<International Circulation>: Valsartan has the most abundant evidence of protecting the heart and has the most cardiovascular disease treatment indications. How do you evaluate the cardiovascular protective effect of valsartan? What do you think about the optimal or target doses of valsartan for hypertensive patients with high risk factors?

　　《国际循环》：缬沙坦在保护心脏方面证据最多，并且心血管疾病治疗适应证也最多。您如何评价缬沙坦的心血管保护作用？您认为对于有高危因素的高血压患者，缬沙坦的最佳或者靶剂量应该是多少？

　　Prof. Unger: Valsartan is certainly a beneficial drug in high risk patients， with patients with all kinds of cardiovascular and metabolic diseases. It’s like other sartans -- a very good means of treating patients.

　　Unger教授：对于高危患者以及所有有心血管和代谢疾病的患者，缬沙坦当然是非常有益的药物。和其他沙坦类药物一样，是非常好的治疗药物。

　　Indeed， it has the highest number of treated patients. In all the studies have been done world-wide， so there is a lot of potential for evidence， and we know a lot about the effects of this drug in various cardiovascular and metabolic diseases， starting with hypertension. That was the beginning. Valsartan was the second ARB on the market after losartan. It came very early， so it had a good start， and has had a long period of experience， starting with hypertension， then going into the other studies; in the kidney， in the heart， in hypertension patients with high risk， myocardial infarction.

　　的确，缬沙坦治疗患者数量最多。在全世界所有完成的临床研究中，有很多证据，我们也知道这种药物对不同的心血管和代谢疾病的作用。缬沙坦是氯沙坦之后第二个上市的ARB。它上市很早，因此有个好的开端，并且有长期的经验，最开始是高血压，然后是其他疾病的研究：肾脏、心脏、高危高血压患者和心肌梗死患者。

　　Most of the areas of interest were covered by valsartan with good results. Especially now that valsartan can be combined， with an antagonist for example， it is a very strong hypertensive.

　　我们所关心的领域中，绝大多数缬沙坦都有相关研究，并且取得了良好效果。尤其是缬沙坦可以和其他药物联合使用，例如和钙拮抗剂联合使用，有非常强的降压效果。

　　<International Circulation>: The NAVIGATOR study has confirmed that valsartan can prevent microalbuminuria in patients with abnormal glucose tolerance; the DROP study confirmed that valsartan can reduce the level of massive proteinuria in patients with type 2 diabetes; HKVIN study confirmed that valsartan can reduce the level of proteinuria in patients with IgA nephropathy and urinary proteins. These show that valsartan can reduce proteinuria and protect the kidney in the whole course. How do you evaluate the renal protection of valsartan?

　　《国际循环》：NAVIGATOR研究证实缬沙坦可以预防糖耐量异常患者发生微量蛋白尿。DROP研究证实缬沙坦能够降低2型糖尿病患者大量蛋白尿水平。HKVIN研究证实缬沙坦能够降低IgA肾病和蛋白尿患者尿蛋白水平。这些研究显示缬沙坦降低蛋白尿，全程保护肾脏的作用。您如何评价缬沙坦的肾脏保护作用？

　　Prof. Unger: I think the renal protection of valsartan is established -- no doubt about it. The question is really how far we want to go， and where we still see room for improvement.I’ll give you an example. If you have a study， let’s say， with valsartan， which reduces proteinuria， that’s fine， that’s what you want you have， because proteinuria is not only a risk factor， but it also contributes to the risk by various mechanisms. So we want to reduce it. That’s fine.

　　Unger教授：我认为缬沙坦的肾脏保护作用已被证实，没有疑问。问题是我们能够走多远，哪里还有改进的空间。
我举一个例子，一个研究如使用缬沙坦，可以降低蛋白尿，这的确很好，是你希望得到的结果，因为蛋白尿不仅是危险因素，还能通过多种机制增加风险。因此我们希望能够降低它。这很好。

　　Then， we go a bit further and say， "Well， we have a patient with advanced renal problems， going to renal failure. We want to improve the situation here as well. Well， we ought to get him into dialysis and transplantation. So what can we do here?" Well， again， valsartan and also some other ARB have proven beneficial.But in the end， when you look to see what you can gain from these studies， which have given us the evidence， there is a question. Let’s say there is a three week， or two month delay of dialysis in a given patient. So my question is: "Wouldn’t we like to have three years of delay of dialysis?" So when you look at this， at the absolute figures， then you would say， "Well， the relative figures are fine. This is great. And it’s the first time that we can do something to really protect the kidney." But we want to have more. And we want to have the patients more protected for a longer period of time. And even patients that run into renal failure， we want to stop them， we want to hold this disease. That is something that we still need to work on， maybe also with development of new drugs.

　　然后。我们再进一步，“我们有一个有严重肾脏问题的患者，已经进展到肾衰竭，我们希望能改善他的情况。那么，我们应当让他去进行透析和肾移植。我们现在能做什么？”对此种情况，缬沙坦和其他一些ARB被证实有获益。
但最终，如果分析我们从研究中能获得的信息，这些研究给我们提供了证据，就有一个问题。如果对于一个患者，透析延迟了3个星期，或者2个月，那么我的问题是“我们会让透析延迟3年吗？”看到这个绝对数值的结果，你会说“相对数值很好，非常了不起，这是我们首次能够真正的保护肾脏。”但是我们希望能够做的更多，让患者接受更长时间的保护。即使是已经进展为肾衰竭的患者，我们也希望能够阻止其进展，控制这种疾病。这是我们仍然需要做的事，也许需要开发新药。

　　<International Circulation>: Hypertension， diabetes and atrial fibrillation are the important risk factors for stroke， a large number of studies have shown that valsartan has the effect of potent antihypertensive， improving glucose metabolism， preventing atrial fibrillation， thus prevent stroke comprehensively， how do you think of this effect of valsartan?

　　《国际循环》：高血压、糖尿病和心房颤动是卒中的重要危险因素。许多研究显示缬沙坦能够有效降低血压，改善糖代谢，预防心房颤动，因此能够预防卒中。您如何看待缬沙坦的这个作用？

　　Prof. Unger: Among others， valsartan has also proven to reduce the stroke incidence and the mechanisms that were mentioned. That is， against atrial fibrilation， against diabetes， and especially as an anti-hypertensive. Those are the major mechanisms that help to prevent stroke.I think that preventing stroke is one of the best things that a doctor can do in medicine. I keep saying to doctors: if you can control blood pressure with a good drug that also gives you additional organ protection， like preventing atrial fibrillation， then this is the right way to go， and valsartan is certainly a drug that has proven itself in this way.

　　Unger教授：和其他ARB一样，缬沙坦也被证实可以降低卒中发生率，机制刚才你已经提到，减少心房颤动，减少糖尿病，尤其降低血压。这是其预防卒中的主要机制。我认为预防卒中是医生在医疗方面能做的最好的工作之一。我总是和医生说：如果你能够使用好药物来控制血压，并且提供额外的器官保护，例如预防心房颤动，那么这就是正确的用药方式。缬沙坦当然就是这类药物，已经得到了证实。