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Molecular Mechanisms in Hypertension Richard N.Re, MD; Donald J.DiPette, MD; Ernesto L.Schiffrin, MD, PhD; James R.Sowers, MD 432 pages . Oxford, UK ; Taylor and Francis ; 2006 $229.95 ISBN 1842143042

Hypertension continues to be a major health issue, increasing the severity of heart disease, stroke, renal failure, and other diseases. Hypertension is a multifactorial disorder arising from the imbalance of one or more regulatory systems. Therefore, investigations into hypertension and its causes span a wide domain. Reflecting this complexity, the series of reviews in this book summarize current knowledge on many of the causes and mechanisms of hypertension. The formula of each chapter focuses on molecular mechanisms, highlighting gene and protein regulation for key players in hypertension, including hormones and intermediates, as well as organ system interactions. The book is aimed at the nonspecialist, yet most reviews provide updates that will be useful for investigators. The book might also be valuable for clinicians, as it provides a scientific background for nearly all aspects of hypertension.

The book is easy to read with short and direct reviews, generally with well-defined messages. Also, many chapters have useful algorithms that will assist the nonexpert. In general, authors have been selected both for their ability to articulate a comprehensive overview and for their productive experimental background. The editors have succeeded in keeping the approach simple and direct, managing to standardize the format somewhat. Therefore, the reader gets a sense of both current and practical information. Interspersed with reviews that focus strictly on molecular mechanisms are chapters on clinical aspects of the relevant systems. These serve a valuable purpose in describing the applications of the study of molecular mechanisms and complement the basic studies.

The book is divided into 3 parts. Part I includes 15 chapters on the renin-angiotensin-aldosterone system (RAAS), including generation of active peptides, regulation of receptors, and identification of new proteins impacting this system. Included are chapters on the important new findings on aldosterone and its receptors on the regulation of fluid balance, which is often overlooked in evaluating the RAAS.

The second part of this review explores non-RAAS peptides, many of which have been undervalued in the role in hypertension in the past. Included in this section is a valuable review of the new technologies available to define the role of these and other peptides.

Part III of this book includes reviews of nonpeptides, but also includes organ system interactions and how these impact hypertension. These may be of most interest to clinicians. Included are chapters on the role of oxidative stress, inflammation, salt loading, obesity, and diabetes in the onset and comorbid aspects of hypertension. Whereas many of these topics are familiar to the clinician, these chapters manage to provide insight to molecular regulation. A useful review of the sex differences in hypertension has also been included.

Some chapters provide unusually thorough updates that are appropriate for investigators. Of particular interest was the chapter on cell biology of oxidative stress. The basics of this important subject and its impact on hypertension are often poorly understood. This chapter provides a useful chemical and biological review of reactive oxygen species and addresses how it may impact vascular biology. Another valuable chapter is the review of obesity and hypertension, a continually dominant aspect of clinical medicine.

One drawback of any book compilation of reviews is the loss of the feeling of currency of its message. Indeed, many of these reviews fail to cite work within the last 3 years. Biomedical journals are capable of providing more timely reviews of many of these topics; however, the major strength is the comprehensive nature of over 40 chapters devoted to hypertension and its molecular regulation. For a valuable overview, this approach remains useful to the modern investigator and clinical practitioner.—William J. Welch, PhD, Department of Medicine, Georgetown University, Washington, DC