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[ACC2009]Suzanne Oparil教授和张维忠教授对话高血压治疗
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作者:张维忠|S.Oparil 编辑:国际循环网 时间:2009/4/1 16:32:00    加入收藏

 标签:  关键字:高血压 JNC 8 

International Circulation: First of all I’d like to thank Dr. Suzanne Oparil at joining us today at ACC 2009 and also Dr. Zhang a great pleasure to have you here from Shanghai. The first question I would like to ask is can you talk a little bit about what is the status about the updated JNC 8 guidelines, Dr. Oparil?
《国际循环》:首先我要感谢Suzanne Oparil博士和张维忠教授能在2009年ACC会议上接受我们的访问,很高兴张维忠教授从上海来到这里。Oparil博士,我要问您的第一个问题是,您能谈一下有关JNC8指南的最新情况吗?

Prof. Oparil: The JNC guidelines are going to be different from previous guidelines because of the way the sponsor, the US National Heart Lung and Blood Institute, has organized things is that the JNC 8 will be part of a more comprehensive set of guidelines designed to try to reduce cardiovascular risk by dealing with lipids and by dealing with obesity, which is very common in the US.  Now in addition to the three specialty groups; JNC 8 which is for hypertension, ATP IV which is for lipids, and an obesity group that does not have an acronym there will also be three cross cutting groups; one looking at risk assessment, one looking at implementation, and another one looking at adherence.  So we are trying to very comprehensively deal with cardiovascular risk reduction and hypertension management is only a part of that. 
Oparil教授:JNC指南与先前的指南将会有不同,因为主办者,美国国立心肺及血液研究所已经明确JNC8指南所涉及的内容将更加广泛,在指南的设计上将试图通过应对美国常见的血脂和肥胖问题来减少心血管风险。现在除了3个专业组高血压组、对血脂的ATP IV组以及目前还没有缩写的肥胖组之外,还有其它3个跨领域组。一个组主要注重危险性评估,一个组寻找实现方法,还有一个组寻找其它相关因素。我们正试图在更大范围上减少心血管危险因素,处理高血压只是其中的一部分。

International Circulation: You mention those three groups, how much cooperation is there between those three groups and the discussions?  Are there on going discussions between your fellow guideline groups?
《国际循环》:您提及了3个组,那么这3个组之间的合作和会谈有多少?编写这些指南的各小组之间进行讨论吗?

Dr. Oparil: Yes that is correct. There are shared meetings between, well actually the six groups – the three cross cutting groups and the three specialty groups, and then we share a lot of things on the computer.  Webinar broadcasts where you hear an expert like speak on dissemination or speak on the translation from guidelines to practice, topics like that. So there is a lot more interchange than there was before. Another innovative feature is that we are using formal literature reviews, formal evidence based gathering of information, formal evidence as opposed to expert evidence on which the previous JNCs relied upon. So it is a longer and more laborious process which is why I can not give you specific information on what the recommendations will be. We do not know yet.
Oparil教授:是的。这六个小组,就是3个跨领域组和3个专业组之间会共同举行会议,此外我们还通过计算机分享很多东西。你可以在互联网上听到专家对指南进行的普及和翻译,或其他类似的话题。所以现在这样的交流比以往多了很多。另一个具有创新性的特征是,我们使用了正式的文学评论,对信息进行了权威的偱证收集以及权威的证据推翻了以前JNC指南上的有些专业建议。因此这是一个更漫长和艰辛的过程,这也是我为什么不能给你有关指南上更多信息的原因。因为目前我们还不知道。

International Circulation: Dr. Zhang what about your views on the new guidelines? How will it influence your work in China compared to the previous guidelines? Can you share a little bit about your views?  What do you expect maybe or what do you think or how it will help your work here in China? 
《国际循环》:张维忠教授,您对新指南有什么看法?与之前的指南相比,新指南对您在中国的工作将会有多大影响?您能都和我们分享一些您的观点吗?对此,您有什么期待或想法,或者您觉得对中国的工作将会有多大的帮助?

Dr. Zhang: The last guideline in China was published in 2005 so up to now, five years has passed.  We were notified and then revised the guideline this year, it may be published next year. So we expected the American JNC 8 to be published as they are a strong influence to us. Of course we also mixed in China’s data to the guidelines. 
张维忠教授:最近的指南是在2005年公布的,至今已经过去5年时间了。我们知道指南在今年进行了修改,可能新指南会在明年公布。我期待美国JNC指南公布后能对我们有深远的影响。当然,我们也会在指南中加入中国的数据。

International Circulation: With patients with hypertension, we talk about the treatment of patients with hypertension.  Reducing blood pressure below certain levels has been a clinician’s focus for a long time.  But obviously when we talk about the goal of hypertensive treatment we want to get some kind of cardiovascular benefits. So do you think clinicians should pay more attention to the cardiovascular benefits in the treatment of hypertension, Dr. Oparil?
《国际循环》:对高血压患者来说,我们谈论的是他们的治疗。长期以来,临床医生所关注的是把血压降至一个确定的水平之下。但是很明显,当我们谈到高血压治疗的目标时,我们想得到的是某种程度上的心血管获益。那么Oparil博士,您是否认为临床医生在治疗高血压时应该更关注心血管获益呢?

Dr. Oparil: Yes the bottom line in assessing the importance of clinical trials for example, is that those who have hard outcomes, that are death, heart attack, and stroke, clearly carry more weight than studies that just look at blood pressure. But we can not forget completely about the blood pressure per se because observational studies and ecological studies have shown the blood pressure per se is a strong determinant of cardiovascular disease outcomes. So it works both ways but we emphasize outcome studies.
Oparil教授:是的。举个例子来说,我们评估临床试验的底线是结局事件,也就是死亡、心脏病发作和卒中,这比关注血压占更大的权重。但是我们不能完全忽略血压本身,因为观察性研究和生态学研究都显示血压本身就是心血管疾病结局的重要决定因素。所以两者都应该被关注,但我们更强调结局研究。

Dr. Zhang: I agree with Dr. Oparil’s point of view.  Many patients benefit from blood pressure reduction.  But in some instances maybe some antihypertensive drugs may have some benefits beyond blood pressure reduction.
张维忠教授:我同意Oparil博士的观点。有很多患者在降压治疗中获益。但是在某些情况下,可能有些降压药物在降血压以外对患者还有其他益处。

International Circulation: And I suppose in China, when we talk about some of those consequences and some outcomes of not treating hypertension – stroke in China is obviously serious so that must also influence your treatment of hypertension as well.  Dr. Zhang when you are treating someone with hypertension that would be a consideration I am sure that you think about as well.
《国际循环》:我推测,在中国我们谈论不治疗高血压的后果和结局时,卒中是一个十分严重的后果,而卒中也必定会影响您对高血压的治疗。那么张维忠教授,您在治疗高血压患者的时候,会考虑些什么呢?

Dr. Zhang: That is true, in China and in Japan, the main complication of hypertension is stroke.  It is different from the western countries where the main complication is myocardial infarction.  Of course in recent years, the prevalence of coronary heart disease has increased year by year.  But today the stroke remains the main topic for the treatment of hypertension. So for this reason, calcium channel blockers is the main antihypertensive drugs to be selected because in Chinese hyperte

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