<International Circulation>: Prof. Liu， are there any changes for ARB’s for different patient populations or combination therapies than before? And could you comment on these aspects?
Prof. Liu: Actually we still keep the drug classes in our consideration for other treatments.  We also started to pay attention to the fix dose combinations for the very high risk patients when you are initiating intensive treatment. I think we need to think about the renal outcomes because previously we did not pay attention to the renal outcomes or even the classification or stratification according to the CKD situation in our guidelines. So later on I think we must further focus on this because in a very important risk factor is blood pressure for cardiac and heart disease so I think we need to get into stratification.  We also need to use the dip sticks for the primary care to test the urinary output at the very beginning. For combination therapy， with Professor Redon’s suggestion 60% will need combination therapy so we can start with combination therapy. Currently we are considering more patients for a clinical trial; a trial where we use ARB plus CCB and compare with the CCB plus diuretic， so that is something coming different for Chinese doctors. We wish to go further into research and it is still in the works.

 　　《国际循环》：刘教授，ARB对不同的患者人群或联合用药方面，和过去相比，有哪些变化？您对此有何评论？
刘力生教授：实际上，这类药物还被用于其他疾病的治疗。对于极高危患者，在开始强化治疗时我们还会注意固定复方制剂。我认为我们应当考虑到肾脏，因为过去我们并没有对肾脏给予重视，甚至没有在我们的指南中根据CKD进行危险分级或分层。我认为今后我们会更加注意到这一点，因为这对于心脏疾病是一个重要的危险因素，我们需要将其纳入危险分层。我们还应当使基层医院在最开始就进行尿液检查。关于联合用药，Redon教授已经指出60%的患者需要联合用药，因此我们可以从初始就进行联合用药。目前我们正在进行的一项临床试验，观察ARB联合CCB以及CCB联合利尿剂的效果，对于中国医生来说，情况可能会有所不同。我们希望能够就此进行更深入的研究，目前还在进行中。

<International Circulation>: Angiotensin receptor blockers (ARB) safety and effectiveness have been confirmed by clinical research and practice. Prof. Redon， could you please comment on the new European hypertension guidelines published this year and any extended?indications of ARB? If there are， could you comment on which risk population could be applied for? Are there any changes about risk assessment in the new European guidelines?
Prof. Redon: Ok of course， I think the new guidelines there is a change in the process of stratification of patients. The main differences between the first in 2007 and 2013 is that the patients with diabetes who have some damage， so microalbuminuria automatically move to the very high risk category. The very high risk category for sure implies that the treatment will be automatically started because it is very high risk， not just only for the kidney， but mainly for cardiovascular disease and this is one of the main changes in the stratification of patients. Considering ARB， that the guidelines collected all the knowledge and the first that the guidelines say is that it states that these things that the past which was published the risk of cancer was over， that this was not from reality， and they are very safe drugs. ARB is safe and very well tolerated. In terms of efficacy in different diseases or hypertension with congestive heart failure， hypertension with coronary artery disease， it is clear that there are no differences in ACE inhibitors. Some protocols， for sure， for congestive heart failure prefers to start with ACE inhibitors， but intolerant patients， we treat very well with this. Also if a patient is able to receive medication， sometimes combination for congestive heart failure will be good. So far what is recommended is to combine ACE inhibitors or ARB for patients with diabetes or for patients with hypertension in general. This combination that expressed in the guidelines that say not accepted.  My opinion is that this is true， but we need to take into account that some nephrologists that are treated with nephrotic syndrome， some specific situations can use the combination but this can be done in experts that can control very well the side effects that can be produced. But then ARBs are still one of the most important groups of antihypertensive drugs because they are effective and have demonstrated reduction of cardiovascular risk and have protection， and mainly patients with diabetes and that of course are drugs that are very well tolerated.

 　　《国际循环》：血管紧张素受体阻滞剂（ARB）被临床研究和实践证实安全有效。Redon教授，最新欧洲高血压指南中ARB的适应证是否有扩展？如果有，您是否能介绍哪些高危人群适用？最新欧洲指南中危险评估方面是否有变化？
Redon教授：当然，新指南中关于危险分层的方法有所变化。2007和2013年指南的主要不同之处是糖尿病患者，微量蛋白尿被列入极高危分级。极高危分级患者会立即开始治疗，不仅是治疗肾脏，主要还要治疗心血管疾病，这就是患者危险分层方面的主要变化。关于ARB，指南收集了所有关于ARB的证据，指南首先指出，过去发表的关于ARB增加肿瘤风险的文章并不确切，ARB是非常安全的药物，并且耐受性良好。对于高血压合并心力衰竭，高血压合并冠心病来说，ACEI和ARB的效果没有差异。当然，有一些方案认为心力衰竭患者应当优先使用ACEI治疗，但是不能耐受ACEI的患者使用ARB治疗效果也很好。如果患者能够接受药物治疗，对于心力衰竭进行联合用药也很好。关于ACEI和ARB的联合，指南中并不推荐。我认为这个推荐是正确的，但需要考虑的是肾内科医生治疗肾病综合征的情况下，以及其他一些特殊情况下，可以使用这个联合用药方案。ARB是重要的降压药物之一，安全有效，并且被证实能够降低心血管风险，尤其是对于糖尿病患者，且耐受性良好。