<International Circulation>: What is your opinion about the research that suggests that overdipping blood pressure can be associated with atherosclerosis in the future?
　　Prof. O’Brien: I think the way we have to approach this is that firstly we need to be able to define nocturnal blood pressure because without defining it and without knowing whether our patients are dippers or nondippers， then we are unable to answer any such questions. There is no doubt the evidence shows that a nondipping pattern of blood pressure is associated with the worst cardiovascular outcomes. But the question you specifically asked was whether excessive dipping is associated with an adverse outcome. I do believe there is evidence that this is happening. What it means is that we have to be careful when we are treating patients， particularly elderly patients， and we are administering drugs to them which may cause excessive dipping of blood pressure at night. We think we are doing good things with the drugs but in fact we are not doing good at all. We might be compromising a circulatory system that is already at risk whether it is cerebral or cardiac. This is one of the big roles for ambulatory blood pressure measurement in that we can look at what the nocturnal pattern of blood pressure actually is in these patients.

　　《国际循环网》：有研究提示过度杓型血压与未来动脉粥样硬化发生相关，您怎么看？
　　O’Brien教授：我认为要回答这一问题，我们首先必需要做的是能够定义夜间血压，因为如果不能定义夜间血压，不知道患者是杓型血压还是非杓型血压，我们就没法回答这个问题。毫无疑问，证据显示，非杓型血压人群的心血管转归最差。但是，你刚才的问题是过度杓型的血压与不良转归相关。我确信有这样的证据。它的意义在于我们治疗患者的时候一定要细心，尤其是治疗老年患者时，给他们开的处方药物有可能引起夜间血压的过度下降。我们自认为给患者用药是好的，但实际上并没给患者带来好处。我们可能会破坏已经处于危险状态的循环系统，无论是脑还是心脏的血液循环。这就是动态血压监测发挥重要作用的情形之一，我们可以通过动态血压监测观察患者的夜间血压情况到底是怎样的。

　　<International Circulation>: Is cardiovascular risk increased in patients with white coat hypertension but who have normal ambulatory blood pressure? Or do they need any intervention at all?
　　Prof. O’Brien:  I don’t think there is any doubt that patients with white coat hypertension are at much less risk than patients with sustained hypertension. As to whether or not patients with white coat hypertension can be classified as being without risk and therefore normal， the answer is no. If white coat hypertension was a normal state， we would all have white coat hypertension and we don’t. Therefore the practical way to approach this problem is to say that if we identify a patient with white coat hypertension， we put them in a low risk category but they should be followed annually and maybe every two years at least to be able to identify the moment when they develop sustained hypertension and most of them will do that.

　　《国际循环网》：动态血压监测正常的白大衣高血压患者心血管风险是否增加？这些患者是否需要治疗？
　　O’Brien教授：我认为，毫无疑问白大衣高血压患者的心血管风险比持续高血压患者要低很多。至于白大衣高血压患者是否可以被归为心血管风险正常，答案是否定的。如果白大衣高血压是一个正常状态的话，我们都会有白大衣高血压，可事实并非如此。因此，针对这一问题实际的做法是如果发现白大衣高血压的患者，我们就将其归入低危人群，但是应当每年随访一次，也许每两年随访一次，至少要发现白大衣高血压何时转为持续的高血压，大多数白大衣高血压患者都会转为持续的高血压。

　　<International Circulation>: It is then predictable that someone with white coat hypertension will eventually have hypertension that is not associated with the white coat?
　　Prof. O’Brien: That is correct. From a governmental or health management point of view， we can defer the moment to initiate treatment which can save a huge amount of money. But we must never discard them and say they are normal because they have white coat hypertension. They do need to be followed.

　　《国际循环网》：那么，可以预测某些白大衣高血压患者最终会患上高血压，此时血压升高与白大衣无关？
　　O’Brien教授：没错。从政府或健康管理的角度来看，我们可以推迟白大衣高血压患者开始降压治疗的时间，这样可以节省一大笔开销。不过，我们永远也不应置这些患者于不顾，说他们是正常人，因为他们有白大衣高血压。确实需要对这些患者进行随访。