INTERNATIONAL CIRCULATION: There are a gap between recommendations and real blood pressure control rates. Some studies have shown that combination therapy achieves superior blood pressure control with no increase in adverse events compared with their monotherapy. Shall we adopt combination therapy more aggressively than before to achieve successful blood pressure control? It is sometimes said that ARBs and ACE inhibitors don’t lower blood pressure quite as much as the other classes of antihypertensive drugs(such as Calcium Channel Blocker )-- is that correct?
INTERNATIONAL CIRCULATION:建议的血压控制率与事实控制率之间存有显著差异。许多研究显示联合降压治疗优于单药治疗，此时的血压控制率更好并且不增加不良反应。能否较以前更加积极地采用联合治疗以获取血压控制达标？有时认为ARB和ACEI降压效果不如其他类降压药物如钙拮抗剂，您认为这种观点是否正确？

MANCIA: Your question about combination therapy is very important. The new guideline highlights and emphasizes that the combination therapy should be used more frequently than it was used in the past. Maybe four out of five hypertensive patients need combination therapy to control their blood pressure. In addition， there is some evidence that starting treatment with combination therapy at least in high risk individuals can be beneficial. So in the future we will see more and more combination treatment. Maybe they accept low doses of combination therapy， maybe at regular doses of combination therapy in order to achieve the lower blood pressure targets.
MANCIA:你问的这个关于联合治疗的问题非常重要。新的指南强调我们应该比过去更积极地选择联合治疗。五名高血压患者中很可能就有四个人需要通过联合治疗来控制血压。此外，有证据表明一开始就采用联合治疗，至少对于高危患者而言是有益的。所以，以后联合治疗越来越常见。他们（患者）可能会接受低剂量的联合治疗，也有可能接受常规剂量的联合治疗以达到更低的降血压目标。

INTERNATIONAL CIRCULATION: Thank you. The second question is: We often hear that physicians would like pursue "aggressive blood pressure lowering" for their hypertensive patients. But what is meaning about aggressive BP lowering? Assuming that it is indeed the goal， how do we achieve it， and what type of patients most need it? Does it mean giving as many drugs as needed to get the BP as low as possible? Are the patients going to be on it all their lives?
INTERNATIONAL CIRCULATION:谢谢。第二个问题是：我们经常听到医生希望能够使其患者血压得到“积极降低”。您认为这种“积极降压”意味着什么？如果是指降压目标，您认为血压应降到多少合适？哪些患者最需要进行这种治疗？是否意味为了使血压尽可能低，而应尽可能给予足够多的药物？患者是否需要终生进行这样的治疗？

MANCIA: Well， the new guidelines emphasize the concept of flexible target—flexible blood pressure target and also flexible blood pressure threshold. And this is based on evidence. That is there is evidence that you know for hypertensive patients blood pressure target should be at least less than 140/90mmHg. But for high risk individuals， that is individuals with diabetes or history of cerebral vascular disease or history of coronary disease， blood pressure goals should be lower—less than 130/80mmHg. And in these patients， one should start treatment when they had blood pressure in the high normal range. So how to achieve this? It’s not easy at all. In many trials， the majority of patients did not succeed to in going below 130mmHg. So we need more effective strategies and once again combination treatment is of utmost importance to try to hit target blood pressure in these individuals.
MANCIA:嗯，新的指南强调灵活目标的概念－包括灵活的血压控制目标和灵活的血压阈值。而且这些都是有循证医学基础的。你知道，目前已经有证据表明高血压患者的血压控制目标是血压至少低于140/90mmHg。但对于高危患者，也就是患有糖尿病或既往有脑血管病史或冠心病史的患者，血压应该降的更低－低于130/80mmHg。而且对于这些患者应该在他们的血压还只是正常高限的时候就开始治疗。怎样做到这一点呢？确实不容易。在很多临床试验中，大多数的患者并没有成功地将血压降到130mmHg以下。因此我们还需要更有效的治疗策略，而联合治疗对于让这些患者达到血压控制目标具有非常重要的作用。

