Bryan Williams 英国莱斯特大学 

   <International Circulation>: You have participated in a debate with Dr Laurent. There is another interesting debate on heart rate reduction in hypertension and whether it is beneficial or detrimental. What is your view?

   《国际循环》：您已经参加了与Laurent医生的辩论。还有另一个有趣的议题是关于高血压患者降低心率有益还是有弊，对此，您的观点是什么？

    Prof.Williams: My issue is that most people with hypertension have stiff arteries and if you lower the heart rate， you increase drug volume and therefore you have the potential to limit the effectiveness of drugs lowering systolic blood pressure. I think in the elderly the evidence is pretty overwhelming that beta-blockers have been less effective at reducing stroke in particular and we think that is primarily related to their hemodynamic effect and they are less desirable drugs to use in older people. I think that therapeutic lowering of heart rate in people who are older is probably not a physiological sensible thing to do. The paradox is if you consider athletes， it is completely different. They have flexible arterial systems that can accommodate any big change in cardiac output. Elderly people cannot because they have stiff aortas and consequently they are going to get a wide pulse pressure. 

    Williams教授：我的观点是大多数高血压患者患有动脉硬化，如果降低心率，药量增加，因此，降低收缩压药物的有效性可能受限。我认为对于老年患者证据非常充分，即β受体阻滞剂不能有效降低每搏输出量，我们认为这主要与其血流动力学效应有关，它们并非是应用于老年患者的最理想药物。我认为用药物降低老年人的心率从生理上讲很可能并不明智。相比之下，运动员完全不同。他们动脉系统有弹性，能适应心输出量的任何巨大变化。老年人不能，因为他们有动脉硬化，所以他们的脉压差大。
    <International Circulation>:  Now that we see this direct renin inhibitor， aliskiren， does this add any additional consideration?

   《国际循环》：我们现在有了直接肾素抑制剂aliskiren，会考虑应用它吗？

    Prof.Williams: At the moment， I think the data for aliskiren is very preliminary and we are only just getting results from trials. They have been brave enough to put central blood pressure measurements into the studies and what is coming out is really quite fascinating. As well as lowering blood pressure， this drug appears to be having an effect on aortic pressure which is disproportionately large compared to the effect on brachial pressure and if that is sustained then we have a drug which lowers central pressure very well.

    Williams医生：目前，我认为关于aliskiren的数据很初级，我们也仅刚开始获得试验结果。研究者们很有勇气，将中心血压测量纳入研究，结果极具吸引力。在降压的同时，该药似乎对主动脉压的作用远大于其对肱动脉压的作用，如果作用持续，我们就有了能很好降低中心动脉压的药物。