International Circulation:  Dr. Oparil， at ACC 2009， some novel approaches to antihypertensive therapies are being introduced.  What is your opinion about these and any other innovative techniques?

Prof. Oparil:  These are very exciting for that very small group of patients whose blood pressure can not be controlled with existing agents or who are intolerant of many antihypertensive agents.  Most hypertensives can be controlled with drugs and lifestyle combinations. However， there is experience with exceptions.  In our own center we have five patients who were totally resistant to antihypertensive treatment with up to eight drugs.  I have one of them myself， and she has a carotid sinus stimulator， which still does not normalize her blood pressure， but it has made it much more tolerable. I think both of these devices – the carotid sinus stimulator and the renal nerve ablation device may be very useful in selective cases.

International Circulation： Dr. Oparil，ACC2009会议上介绍了几种治疗高血压的新方法。您如何看待这些和其他的创新技术？

Prof. Oparil:   对少数现存药物未能控制血压的患者或者不能耐受降压药的患者而言，这些技术非常令人兴奋。多数高血压患者可通过药物联合生活方式调整控制血压。然而，也有例外情况。我们自己的中心里，就有5位患者对最高8种药物的降压治疗无效。我自己就有其中的一位患者，她安置了一个颈动脉窦刺激器，虽然仍不能使其血压正常，但已让人更可以接受。因此，我认为颈动脉窦刺激器和肾神经消融两种技术，可能对特定的患者非常有用。

International Circulation:  With the focus on systolic blood pressure， particularly in older patients， adequate control of systolic blood pressure and the risk of lowered diastolic blood pressure also rises.  What is your advice on how to control this effect and balance the targets of the systolic and diastolic blood pressures?

Prof. Oparil:  That’s a challenging question.  First of all， we all agree that because of increased stiffness in arteries that high systolic blood pressure is the major problem in the older hypertensives. Furthermore， we know that if we can lower that blood pressure the benefit that the patient derives is proportionate to the magnitude of the blood pressure reduction.  We also know that most of these older people have very high systolic blood pressure and slightly low diastolic.  Fortunately when we treat the systolic， the reduction in systolic is much greater than the reduction in diastolic so usually the patient is fine and usually there is nothing to worry about.  The exception is when the patient has underlying coronary artery disease and we treat the systolic blood pressure excessively aggressively， we may precipitate angina or heart attack because of decreased blood flow in the coronary arteries.  Coronary blood flow progresses during diastole， not systole so that’s a problem there. I believe that the risk of the so called J shape curve and reducing the diastolic pressure too much is exaggerated.  We need to focus on the systolic， watch the patient carefully， make sure we know the patient’s cardiac status and be a little bit more prudent and a little bit slower in reducing blood pressure in the older person than we would in the middle aged or younger person. 

International Circulation:   目前对患者特别是老年人的收缩压更加重视，但在收缩压充分控制的情况下，舒张压更低的危险也会增加。您如何避免这种现象，如何平衡收缩压、舒张压的降压目标？

Prof. Oparil:   这是一个挑战性的问题。首先我们都赞同由于动脉僵硬度的增加，高收缩压已成为老年高血压患者的一个主要问题。我们知道如果能降低血压，患者的获益是与血压的减少幅度相称的。我们也知道，多数老年人的收缩压很高，而舒张压却非常低。幸运的是我们治疗收缩压时，收缩压的减少明显超过舒张压的减少，所以一般情况下患者很好，通常不需要担心。例外的是患者合并冠心病时，如果治疗收缩压过份激进，有可能因为冠状动脉血流减少而引发心绞痛或心脏事件。冠脉血流增加主要在舒张期，而不是收缩期，所以会导致上述问题。但我相信，所谓J型曲线和舒张压过份降低的风险已被夸大。我们需要关注收缩压，认真观察患者，确保知晓患者的心脏状态，在对老年人降压时，相对中年或年轻患者应更加谨慎和更加缓慢。