国际循环：很多高血压患者都有血脂异常，所以他们可能同时服用抗高血压药物和抗高血脂药物。Nilsson博士，您觉得他汀类药物对高血压会产生什么影响？

 

Peter Nillson: Well， there have been different views on this topic. In fact， we have a lack of good data from the trials to really address it， especially a lack of ambulatory blood pressure recording data. However， according to one recent meta-analysis by an Italian group， there is a blood pressure lowering effect associated with statin therapy if you are hypertensive. It is not seen in normal-tensives and not that pronounced in treated hypertensives， but there is an effect of a few millimetres of mercury lowering of blood pressure in some hypertensive patients， and this is encouraging because we know that they have so many risk factors， so it is essential to treat all of them. What was also addressed in a symposium this morning is that there are some families with a combination of elevated blood pressure hypertension and dyslipidemia， so there might be a genetic clustering of people with both conditions， so they have to be treated with both kinds of drugs. Finally， I would say that the most potent statin we have so far is rosavastatin， which was recently shown to be very effective versus placebo in the JUPITER trial， leading to a reduction in mortality and cardiovascular risk in patients where normally they have cholesterol and elevated CRP， a mark of inflammation. However， so far we have no blood pressure data from this trial， and that would really be proof of the concept， if we could use the most effective statin in relation to the evaluation of blood pressure， and in my opinion， the use of ambulatory blood pressure recordings would be even better.

 

Peter Nillson:关于这个话题有不同的观点。事实上，我们还缺乏好的试验数据证实，尤其是缺乏动态血压监测数据。然而，根据一个意大利研究小组最近做的meta分析结果可见，在高血压患者中，血压下降和他汀类药物治疗是具有相关性的。而在治疗后血压恢复正常的患者中没有出现这种情况。一些高血压患者的血压降低了几毫米汞柱，这对我们是一种鼓舞，因为我们知道高血压的影响因素很多，对高血压的治疗非常必要。今天早上我们还要对血压升高和血脂异常的家族性进行讨论，这两种疾病可能具有家族聚集性，所以对两者均要进行药物治疗。最后，我们目前所用的最有效的他汀类药物是瑞舒伐他汀，在最近的JUPITER试验中，它与安慰剂相比有效很多，它使胆固醇异常和炎症标记物CRP升高的患者的死亡率和心血管事件都有减少。然而，我们迄今为止还没有得到有关血压的数据。如果最有效的他汀类药物与血压评估之间具有相关性，那么动态血压的使用将更好。

 

International Circulation: So， at the moment we do not have blood pressure data. Do you know of any plans for a follow-up study using statins with ambulatory blood pressure readings?

 

国际循环：既然我们现在还没有有关血压的数据，您知道我们以后是否会进行有关于动态血压监测患者使用他汀类药物的试验？

 

Peter Nillson: I am not familiar with any new trials， but it was mentioned this morning by Professor Borghi from Bologna that there is in fact one placebo-controlled statin trial with hypertensive patients comparing pravastatin treatment with placebo using ambulatory blood pressure recordings. It was a small study， but there was an effect this is a proof for the hypothesis that statins might also lower ambulatory blood pressure in hypertensive patients. I think that it would be very useful if the authors behind the JUPITER trial could provide some more information on the blood pressure levels. I think the data is there， so they have to dig it out and analyse it， so hopefully we will learn more about that.

 

Peter Nillson：我对新的试验不是很熟悉，但是今天早上来自博洛尼亚的Borghi教授提到有一个关于高血压患者的以安慰剂作为对照的他汀类药物试验，在动态血压监测的同时，比较普伐他汀和安慰剂的效果。这虽然是一个小型的研究，但是其结果能证实他汀类药物也能降低高血压患者的动态血压这一假说。我认为如果JUPITER试验的研究人员能提供更多关于血压的信息非常有用。我想，得出数据后，他们要做的是挖掘和分析这些数据，希望他们能从中获得更多东西。

 

International Circulation: In the ONTARGET trial， similar clinical effects were seen in hypertensive risk patients receiving either telmisartan and ramipril. So， can you give us some suggestions about the drug selection? Telmisartan to angiotensin-2 recpetor blocker， or ramipril to ACE-inhibitor.

国际循环：ONTARGET研究中，高血压风险患者接受替米沙坦和雷米普利的临床疗效相似。您能给我们在药物选择上给一点建议吗？是选择血管紧张素II受体阻滞剂的替米沙坦还是ACE抑制剂的雷米普利？

 

Peter Nillson: I think in many countries the first line choice is an ACE-inhibitor. They are well-proven， they are cheaper and they are useful in very many patients. However， we also know that in a sub-group of patients， there will be adverse effects like KAF， the risk of angioedema that is much less with the sartans， and this is an argument that we could use sartans， especially telmisartan I think， as it has been shown to be comparable to ramipril， one of the most well-proven ACE-inhibitors. What has been debated and remains controversial is whether we could combine these drugs or not， based on their combination are in the ONTARGET trial – there was an enhanced blood pressure reduction， but no addtional benefits.However， we should remember that the combination of an ACE-inhibitor and an angiotension-2 receptor blocker has been shown to be effective in other types of patients， for example with congestive heart failure， or even in patients with more severe renal damage， with microalbuminuria， and these patients were not really included in the ONTARGET trial. So， for me， we are yet to reach a consensus on this issue and I think that some specialists with a great deal of experience could use them – for example a specialist in nephrology or a cardiologist responsible for patients with congestive heart failure. In normal patients with hypertension and added risk factors， we should be cautious to use the combination， but there might be sub-groups with more benefits.

 

Peter Nillson：我想在许多国家，ACE抑制剂都是首先药物。它们对许多患者来说是既便宜又有效的。然而，我们也知道，在一小部分患者身上会出现一些副作用。而沙坦类药物血管性水肿这一副作用更小。那么在用沙坦类药物——特别是替米沙坦，还是使用被证明最好的ACE抑制剂的雷米普利，是具有争议的。这争议主要在于我们是否需要联合用药，从ONTARGET试验来看，联合用药能使血压下降，但没有额外获益。但是，在其他类型的患者中，ACE抑制剂和血管紧张素II受体阻滞剂结合被证明是有效的，比如充血性心力衰竭患者或有微量蛋白尿的肾脏严重损伤的患者，但这些患者没有纳入ONTARGET试验。所以对我来说，我们已经在这个问题上达成共识，我觉得一些经验丰富的专家可以使用这种方法，比如，肾脏病学专家或心脏病学专家在治疗心衰患者时可以使用。对有其他危险因素的普通高血压患者，我们在药物结合使用时需要注意，但是一小部分患者还是会从中收益。

 

International Circulation: Here at ESH 2009 we have been talking about the 2007 guidelines being updated. We were talking about different categories of drugs， but where do you think calcium channel blockers fit in， perhaps with an eye towards some of these updates that will be seen at this meeting?

 

国际循环：在2009ESH会议上，我们已经谈论了有关2007年指南的更新。我们讨论了不同种类的药物，您认为钙通道阻滞剂如何？这次会议上可能会有那些更新呢？

 

Peter Nillson: Maybe you remember that about 10 years ago the calcium channel blockers were under fire – they were criticised，