<International Circulation>: In the new guidelines， it recommended that BP should be reduced to at least below 140/90 mmHg and to lower values if tolerated in all hypertensive patients; target BP should be at least 130/80 mmHg in diabetics and in high or very high risk patients. Does it mean that we should pursue the BP value as low as possible to be the goals of treatment? If not， how far blood pressure can be safely lowered in hypertension patients?
《国际循环》: 新指南中，推荐“所有高血压患者至少降至140/90 mmHg以下，如能耐受，还应降至更低”、对“糖尿病以及高危或极高危患者至少降至130/80 mmHg以下”，是否意味着我们应该尽可能将降低血压作为治疗目标？如果不是，血压应该降至多低是安全的？

Prof. Mancia: Yes， first of all， flexible threshold and flexible target for treatment. As the functional tool for cardiovascular risk， it is based on this evidence， so it’s very important， It’s no question that blood pressure control below 140/90mmHg is beneficial to all population， including the elderly. There are much more evidence that cardiovascular disease， cerebrovascular disease， diabetes， renal disease， there is recent additional benefits for patients if the blood pressure is lower than 130/90 mmHg， Now the recent study show that the lower value to tolerate in the general hypertension population， that is， not only 139/89， but possible lower， it is based on observational data. We know these observational studies， the lower blood pressure， the more effective for the patient. Also， because the rich evidence that lowering blood pressure to value below 140/90 is not dangerous. So particularly， if my goal is to go well below 140， at least it can hope to just be below 140mmHg. So that’s a good reason based on evidence but also common sense.
Prof. Mancia: 首先需要强调的是，降压治疗需要灵活的血压范围和目标，不能一概而论。对心血管风险的评价要基于事实证据，这一点非常重要，血压降至140/90mmHg以下毫无疑问对所有人群都是有益的，包括老年人。同时也有很多证据表明，针对心血管疾病、脑血管疾病、糖尿病、肾病等，如果血压能够低于130/90mmHg，患者的收益将更加明显。最近有研究证明，在高血压人群中，血压控制得更低一些，不仅仅是139/89mmHg，甚至更低一些，对患者的效果会更好，这些都是基于研究结果得出的结论。而且有研究表明，将血压控制在140/90mmHg以下并无危险。如果我的目标是将血压控制在140mmHg，那么目标的上限就是140mmHg，意味着实际控制的血压比140mmHg肯定更低，而这种血压的安全性也是基于大量试验证据和常识所得到的结论。

<International Circulation>:  In the new guideline， calcium antagonists have been recommended to be suitable for the initiation and maintenance of anti-hypertension treatment alone or in combination with other classes of antihypertensive agents. How is the current position of calcium antagonists in hypertension? What problems remain about calcium antagonists now?
《国际循环》:  新指南已推荐钙拮抗剂可以单独或与其他类降压药联用用于高血压患者的初始治疗或维持治疗。如何看待钙拮抗剂在高血压中的当前地位？

Prof. Mancia: Yes， five class of agents， because they are all protective， but of course， some could be better used in some condition， and some can better be used in another condition. There is longest condition seem to be some of the drugs may bepreferred. But calcium antagonist should be extremely proper for hypertension， there are among the most effective drugs， they combine very well， with virtually all other anti-hypertensive agents， they are being used very frequently， and it’s very important for hypertension. And there is no problem. I mean we were faced more discouraged result years ago， which suggest that the calcium antagonist is less effective than other drugs， but these data were scientifically very weak， and have been totally contraindicated by retrospective controlled trials which shows the calcium antagonist to be excellent drugs in hypertension.
Prof. Mancia: 5种抗高血压药物都有保护作用，但是不同药物具有不同的适用条件。选择哪种降压药物最为合适是比较复杂的问题。钙离子拮抗剂是一类优秀的降压药物，与其他降压药物联合应用，效果很好，使用频率很高，对治疗高血压至关重要。几年前我们曾面临一些不理想的试验结果，提示钙离子拮抗剂效果比如其他降压药，但是后来的大量研究证实这些数据缺乏足够的科学性。这些前瞻性研究的结果证实，钙离子拮抗剂是一类非常出色的降压药。

<International Circulation>:  The new guidelines emphasized the lipid lowering agents， as ASCOT-LLA trial show， it noted that all hypertensive patients with established cardiovascular disease or with type 2 diabetes should be considered for statin therapy aiming at serum total and LDL cholesterol levels of ＜4.5 mmol/l and＜2.5 mmol/l and lower respectively if possible; Hypertensive patients without overt cardiovascular disease but with high cardiovascular risk should also be considered for statin treatment even if their baseline total and LDL serum cholesterol levels are not elevated. Do you think if we should given statin as needed as possible to all the hypertensive patients in the future?
《国际循环》:  新高血压指南强调了应用降脂药物，如同ASCOT-LLA试验结果所示，强调“所有高血压患者，若伴有已发心血管疾病或2型糖尿病，应考虑使用他汀控制总胆固醇和LDL-C (TC<4.5mmol/L，LDL-C<2.5mmol/L)”以及那些“无已发心血管疾病、但属于高危的患者，无论基线总胆固醇或LDL-C是否升高，均应考虑他汀治疗”。对此，是否认为未来应尽可能让所有的高血压患者均接受他汀治疗？

Prof. Mancia:  Well， that’s a game， depends on the level of total cardiovascular risk， that’s a good guideline for treatment， because in high risk individual， especially high risk individual have more problems than we think， and high risk individual is set to be different. They have to start anti-hypertension treatment for lowering blood pressure， and they have to go to lower blood pressure; they have to have combination treatment， even as the first step treatment. And they have to consider treatment with anti-platelet drugs， and last but not least， the recent result from the ASCOT study that， in addition to effective anti-hypertension treatment with statin， can increase cardiovascular protection， regardless of blood cholesterol and blood pressure level， so the guideline indeed is based on the evidence， and they list what should be done in the high risk hypertension individuals， and in addition to effective anti-hypertension treatment， there should be anti-hypertension treatment， and that is lipid lowering treatment and anti-platelet treatment.
Prof. Mancia:这实际上是一场博弈，取决于总体心血管风险的分级，评估心血管总体风险对治疗具有很好的指导意义。尤其是在高危人群中，存在很多出乎意料的问题，需要将高危人群区别对待。必须对高危患者进行降压治疗，旨在将其血压降低到足够低的程度；高危患者需要接受药物联合治疗，包括抗血小板药物治疗。最后，值得注意的是，来自ASCOT研究的结果表明，除了应用他汀类降脂药物治疗带来了有效的心血管保护作用，这样的结果与胆固醇和血压水平关系不大。指南在他汀治疗方面的建议的确基于此项证据，并列举了针对高风险高血压患者应采取的措施，除了有效控制血压之外，还需要降脂治疗和抗血小板治疗。