysiology, diagnosis, risk stratification, treatment, concomitant diseases and management in special populations. Thus, it appears to provide a comprehensive overview of this condition.

To test whether this is in fact the case I consulted a similar publication, Hypertension: a companion to Brenner and Rector’s The Kidney by Oparil and Weber (interestingly, put out by the same publishers, Elsevier Saunders). I would have to say that the Black and Elliott text suffers by comparison. One is struck by the much more comprehensive approach by Oparil and Weber in outlining the pathophysiology of the condition. As well, there is much greater attention to diet and nutrition, with six separate chapters on non-pharmacological management of the condition. There are also extremely thorough assessments of individual drug trials contributing to the evidence base of hypertension management.

Drilling down into my own area of interest (the interface between hypertension and heart failure), again the Black and Elliott book came across as somewhat superficial with little discussion on left ventricular hypertrophy (an important disease entity in its own right) and essentially a restating of management strategies for heart failure per se, rather than as it specifically pertains to hypertension patients.

Despite these reservations, there are particular areas of strength in Black and Elliott’s text. There are extremely important and sorely needed chapters on hypertension in special populations and across Third World geographic areas, which underscores the global epidemic we face (expected to reach almost 50% of the adult population by 2025). Furthermore, chapters on the drug development process in hypertension and a focus on guidelines and their differences across regions also give the text a comprehensive feel.

Clearly, with sections and chapters of this type, this textbook will not be for everyone. For the busy general practitioner requiring guidance as to how best to manage the individual hypertension patient, this is not the book. For others requiring an in-depth review of the fundamentals of hypertension, pathophysiology, diagnosis and management, Black and Elliott is a worthy addition to one’s library (or that of one’s institution). Oparil and Weber may, however, be an even worthier addition!