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[ACC2009]Norman Kaplan 教授与王继光教授对话高血压治疗
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 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?
《国际循环》:您认为这次ACC年会有什么样的热点话题?或者目前在高血压方面有什么热点吗?

 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.
Kaplan教授:很明显,每个人都十分关心我们如何治疗高血压。这次会议中讨论了很多临床试验,而且同期还有很多临床试验刚刚发表。我认为目前我们逐渐意识到使用至少两种,有时可能需要更多不同的药物治疗高血压。目前大家开始认识到仅用一种药物治疗通常是不够的。所以,我们尝试观察一定数目的试验,将两种有效的药物合用与其他比较。我们已经知道药物组合中应有利尿剂。我最近看了一篇来自中国的文章,文中作者调查了所选中国人群的盐敏感度并且发现有相当多的人对钠的作用非常敏感,因为这个原因,我想利尿剂在中国应该是高血压药物治疗的重要组成部分。

International Circulation:  They tend to have a quite high sodium intake as well.
《国际循环》:他们似乎在饮食上摄入比较多的钠。

 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.
Kaplan教授:是的,这就是另外一个问题,饮食中含有大量的钠,目前认为可使卒中可能性上升。卒中在全世界范围内都是一大问题,不过据我所知,在中国高血压患者中,心脏病发作的情况并非很普遍,但是卒中的情况要比我在美国见到的多。我想干预的手段可能与中国饮食结构中高盐、高钠有关。

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.
《国际循环》:对的,在西方,您可能看到很多因高血压导致的心肌梗死,但是在中国则是卒中。

 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.
Kaplan教授:是的,其他人告诉我说肥胖在中国也逐渐增多起来。我担心这种变化如果从农村进入城市,肯定会导致更严重的肥胖问题。我担心是因为当人们进入城市后工作强度减弱、运动减少,以及很多其他问题,有可能导致更多的高血压发生。

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?
《国际循环》:您刚才提到了联合治疗。您认为复合制剂的前景如何?将多种不同的复合物放进一个制剂中?

 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.
Kaplan教授:实际上在几年以前有一篇文献报道了一种制剂叫“聚合制剂”,它包含了抗高血压药物、降低胆固醇的药物以及预防血栓的阿司匹林。是否能够上市应用我目前还不清楚。但我知道有药厂正在研制三联药物。我们有很多含有两种药物的制剂,但到目前为止还没有三联制剂,我知道有家大型药厂正在准备向美国引入这种三联药物。我估计以后也会进入中国。

International Circulation: Do you think it will and how will it improve clinical outcomes? And what is your feeling on that?
《国际循环》:您认为它会改善临床结果吗?又怎样改善呢?您的看法是什么?

 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.
Kaplan教授:我们目前都意识到血压下降的方式没有比血压下降本身这个事实重要。如果血压被降到更安全的水平,真的不用在意是如何达到这一目标的。我的意思是,我知道很多中国传统医学及其药物还有其他的方法也在中国使用,比如针灸等。如果它们真的有效,即使是安慰剂效应,如果它们真的能够降低血压,我想患者也可以受到保护以免发生心脏病和卒中。

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.
《国际循环》:JNC8的预期发放日期是在2010年早些时候。自从JNC7指南发表之后又有了很多新的证据、临床研究等。您的观点如何,当然因为结果还没有公布也不能十分确信,但您预计在JNC8中什么是最关键的变化?

 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.
Kaplan教授:我想其中一点是更加强调对患者的整体风险,而非仅仅是血压,也会引入胆固醇、血糖和吸烟。我想这在中国人群中也是一大问题。我知道很多中国男性及少量中国女性都在吸烟。

International Circulation:  I believe

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