Anthony M Heagerty，英国曼彻斯特大学
International Circulation: The British Hypertension Society Guidelines have moved beta-blockers out of first-line agent recommendations for hypertension. Do you think beta-blockers are already an antihypertensive that are out of style?
《国际循环》：英国高血压学会指南将β受体阻滞剂从高血压一线治疗中移除，您认为β受体阻滞剂是一种过时的抗高血压药吗？
Dr Heagerty: I don’t think they are out of style for at risk patients with coronary heart disease or heart failure but I think they are probably not the best treatment to start in patients with diabetes or metabolic syndrome or uncomplicated hypertension. Beta-blockers still have a role to play when you need more than one drug. When two or three drugs are needed， beta-blockers should be added; there is no question. What the British Hypertension Society has done is to remove them as first-line treatment but they still will allow them to be used as third- or fourth-line treatments.
Dr Heagerty：β受体阻滞剂对有冠心病或心力衰竭风险的患者并不过时，但我认为它并不是糖尿病、代谢综合征或无并发症高血压患者起始治疗的最佳选择。毫无疑问，当患者需要两种或者三种药物时，应该添加β受体阻滞剂。英国高血压学会仅是将β受体阻滞剂从一线治疗方案中移除，但仍可作为三线或四线治疗。
International Circulation: Secondary prevention is said to be woefully inadequate in emerging economies as well as in industrialized countries. What do you think physicians can do about this?
《国际循环》：发展中国家及发达国家的二级预防仍然不尽如人意，您觉得临床医生可以做些什么？
Dr Heagerty: You are absolutely right. Secondary prevention is very poor in developing countries. There was an article published in the Lancet about two months ago by Salim Yusuf which looked at this. There is no question whatsoever. It is a problem of educating both the patient and the clinician and additionally， the patients cannot always afford treatment. So there are problems in the developing world in terms of buying the treatment， knowing you should buy the treatment and the prescribing of the treatment. You need to educate both the patients as well as the prescribing physicians. There are many problems here. The Lancet article is quite revealing and I recommend your readers take a look at it.
Dr Heagerty：的确如此。在一些发展中国家二级预防工作做的很差。Salim Yusuf就这个问题在约两个月前的《柳叶刀》杂志上发表了一篇文章，极具启迪意义。发展中国家的问题在于患者健康教育和临床医生培训的缺乏，以及患者不能承担治疗的费用。因此身处发展中国家的医生应该考虑到费用的问题，斟酌开具的处方。
International Circulation: It has been shown by several studies that anti-hypertensives can delay the onset of hypertension in the pre-hypertensive population but no evidence of prognosis improvement was observed. Considering the health economics， do you think it is necessary?
《国际循环》：一些研究证明抗高血压药物可延缓高血压前期人群高血压的发病，但并没有证据显示可以改善预后。从卫生经济学角度考虑，您认为这有必要的吗？
Dr Heagerty: There is one trial which showed that if you gave treatment to pre-hypertensives you slowed the development of hypertension， but there has been another Danish study by Mike Mulvany’s team published in Hypertension， that was negative. If you could prevent the rise in blood pressure that we see with age， it would be a good thing to do; health economically it would make a lot of sense. The rationale would be to start the treatment earlier and prevent the rise in blood pressure. Of course， every study shows that if you stop the treatment or treat short term， then blood pressure goes back up again. The issue there now is whether or not you can actually achieve it and I don’t think you can at the moment. That is why we have these strategies of establishing the blood pressure levels and then reducing them afterwards.
Dr Heagerty：有一项临床试验表明，对高血压前期进行治疗可以延缓高血压的进展，但丹麦Mike Mulvany团队在Hypertension上发表的文章并没有得到这一结果。防止血压随着年龄增长而上升于健康经济学有很重要的意义。每一项研究都表明，如果停止治疗或只进行短期治疗，血压会再次升高。当前的问题是我们能否真正做到早期治疗降低血压，这很困难。
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