International Circulation: Compared with office or ambulatory BP measures， how do we evaluate the relationship between self-measurement and prognosis?
《国际循环》：与诊室血压或ABPM相比，如何评价自我血压监测与预后的相关性?
Prof Lindholm: I suppose we need a series of prospective trials to evaluate that. It is well known that blood pressure at home is lower and the predictability is quite good， especially with 24 hour monitoring if we look at intermediate endpoints like regression of LVH， the shrinking of an enlarged heart. So to me it seems like a good idea to record blood pressure at home， unfortunately the patients seem to mix home recordings with office recordings and you can’t because they give different types of values. Home recordings are lower. They are lower because I think there is always an element of stress when you go to a doctor. I hate going to my practitioner. I can well understand if the patient feels exactly the same way. The really good data that we have is based on office recordings.
Prof. Lindholm：我认为需要一系列前瞻性试验进行评价。众所周知，家庭自测血压数值较低。如果我们观察中间终点，例如左室肥厚（LVH）的回退，即增大的心脏缩小，还能发现自测血压对预后的预测性很好，特别是进行24小时监测时。因此，记录家庭自测血压似乎是不错的主意，但是遗憾的是，患者易将家庭记录与诊室记录混淆，从而医生因其提供了不同类型的数值而无法获得记录。家庭自测的血压水平较低，主要原因是患者就医时总是存在某种压力成分。我讨厌去见医生，如果患者也有完全相同的感受我完全可以理解。目前，我们所有的质量较高的数据均是诊室记录。
International Circulation: What comments and suggestions do you have for Chinese hypertension prevention and treatment?
《国际循环》：对中国高血压的防治工作有何意见和建议？
Prof Lindholm: I really don’t have any special comments for the Chinese. Get blood pressure down and you avoid stroke. Remember that non-fatal stroke is the most expensive diagnosis we have in medicine， along with alcoholism. People get a stroke and die， it’s sad. People get a stroke and live and there isn’t much we can do about it. And it is preventable. The sad thing is that all over the world we under treat high blood pressure yet it is one of the few things we can treat.
Prof. Lindholm：我确实没有任何针对中国人的特殊评价。将血压降低即能避免卒中。与酗酒相似，非致死性卒中是目前诊断所需花费最高的疾病。如果人们罹患卒中而死亡，这很遗憾，而即使能够幸存，我们也没有太多治疗措施。卒中虽能够被预防（如控制血压），遗憾的是全世界对高血压的治疗均不充分，而高血压却是为数不多的可治疾病之一。
International Circulation: Can you outline the role of aliskiren in cardio-cerebral vascular and renal protection in high-risk patients with hypertension and what do you see as its prospects in clinical application?
《国际循环》：能否请您简单介绍阿利吉仑在高危高血压患者心脑血管及肾脏保护中的作用，并预测其临床应用前景？
Prof Lindholm: I would say it’s a new drug which needs to prove its role in this field. If it is any better than what is already on the market which is considerably cheaper， I don’t know. It takes a lot of head-to-head comparison. It is tough for a new drug to enter the blood pressure lowering market mainly because we have such good drugs which cost next to nothing. In my country， almost all the drugs cost USD0.10 per tablet and the ARBs will join that group after New Year. To get a new product out is very very difficult and it takes some really solid data to convince agencies like the Swedish Drug Agency that a new drug should be reimbursed. I recommend it.
Prof. Lindholm：阿利吉仑是一种需要在该领域证明其作用的新药，不知其是否会比已上市且价格相当便宜的药物有优势，这需要许多直接比较试验。对于进入降压市场的新药而言情况十分残酷，因为目前已有成本近乎为零的好药。我所在的国家几乎所有药物价格为每片0.10美元，而且ARB类药物2010年起也会如此。推出新产品非常困难，需要一些绝对可靠的数据使诸如瑞典药监局（Swedish Drug Agency）等机构确信这种新药应该获得医疗保险偿付。
International Circulation: In the ACCOMPLISH trial， a 20% risk reduction for cardiovascular endpoints was noticed for the combination of benazepril and amlodipine， versus the combination of benazepril and a thiazide diuretic. Does this suggest that the combination of CCB and ACEI is better that that of ACEI and diuretics?
《国际循环》：ACCOMPLISH 研究显示苯那普利联合氨氯地平较苯那普利联合氢氯噻嗪心血管终点事件减少20%，这是否提示CCB与ACEI的联合要优于ACEI与利尿剂的联合？
Prof Lindholm: Well that is the ten thousand dollar question. I was on the safety committee of the ACCOMPLISH trial. It means that I had an open book for four or five years and we knew exactly what was happening. It was amazing. The difference in blood pressure in the trial is so tiny and even though you have such a tiny little bit of blood pressure difference， the patients that got a combination with amlodipine did so much better. So of course this is provocation for the Americans I believe who had been directed that a diuretic was recommended above everything else. So to answer your question， I want more studies like the ACCOMPLISH trial and the investigators， Ken Jamieson and others， should be commended for the way they carried out this trial and I think the results are immensely important. What they showed was the beauty of combining an ACE inhibitor with a calcium channel blocker instead of having the usual combination with a diuretic. Remember it was the same ACE inhibitor on both sides but in one arm it was added to a calcium channel blocker and in the other arm， a diuretic was added. I find the ACCOMPLISH trial one of the best trials we have had for a long time， was very well carried out and is an amazing study. Also remember， 60% of the patients had diabetes which almost makes it a diabetes trial. This is a nice set of results but with people like me， you always ask for more research. That’s how you finish almost every paper that you write – “and in view of this data， we call for more research in this field”.
Prof. Lindholm：这个问题价值一万美元。我是ACCOMPLISH试验的安全委员会成员，了解4~5年的记录，明确知道发生了什么。ACCOMPLISH试验是长期以来我们所有研究中最好的试验之一 ，得到了很好的实施，该项研究令人惊叹。试验中两组患者血压上的差异是如此之小，但是即使只有这么小的血压差异，接受了氨氯地平联合治疗方案的患者结果要好许多，所以对于那些曾被误导认为利尿剂优先于任何其他药物的美国人来说这当然是一个挑衅。对于这个问题，我希望有更多类似ACCOMPLISH的研究，而研究者Jamerson等人应该因他们进行这一试验的方法而获得称赞。我认为该研究结果十分重要，证明了在应用同一种ACEI的情况下联用CCB相比于联用利尿剂的优点。还应记住的是，60%的患者有糖尿病，这使该试验几乎成为一项糖尿病试验。这是一套很好的结果，但是像我这类人总是想进行更多的研究，这就是我们在所写的几乎每篇论文中是如何结尾的——“那么考虑到这一数据，我们要求该领域中更多的研究”。
International Circulation: In your talk this morning you were advocating guidelines but we need to be applying those guidelines clinically…..
《国际循环》： 您提倡应用指南，那么如何将其应用于临床？
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