International Circulation:  What about direct renin inhibition and its effect on cardio-renal protection?  What is the specific clinical manifestation of this cardio-renal protection?

《国际循环》：直接的肾素抑制剂是如何发挥心肾保护作用的？这种心肾保护作用有哪些特殊的临床表现？

GTM:  We now recognize that the renin-angiotensin system is fundamental in the evolution of not only caveat outcomes but also caveat renal outcomes.  The whole pathways are involved， the cross-talk with one pathway with the other.  Angiotensin II is critical in both the evolution of cardiovascular complications such as myocardial infarction and eventually heart failure.  Likewise， in renal complications， usually heralded by the development of protein urea and end-stage renal disease， and mortality also.  The pathways have a great deal in common and we know that the renin-angiotensin system is critical at various steps in these pathways.  Blocking the system， we hope， will interrupt these chain of events and lead to less renal complications， less cardiovascular complications， and less mortality.  At the moment it is looking as though these direct renin inhibitors may potentially have an edge over the other approaches.  Although it is early as yet， the studies are underway and we look forward to their completion and results.

GT McInnes教授：我们现在认识到，肾素-血管紧张素系统不仅是心脏预后而且是肾脏预后进展的基础。血管紧张素II在心血管并发症（如心肌梗死、心力衰竭）的进展中起到关键作用。同样，肾脏并发症通常是由蛋白尿的进展、终末期肾病、以及死亡来预示。这些途径有很多共通之处，我们知道，肾素-血管紧张素系统在这些途径的各个步骤中起到关键作用。我们希望，阻断这一系统将可以打断这些事件链，从而减少肾脏并发症，减少心血管并发症，最终达到减少死亡的目的。现在看来这些直接肾素抑制剂有可能优于其他方法。尽管得到这样的结论为时尚早，但是研究正在进行中，我们期待这些研究能尽早完成，早期看到结果。