<International Circulation>: Angiotensin receptor blockers (ARB) have been hailed as a milestone of cardiovascular drugs in the 1990s; its safety and effectiveness are confirmed by clinical research and practice. Please talk about in the new European hypertension guidelines published this year， are there any extended indications of ARB?

　　《国际循环》：血管紧张素受体拮抗剂（angiotension receptor blockers， ARB）被誉为20世纪90年代心血管药物的里程碑。它的安全性和有效性被临床研究和实践所证实。请您介绍新的欧洲高血压指南中，是否有ARB的扩展适应证？

　　Prof. Unger: Historically， angiotensin receptor blockers (ARB) had a difficult time because when they came to market， angiotensin-converting-enzyme inhibitors (ACE inhibitors) had already been on the international market for 15 years. The inhibitors had already covered the market， and had good clinical results. And， there was good reason to use them.

　　Unger教授：历史上，血管紧张素受体抑制剂（ARB）曾经有段艰难的时间，因为当它们上市时，血管紧张素转化酶抑制剂（angiotensin-converting-enzyme inhibitors， ACEI）已经在上市了15年。ACEI已经占领了市场，并且有很好的临床效果。所以有很好的理由使用ACEI。

　　Now， ARB was a new class of drugs that went into the same system， and had the same aim: to reduces angiotensin. So the drug makers had a hard time proving that the ARB were equally active and equally beneficial to the ACE inhibitors， both in terms of blood pressure protection and organ protection， as well as reducing morbidity.

　　ARB是作用于同一个系统的新的一类药物，有同样的目的：降低血管紧张素。因此药物开发商为了证实ARB和ACEI在降低血压和器官保护以及降低发病率方面的作用和获益相同，经历了一段困难时期。

　　Meanwhile， I think they have succeeded. They have shown their effectiveness in many studies， including renal studies， such as studies using valsartan， eprosartan and candesartan. These studies have shown that the ARBs are renal protective， even better and in some respects more consistent than the ACE inhibitors. But this could also be due to the fact that renal problems have been more concentrated with the ARB than with ACE inhibitors.

　　同时，我认为他们成功了。ARB在许多研究，包括肾脏研究中显示了有效性，例如使用缬沙坦、依普沙坦和坎地沙坦的研究。这些研究显示ARB可以保护肾脏，甚至在某些方面优于ACEI。但是这些也可能由于肾脏问题更多集中于ARB而非ACEI。

　　With the heart， it is a bit more difficult. Concerning myocardial infarction， there was always a bit of controversy. ACE inhibitors were considered better than the ARB in terms of myocardial infarction. I think this is not a controversy anymore. They seem to be equally active， and equally protective in reducing secondary infarctions， and also helpful in preventive first line treatment.

　　而在心脏方面，困难就更多一些。关于心肌梗死，总是有一些争论。ACEI被认为在心肌梗死方面优于ARB。我认为目前这已经不是争论了。它们在减少继发性心肌梗死方面的有效性和保护性相同，并且对预防性一线治疗方面都有帮助。

　　And， mind you， we have just sent a manuscript to a journal from a study of ACE intolerant patients with high risk. We have shown that the hypertensive patients in this group really profited from telmisartan treatment beyond those patients receiving the best treatments at the time without telmisartan. These patients receiving telmisartan were shown to have less myocardial infarction.

　　我们刚向一家杂志就ACEI不耐受的高危患者的研究投稿。我们的研究显示，高血压患者中，使用替米沙坦治疗的患者和除替米沙坦之外的最佳治疗的患者相比，获益更多。使用替米沙坦治疗的患者心肌梗死更少。

　　With heart failure， it also was a little problem. Are the ARB equally active as the ACE inhibitors? Yes， I think they are. And we have the studies to show this， including studies that focused on valsartan and candesartan.

　　心力衰竭方面也有些问题。ARB的作用和ACEI相同吗？是的，我认为相同。而且我们有研究证实这个结论。包括缬沙坦和坎地沙坦的研究。

　　Reducing new onsets of diabetes is one of the strengths of the ARB over the ACE inhibitors. Studies have shown consistently that ARB reduces new onsets of diabetes by about 20 to 25 percent， which is quite good. And of course， ARB performing much better than old drugs like diuretics， which may even increase the numbers of diabetic patients.

　　减少新发糖尿病是ARB优于ACEI的作用之一。研究一致显示，ARB可以降低新发糖尿病20%~25%，这非常了不起。当然，ARB和老药相比作用好很多，例如利尿剂。利尿剂甚至可能增加糖尿病发病。

　　So this is really the advantage of ARB. And also， the lack of side effects -- placebo-likes side effects in a number of patients. This is something that makes ARBs much better than ACE inhibitors， especially in Asian women. Up to 40 percent of Asians experience a cough after using ACE inhibitors. That has led to some of the Asian countries prohibiting ACE inhibitors from entering the market.

　　这的确是ARB的优势。而且ARB副反应较少，一些患者有安慰剂样副反应，这就使得ARB大大优于ACEI，尤其对于亚裔女性。高达40%的亚裔人群使用ACEI后会发生咳嗽。这已经导致一些亚洲国家禁止ACEI上市。

　　So when you do a summary of the two classes of drugs， the ACE inhibitors and the ARB， we find that both are beneficial. The ACE inhibitors came first; this was their greatest advantage， but the ARB have some advantages in terms of fewer side effects， with less diabetics and other advantages.

　　当就ACEI和ARB这两类药物进行总结时，我们发现两种药物都有获益。ACEI先上市，这是它们最大的优势，但是ARB副反应较少，在减少新发糖尿病及其他方面具有优势。