Luis M. Ruilope 西班牙马德里Complutense 大学

    <International Circulation>: In a previous paper of yours， you stated that a low blood pressure goal when cardio-renal disease is advanced can be risky. Can you elaborate on those risks and what difficulties do clinicians face in tackling those?

   《国际循环》：在您的一篇文章中，您写道：心肾疾病严重时目标血压过低存在 风险。您能详述有哪些风险吗？临床医生处理时会遇到什么困难呢？

    Prof.Ruilope: What we are saying is that in several studies (ONTARGET with people with established coronary artery disease， diabetics and non-diabetics; INVEST which is a study for diabetics with established coronary artery disease; and ROADMAP which is a study of primary prevention of microalbuminuria but in which one-in-four patients had established coronary artery disease)， in these three trials， a low blood pressure attained with treatment below 125mmHg was accompanied by an increase in death of cardiovascular origin in these patients. At the same time， a low blood pressure was accompanied in other studies like ACCORD (a study where blood pressure was lowered more in diabetics to 119mmHg) by a decrease in glomerular filtration rate which was estimated in ml/minute/year to be about 3. It means that for the kidney it is not good. Also， with a difference in blood pressure of 14mmHg， the prevalence of microalbuminuria was the same in the two groups indicating that for the kidneys and for the coronary arteries， a low blood pressure can be dangerous. Maybe for the brain it is another story but we need more data; it may be the lower， the better

    Ruilope教授：我们是说在一些研究中（例如ONTARGET涉及确诊的冠心病、糖尿病和非糖尿病患者；INVEST研究涉及确诊冠心病的糖尿病患者；ROADMAP研究则是微量白蛋白尿的初级预防，其中1/4的患者确诊冠心病），在这3个研究中治疗后血压低于125 mm Hg患者往往伴有心血管疾病死亡风险的增加。在另一些研究如ACCORD（该研究中糖尿病患者降压强度更大，血压降至119mmHg），较低的血压伴有每年约3 ml/min的肾小球滤过率的降低。这意味着对肾脏产生不良影响。并且，血压虽差14mmHg，两组微量白蛋白尿发生率相同，表明对肾脏和冠状动脉来讲，较低的血压有风险。对大脑情况可能不同，但我们需要更多的数据；或许是越低越好。