<International Circulation>: Angiotensin receptor blockers (ARBs) have been hailed as a milestone of cardiovascular drugs in the 1990s; its safety and effectiveness are confirmed by clinical research and practice. Prof. Nilssion， please talk about in the new European hypertension guidelines published this year， are there any extended?indications of ARBs?
Prof. Nilsson: I think the ARBs are very useful and can be used in many patients except for pregnant women， as we discussed. There are a number of excellent studies to show the benefits， the crucial question is whether they are similar to angiotensin converting enzyme inhibitors， in many patients I guess they are similar but the evidence is a bit different for example in the treatment of diabetic nephropathy， ARBs have been more documented. Both classes of drugs can show benefits according to glucose metabolism but we know that some patients will not tolerate ACE inhibitors because of cough and ARBs are a perfect alternative.  I guess the regression of nephropathy as shown as use of ARBs is good， diabetes prevention we mentioned， treatment of diabetic nephropathy.  Sometimes individual patients will better tolerate one drug as compared to another drug， as was mentioned previously， we appreciate all classes of drugs. They have their good sides and sometimes adverse effects， so basically we believe in individualizing drug choice for the clinician to think about what is useful for my patient and also be prepared and ready to listen to the patient at the next visit and to ask for side effects.  Most ARBs are very well tolerated so this is a plus.

　　《国际循环》：20世纪90年代，血管紧张素受体阻断剂（ARBs）被誉为心血管药物的里程碑，其安全性及有效性已被多项临床研究及临床实践所证实。Nilsson教授，今年公布的欧洲高血压新指南中，ARB的适应证是否有所扩展？
Nilsson教授：我认为ARBs是非常有用，除了我们之前所提到的妊娠女性外，很多患者都可选用该类药物。很多优秀研究显示，ARBs的临床获益与ACEI类药物相当。我认为在很多患者中两者的临床获益应该是相当的。但临床证据显示，两者在糖尿病肾病治疗中的获益上还是存在一些差别，与ACEI类药物相比，这类患者中更多应用的是ARBs。虽然两类药物均能通过改善糖代谢为患者带来临床获益，但是我们知道有些患者无法耐受ACEI类药物引发的咳嗽，ARBs是较好的替代之选。我认为ARBs有利于肾脏的转归、糖尿病预防及糖尿病肾病的治疗。如前面所提到的，有时个别患者对一种药物的耐受性优于另一种药物，所以所有类别的药物都是具有应用价值的，都有各自的优势及不良反应。基本上我们认为临床实践中医生应思考哪些药物更适合患者，进行个体化的药物选择，并随时倾听患者复诊时的意见反馈、询问不良反应情况。大多数ARBs均具有非常好的耐受性，这是其优势之一。

<International Circulation>: Prof. Zhang， how to adjust clinical practices corresponding to the changes of guidelines?
Prof. Zhang:  Yes， of course， I think so.  Not only for the European people but also for the Chinese.  I think the European guidelines are the most advanced in the world.
Prof. Nilsson: Thank you so much， I would like to emphasize， as Professor Mancia often tells that guidelines are educational， not prescriptive and we should respect our Chinese colleagues to find out what is most appropriate for China and Chinese patients. I have a question for you. It has been told that Asian patients are more susceptible to cough when treated with ACE inhibitors. Is this true or what do you think?
Prof. Zhang: I think this is true. There may be a link to an ACE gene polymorphism or a subtype of ACE gene such a DD genotype.
Prof. Nilsson: I also have another thing I would like to tell the viewers， I am also board member of the World Hypertension League dealing with public health and sodium restriction. I know that in China， you have a North South gradient according to salt consumption and the risk of stroke， so I believe we should not only think about drugs， we should also think about lifestyle and public health. Sodium restriction， I guess you know much about this， so what is your opinion on sodium restriction?
Prof. Zhang: The sodium conception is as you said， in the North is higher， and in the south is lower.  Such as in Shanghai， the average is 8 to 10 grams per day. In the north of China， maybe 12 to 15 grams， so that is a very important lifestyle change. In the new guidelines， salt should be restricted to 5 to 6 grams a day， so I think in China， this will have to be gradually. Because I think some hypertensive patients suffer from coughing due to ACE inhibitors， but from the evidence based of preferred drugs， the ACE inhibitors is better. In clinical practice， some people who suffer from cough cannot tolerate it， so most of the patients turn the ACE inhibitors into the ARB， an important reason.
Prof. Nilsson: I understand. This is important information because most of the studies have been done on the western populations， but as I mention， we should respect our Chinese colleagues to understand what is best in your country. You have more information on your patients than I have， so therapy should be tailored to the needs of the population.
Prof. Zhang: So fixed dose combinations such as valsartan combined with amlodipine is widely used in China so it got very good response. We widely use the ARB and the CCB.
Prof. Nilsson: I would like to finish by sending a message to my Chinese colleagues and viewers representing the European Society of Hypertension， I am very glad to have good links with China and just recently I started a collaboration I would like to tell you about in a few words. There is something called the European Society of Hypertension Chinese Hypertension League Systolic Hypertension Optimal treatment study. It is a very important study for secondary prevention of stroke， a randomized study， with three different goals: below 145 mm Hg， below 135 mm Hg and below 125 mm Hg. Professor Zanchetti is collaborating with Professor Liu， and he has told me a few days ago it has started now in China.  The first patients have been recruited， and this important study is not only of great scientific importance， it also means a link between Europe and China in research， so I think this is something for the future， so I would like to thank you Professor Zhang  and all the viewers.

