<International Circulation>: The new European hypertension guidelines have finally been released at this year’s ESH conference. Compared with the 2007 and 2009 versions， Prof. Redon， are there changes in initiation time goals of antihypertensive therapy?
Prof. Redon: Yeah of course， the 2007 guidelines usually for the general hypertensive population. Time to start treatment will be started will be 140/90 but also in these guidelines in 2007 there are high risk patients that should start treatment earlier， but after the release of the deadlines and consulting our literature， deep analysis of the literature was telling us that this is maybe not very grounded in information for that.  This is the risk of why in the new guidelines， we are a little bit more conservative in terms that the threshold we need to see for treatment is 140/90 and the goals is that the blood pressure will be in between 135 and 140， not below 130.  This is basically because in the high risk population， it is a real heterogeneous population.  There the recommendation is to stay in this range between 135 and 140， which is the goal to obtain treatment.  Then of course you will have the general goal， the general goal that the guidelines put.  Of course you will have some patients who can have benefit to go down to 130， but today the recommendation is this other one.

 　　《国际循环》：最新的欧洲高血压指南最终在今年的ESH大会公布。和2007年和2009年版本相比，Redon教授，在开始治疗的时间以及降压治疗目标方面是否有变化？
Redon教授：当然有，2007年指南中，对于一般高血压人群，开始治疗的时机是140/90 mmHg，但是同样在2007年指南中，高危患者应当更早开始治疗，但是在新指南公布后，对文献的深入分析告诉我们，这些推荐的依据可能并不是很充分。这就是新指南中，我们对于治疗阈值更加保守的原因，我们将其设定为140/90 mm Hg，收缩压会在135和140 mm Hg之间，而非低于130 mm Hg。这主要是因为高危人群是一个成分很复杂的人群。因此，推荐血压控制在135和140 mm Hg之间。当然，这是指南推荐的一般目标，对于一些患者来说，将血压降至130 mm Hg可以有更多获益，对于最新指南来说，这就是另一条推荐了。

<International Circulation>: Prof. Liu， would you like to comment on the?impact that the 2013 European hypertension guidelines will have?on Chinese clinical practice?
Prof. Liu: The chance initiated in Asia， so for blood pressure first our guidelines were in 2010. We still have some goal blood pressure for high risk patients. High blood pressure we focus on is 130/80， I think there is not enough evidence based practice so we need to update our guidelines， especially on drug coverage to make it more flexible and easier for physician in charge to modify and follow the guidelines.  I think Asians can lower their BP totally.

 　　《国际循环》：刘教授，您是否能介绍2013欧洲高血压指南将对中国临床实践产生哪些影响？
刘力生教授：我认为亚洲的指南也会有变化，在2010年中国高血压指南中，我们设定的高危患者降压目标是130/80 mm Hg，我认为这还缺乏足够的循证依据，因此我们需要更新指南，尤其是药物治疗的适用范围，以使其更加灵活，使医生能够遵循指南。我认为亚洲人群的降压目标值可以更低一些。

<International Circulation>: Prof. Redon， 2009 release of European guidelines on hypertension management cancelled the traditional classification of five kinds of antihypertensive drugs to line one or two. In the guidelines published this year， are there any changes for drug recommendations?
Prof. Redon: The guidelines include in 2007 and this is my take on 2013.  It stated that we can use whatever the drug to lower blood pressure of the five categories and we have everything; beta blockers， calcium channel blockers， ACE inhibitors， and ARBs. But one thing that has been mainly introduced in the reappraisal in 2009 was when we need to combine drugs because combination of drugs is a real story in many of the patients， more than 60% or 70% of the patients are going to need combination therapy.  In this case， the recommendation was be to combine one drug that belongs to the renin angiotensin system such as ACE inhibitors or ARBs with a diuretic or with a calcium channel blocker. Finally in 2013， there appears another combination that will be also used.  At this combination with diuretic and calcium channel blockers， but this has been included because when you are not able to control with the two other combination therapies， ACE inhibitors or ARBs plus diuretics or plus calcium channel blocker， the other category， if the patient is treated with a blocker of the renin angiotensin system plus calcium channel blocker， you can add diuretic as a triple combination， and it is very good. If you have used diuretics for sure， then you can add calcium channel blocker， and this is what is recommended mainly for combination therapy， but the guidelines have stressed that the most important story in blood pressure is that are patients who will need the use of beta blockers because of some compelling indications， coronary artery disease or congestive heart failure， and these cases deserve beta blockers and the use of those.

 　　《国际循环》：Redon教授，2009年欧洲高血压指南取消了传统的五类降压药物的一二线分类。在今年公布的指南中，药物治疗部分是否有变化？
Redon教授：指南指出我们可以使用五类降压药中的任何一种：β受体阻滞剂、钙通道阻滞剂、ACEI和ARB、以及利尿剂。但2009年再评估版中主要引入的一个概念是60%-70%的患者需要联合用药，当联合用药时，推荐作用于肾素-血管紧张素的药物，包括ACEI和ARB，和利尿剂或钙通道阻滞剂的联合。在2013年指南中，还推荐了另一联合方案，即利尿剂和钙通道阻滞剂，如果使用其他两种联合治疗方法，即ACEI或ARB联合利尿剂或钙通道阻滞剂，仍然无法控制血压，那么可以将三种药物联合使用。指南还强调了需要使用β受体阻滞剂的一些适应证，包括冠心病和心力衰竭。