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[ACC2009]Norman Kaplan 教授与王继光教授对话高血压治疗

 编辑:国际循环网 时间:2009/4/21 16:48:00    加入收藏

 标签:  关键字:Norman Kaplan  王继光 高血压 钙离子通道阻滞剂 非洛地平 ACCOMPLISH试验 利尿剂 王继光 

International Circulation:  What do you think some of the important topics or hot topics could be here at ACC?  Or presently, here in hypertension are right now?

 Prof. Norman Kaplan:  Well, I think everyone is obviously most concerned with about how we treat hypertension.  There are a number of clinical trials that are being discussed at this meeting and a number of others that have been recently published.  And, I think, what we are increasingly aware of is the need to use at least two, and sometimes more, different medications to treat hypertension.  I think there is awareness that one medication is usually not adequate. So, we are beginning to see a number of trials where they’ve combine two particularly effective medications to compare one against the other.  One of the things we have learned is that there is a need for a diuretic.  I recently saw a paper from China in which they looked at salt sensitivity in a number of Chinese people and noted that there was a very high prevalence of being sensitive to the effects of sodium, and for that reason I think a diuretic will probably be an important part of the treatment of most people in China with the hypertension.

International Circulation:  They tend to have a quite high sodium intake as well.

 Prof. Norman Kaplan: Yes, and that has been another problem, that the very high level of sodium in the diet, and, I think, that has been mainly known to effect the likelihood of stroke.  And I think that strokes has been a major problem all over the world but, from what I understand, heart attacks are not as common among Chinese hypertensives, but strokes are probably even more common than we see here in the United States.  I think a good deal of that may relate to the high level of salt, sodium, in the Chinese diet.

International Circulation: Sure, in the west you tend to see more myocardial infarction as a result of hypertension.  In China we tend to see more stroke.

 Prof. Norman Kaplan: From what I’ve been told, obesity is going into China as well.  And so, I’m afraid if current change from the rural community into the urban cities is going to lead to more obesity.  So I’m afraid that because people don’t work as hard, and they don’t walk as much, and a number of other things when they go to the city, and that in itself might lead to more hypertension.

International Circulation: You mentioned the need for combination therapy.  What’s your feeling on the future of a combination pill?  Combining various compounds into one pill?

 Prof. Norman Kaplan: There was actually a publication a few years ago about a single tablet called the poly-pill, which would include the anti-hypertensives and another drug to lower the cholesteral and aspirin which would prevent thrombosis.  Whether that will ever be available I am not sure.  But what I do know pharmaceutical companies are looking now at triple therapy.  We have a number of preparations of two drugs but up until now we haven’t had a triple and I understand that one of the major pharmaceutical companies is about to introduce such a triple drug for the Unites States.  And I would assume that that would also go over to China.

International Circulation: Do you think it will and how will it improve clinical outcomes? And what is your feeling on that?

 Prof. Norman Kaplan: I think the one thing that we all realize is that the way in which the blood pressure is reduced is less important than the fact that it is brought down.  If the blood pressure is treated to a level that is safer, it really doesn’t matter too much as to how that’s done.  I mean, I’m aware of traditional Chinese medication and other things that are done in China, acupuncture and such.  If they work, even if it’s the placebo effect, if they lower the blood pressure I think patients will be protected further from heart attacks and strokes.

International Circulation:  The expected release date for JNC8 is early in 2010.  So, there has been a lot of new evidence, clinical studies etc, since the publication of the JNC7 guidelines.  What is your feeling, of course you cannot really say for sure yet since it hasn’t come out, but what do you think some of the key changes perhaps will be in JNC8.

 Prof. Norman Kaplan: Well one thing I think is that there will be greater emphasis on the overall risk of a patient that is not just blood pressure, but also to take into account cholesterol, blood sugar, and smoking.  Now, I think that will be a major problem among the Chinese.  I understand that a lot of Chinese men smoke and fewer women.

International Circulation:  I believe

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