　　《国际循环》：张教授，按照新指南的更新，我们应如何调整临床实践？
张教授：我们应根据新指南的最新更新来调整我们的临床实践，这不仅仅是只针对欧洲患者，对中国患者也是如此。我认为，欧洲指南是世界上最先进的指南。
Nilsson教授：非常感谢您这样说。我想强调的是，正如Mancia教授经常说的，指南旨在教育而非下指令。我们对中国同道找到了更适合中国患者的治疗方法表示尊重。我有个问题想请教的是，有研究显示亚洲患者应用ACEI类药物时更易发生咳嗽。事实果真如此吗？您对此有何看法？
张教授：我认为是这样的。这可能与亚洲人群中存在ACE基因多态性或DD亚型等ACE基因亚型有关。
Nilsson教授：作为世界高血压联盟的委员，我负责处理公共健康问题及限制钠盐摄入。据我所知，在中国钠盐的摄入及卒中风险存在南北差异，因此，我认为我们不仅要关注药物，还需要关注生活方式干预及公众健康。我想张教授对钠盐摄入了解得更多，您对限制钠盐摄入有何看法？
张教授：在中国正如您所说的一样，钠盐的摄入量北方高于南方。以上海为例，每日平均钠盐摄入量为8~10 g；而中国北方地区摄入量高达12~15 g。因此生活方式干预非常重要。新指南推荐的钠盐摄入量是每日5~6 g，我认为对中国患者可能需要逐步限制钠盐的摄入。因为我认为有些高血压患者应用ACEI类药物会发生咳嗽，但循证依据却提示ACEI类更适宜作为首选药物。临床实践中，有些因咳嗽无法耐受ACEI类药物的患者会改用ARB类药物。
Nilsson教授：这是非常重要的信息。因为大多数研究主要是在欧洲人群中开展的，正如我所提到的我们应该尊重中国同道对“其国家中哪种治疗更好的”的理解。与我们相比，中国医生对他们的患者更了解，因此能够更有针对性地对患者进行治疗。
张教授：因此，在中国固定复方制剂（如缬沙坦与氨氯地平固定剂量联合）得到了广泛应用，并取得了很好的效果。我们最常选择的是ARB类药物与CCB联用。
Nilsson教授：我想代表欧洲高血压学会向我们的中国同道及观众表示我们愿与中国保持良好沟通与合作的意愿。近期我们已经开始了合作，简单透露一下目前双方正在合作开展收缩期高血压最佳治疗研究。该研究是一项有关卒中二级预防的随机研究，将患者随机分为三种不同的降压目标治疗组（<145 mmHg、<135 mm Hg及<125 mm Hg）。这项研究主要是由Zanchetti教授和刘教授共同牵头开展，目前已经在中国启动，并成功入选第一批患者。该研究不仅具有极大的科学价值，也意味着欧洲与中国在研究领域的合作。我认为这将是未来的发展方向。