International Circulation： How to view the difference between the ESH hypertension guideline and JNC?

Giuseppe Mancia：Well， we normally emphasise differences between guidelines， but we should emphasise similarities， because on basic principles， the guidelines agree. But， there are differences. For example， in the European guidelines， importance is given to quantification of total cardiovascular risk as a guide to anti-hypertensive treatment， the aggressiveness of anti-hypertensive treatment as well as the need for other types of treatment. The JNC 7 guidelines do not consider cardiovascular risk. Then， a second important difference is over the first choice drugs. The European guidelines emphasise that five classes of drugs are all suited to the initiation and maintenance of anti-hypertensive treatment: diuretics， beta-blockers， calcium channel blockers， anti-tension receptor antagonists and ACE inhibitors， whereas the JNC 7 guidelines consider diuretics as the first choice of drugs. So， these are two main differences – there are some other differences but many similarities as well.

《国际循环》：如何看待ESH高血压指南与JNC之间的不同？
Giuseppe Mancia：我们通常会强调两个指南间的差异，但我们更应该强调相似处，因为对基本原则而言，指南是一致的。但是，也存在差异。例如，欧洲指南中，重点是量化总体心血管风险，由其指导降压治疗，指导降压治疗的强度和对其他类型治疗的需求。JNC7指南不考虑心血管风险。第2个重要不同是首选药物的选择上。欧洲指南强调5类药物均适合作为起始和维持降压治疗：利尿剂、β受体阻滞剂、钙拮抗剂、ACEI、ARB；而JNC 7指南则认为利尿剂应作为首选药物。因此，指南间存在2项主要差别，还有其他的差异，但同样存在许多相似之处。

International Circulation：  And， what are the main similarities that you can see?

Giuseppe Mancia：Well， for example， the need to lower blood pressure， threshold for drug treatment， the target blood pressure values， the importance of ambulatory drug pressure， monitoring， many， many things. Both stress the importance of combination treatment to control blood pressure， and so forth.

《国际循环》：您认为指南的主要相似点在哪里？
Giuseppe Mancia：例如，降低血压的需求，药物治疗的门槛、目标血压值、动态血压的重要性、监测等等。两个指南均强调联合治疗控制血压的重要性，等等。

International Circulation：  Very good. What is your opinion about some late-breaking trials such as ACCOMPLISH?
Giuseppe Mancia ACCOMPLISH is a good study， it was well done， the design is appropriate， so the data are quite important and a combinations without a diuretic – a calcium channel blocker and an ACE inhibitor was superior for a similar reduction in blood pressure to the combination of the same ACE inhibitor with a diuretic， and I think this is interesting. Of course， in the mean time， however， in these two years， we have also had important studies on the protective effect of the combination of a blocker on the renin-angiotensin system and a diuretic， and so it could be that in guidelines， these two types of combination could be mainly recommended in the future.

《国际循环》：非常好。您如何看待新近突破性的研究如ACCOMPLISH？
Giuseppe Mancia：ACCOMPLISH是一项很好的研究，做得不错，设计合理，因此数据相当重要，并且非利尿剂联合治疗——钙拮抗剂和ACEI，优于相似降压效果的同一个ACEI与利尿剂的联合。我认为这很有意义。当然，与此同时的2年期间，我们也有一些重要研究证实肾素-血管紧张素系统阻滞剂联合利尿剂的保护作用。因此，在指南中，这两种类型的联合未来仍将属于主要推荐。

International Circulation：  Should that somehow influence ESH guidelines?
Giuseppe Mancia：I would think that they would influence the ESH guidelines in that although many combinations can be used， it looks like in the future there will probably be a few combinations ahead of others: a blocker on the renin-angiotensin system either with a calcium antagonist or with a diuretic

《国际循环》：其是否会对未来的ESH指南产生某些影响？
Giuseppe Mancia我认为其将会影响ESH指南，因为虽然可使用许多种联合治疗，但看来有几组联合用药将会走在其他联合前面：一种肾素血管紧张素系统阻滞剂联合钙拮抗剂或利尿剂。

International Circulation：  And， doctor， JNC 8 hypertension guideline will be released in the late of this year or published next year. What does that revision do to ESH， will those guidelines be revised?

Giuseppe Mancia：Well， the ESH guidelines will be an update， not a new set of guidelines， but an update on a number of points from publications in these last two years. This will be presented at the European Hypertension Meeting in Milan in June and published in the Journal of Hypertension probably in September or October.

《国际循环》：高血压指南将在今年年底公布或明年年初发表，ESH将何时修改其指南？指南哪些部分会做出修改？
Giuseppe Mancia：是的，ESH指南将会进行更新，而非制订一套新的指南，但大量的更新要点来源于过去2年所发表的文献。这将在6月米兰欧洲高血压会议上公布，并可能发表在9月或10月的高血压病杂志上。

International Circulation：  Do you think that the new guideline of ESH will add the new recommendations of direct renin inhibitors or approaches to antihypertensive therapies?

Giuseppe Mancia：Well， I’m not sure， but certainly renin inhibitors， certainly， Aliskiren， because this is the only one we have at present， in these two years have managed to collect interesting data about the anti-hypertensive treatment properties， about the use and combination of treatment and also about the ability to protect against organ damage. There is no outcome trial yet， but certainly the data are interesting.

International Circulation：  Very good. Thank you Sir.
Giuseppe Mancia： OK
《国际循环》：您是否认为ESH新指南会增加对直接肾素抑制剂或降压治疗方法的新建议？
Giuseppe Mancia：我不能确认，但无疑会出现肾素抑制剂——阿利吉仑，尽管目前只有一种。过去2年期间，已在收集有意义的资料，如降压治疗的优点，关于治疗的使用及联合，也包括免除靶器官损害的能力。然而，尚无结论，但无疑资料很有意义。
《国际循环》：非常好。谢谢您。
Giuseppe Mancia：不客气。