INTERNATIONAL CIRCULATION: My another question is: we all know that United States FDA has issued the approval for Tekturna as the first in a new class of drugs called direct rennin inhibitors on March 2007. It acts on one of the key regulators of blood pressure by targeting rennin， and provides significant blood pressure reduction for a full 24 hours and is generally well tolerated. Would you like to outlook the direct rennin inhibition in the future? What should we do to get more information about this?
INTERNATIONAL CIRCULATION:我的另一个问题是：我们都知道美国FDA于2007年3月批准了Tekturna用于临床，这也是新一代降压药肾素抑制剂的首个上市产品。该药主要作用于肾素这个关键的血压调节器，并且能够提供持续24小时的显著降压效应，而且耐受性良好。您能否展望这种肾素抑制剂的未来应用前景？对此，我们还需要进行哪些工作了解该药？

MANCIA: Well， no question that rennin inhibitors are a new class of agents， promising agents. The mechanism by which they block the rennin-angiotensin system is different. It up-stimulate the cascade of events leading to angiotensin II formation. There is evidence that Aliskiren which is the drug， on which clinical data are available， it’s capable of lowering blood pressure alone and in combination. There is also pre-clinical evidence of the favorable effect on proteinuria for example. Of course， being a new drug， more data are needed and once that will be available for clinical practice， there will be， for sure， many new data. The promise of these drugs is also connected to the fact that we have begun to understand that rennin may have effects independently on the formation of angiotensin II to the traditional pathways. If these would demonstrate that then there would be an even stronger rationale to use rennin inhibitors alone or in combination.
MANCIA:嗯，肾素抑制剂确实是一种新药，一种很有前景的药物。这种药物阻断肾素－血管紧张素系统的机制不同于其他药物。而我们知道肾素是可以正向刺激一系列的反应从而导致血管紧张素II的形成的。阿利克仑就是这种新药中的一种，从临床研究资料看来，无论是单独用药还是和其他药物联合治疗它都能发挥降低血压的作用。另外还有临床前研究的资料证实这些药物对于蛋白尿也有一定的治疗效果。当然，作为一种新药其疗效和安全性还有待更多研究资料的证实，但一旦这些药物能够投入临床应用相信一定会有很多新的资料产生，（从而有助于我们更好地了解这些药物）。之所以说这种新药很有前景还有一部分原因是，我们已经开始懂得肾素对血管紧张素II的形成有一定的作用，且这种作用不依赖于传统的作用途径。如果这一点得到证实的话，那么我们就会更有理由在单独用药和联合治疗中使用肾素抑制剂了。

INTERNATIONAL CIRCULATION: Thank you. In recent years， diastolic dysfunction has become widely recognized and hypertension is one of the major causes of diastolic dysfunction. My questions is when diastolic dysfunction becomes diastolic heart failure in hypertension? How are diastolic dysfunction or diastolic heart failure diagnosed in hypertension?
INTERNATIONAL CIRCULATION:谢谢。最近几年，舒张功能不全已被广泛认识，并且认为高血压是引起舒张功能不全的一个主要原因。高血压患者何时能够认定已由舒张功能不全转变为舒张性心力衰竭？高血压患者如何诊断舒张功能不全或舒张性心力衰竭？

MANCIA: Diastolic dysfunction? The question is?
MANCIA:舒张功能不全？你的问题是舒张功能不全吗？

INTERNATIONAL CIRCULATION: Yes， diastolic function.
INTERNATIONAL CIRCULATION:对，就是舒张功能不全。

MANCIA: No question that diastolic dysfunction is common in hypertension and can even proceed to be left ventricular hypertrophy. Having said this， the new guidelines do not consider diastolic dysfunction as one of the primary measure of target-organ damage. It can be measured but the evidence of its prognostic importance and particularly how effectively it can be improved by treatment is still more limited than th