bookbook

　　<International Circulation>: This evening you have been speaking about olmesartan based combinations. What are some of the features of olmesartan as an individual agent and also in combination?
　　《国际循环》：今晚您就以奥美沙坦为基础的联合治疗发表演讲。奥美沙坦作为单个药物以及用于联合治疗有何特点？
　　Prof. Oparil: When we choose within a class of drugs it is important to choose the agent that is not only the strongest but also the safest. We believe that all ARBs are safe. I believe that olmesartan is more effective in reducing blood pressure because it binds to the AT1 receptor in a way that is very sustained throughout the entire 24 hour period.  That has been shown in studies where normal subjects take the pill and then have an injection of angiotensin and the higher dose of olmesartan blocks the angiotensin pressor effect for an entire day and is very highly effective. In addition， combinations of olmesartan with the diuretic HCTZ and also the CCB amlodipine are also available and are very powerful blood pressure reducing agents.
　　Oparil教授：当我们在一类药物中选择时，选择不仅最强效而且最安全的药物至关重要。我们认为，所有ARBs都是安全的。我认为奥美沙坦降低血压更为有效，因为它在整个24小时期间以一种非常持久的方式与AT1受体结合。已有研究显示，正常受试者服用这种药物继而注射血管紧张素，则较高剂量的奥美沙坦可阻断血管紧张素升压作用达一整天，且非常高效。另外，已有奥美沙坦与利尿剂HCTZ以及CCB氨氯地平的联合药物，是非常强效的降压药物。

　　<International Circulation>: Professor Hu， can you discuss your experience using that type of combination?

　　《国际循环》： 胡教授，可否谈一下您在使用这种联合治疗方面的体会

　　Prof. Hu: I can not predict the future， but I believe that the fixed pill combination is the way of the future. I do not believe that in the future any new class of drug can work alone and must be used in combination with another antihypertensive drug. At this time， I believe the best combination is an ARB or ACE inhibitor plus long acting CCB. ARB and diuretic—this works well. China has a long history of using fixed dosage antihypertensive combinations but early on we used the older type of drugs like. We have finally started to change the prescription behavior. We can use a single pill combination for a large majority of patients like JNC7 recommended that if systolic pressure is 160 or above and diastolic is 100 or above then you can start combination treatment. I think the best choice is fixed dose combination because one pill can provide 24 hour control. Olmesartan is not only strong but can last longer and amlodipine is also strong and long lasting so this combination is the best choice.
　　胡大一教授： 我认为，将来任何新的药物种类均不应单独应用，而必须与另一种抗高血压药物联合应用。目前，我认为最佳联合是一种ARB或ACE抑制剂加长效CCB。 ARB联合利尿剂同样有效。若收缩压≥160 mm Hg且舒张压≥100 mm Hg，则你可以开始联合治疗。奥美沙坦不仅强效，且可持续较长时间，氨氯地平也是强效和长效药物，因此这一联合是最佳选择。

　　<International Circulation>: Professor Hu， you mentioned the possible combination with an ACEI. Would you feel more concerned with a combination with an ACEI since ACEI has a high rate of the side effect of cough in China?
　　《国际循环》：胡教授，您提到了联合使用ACEI的可能性。由于在中国人群中使用ACEI咳嗽并发症的发生率非常高，您是否感到联合ACEI会有一些担忧？
　　Prof. Hu: Either an ACEI or ARB combined with amlodipine is a good combination but cough is a concern especially for Chinese patients because the rate of cough is higher compared to other populations. China does not have a systemic system for patient follow-up. For example， a patient may come a long way to Beijing to see me and I prescribe an ACE inhibitor and after they leave they may have cough and discontinue the drug.
　　Prof. Oparil: Yes， I agree.
　　胡大一教授：无论是ACEI还是ARB与氨氯地平联合都是好的联合，但咳嗽是一个要关心的问题，尤其是对中国患者，因为其与其他人群相比咳嗽发生率较高。中国没有系统性的患者随访制度。例如，一位患者可能从路途遥远的地方来到北京找我看病，我处方了一种ACE抑制剂，之后他们就离开了，他们可能会出现咳嗽并停用这种药物。
　　Oparil教授：是的，我完全赞同。

　　<International Circulation>:  It may be slightly less of a concern in the U.S. but still something you would consider?
　　《国际循环》： 在美国对这一点可能没有那么关注，但仍是您会考虑的事情吗？
　　Prof. Oparil: We have many Asian people in the United States and it seems like 100% of my Chinese patients have cough with ACEI so I do not use ACEI.
　　Oparil教授：在美国有很多亚洲人，我的中国患者用ACEI好像100%会有咳嗽，因此我不用ACEI。

　　<International Circulation>: What kinds of patients are the best candidates for olmesartan-based solutions?
　　《国际循环》： 何种患者是奥美沙坦为基础的治疗方案的最佳人选？
　　Prof. Oparil: They would be the kinds of patients who require the fixed combinations. As Professor Hu said， most people can not be controlled on one drug. Only about 30% of all patients with primary hypertension can be controlled on monotherapy and that leaves 70% who can not be controlled. This group includes those who have stage 2 hypertension (20/10 over blood pressure goal)， people over age 65， black people—you don’t have very many black people in China but they have severe hypertension and tend to have a high salt intake and a lot of target organ damage， and diabetics—I think diabetes is a growing problem in China because of the increase prevalence of a western diet.
　　Oparil教授：如胡教授所言，大部分患者用单药治疗不能有效控制血压。所有原发性高血压患者中，用单药治疗可控制的仅约30%，仍有70%的患者血压未被控制。这一群体包括那些2期高血压（超过目标血压20/10 mm Hg）患者、年龄大于65岁者和黑人——在中国没有那么多黑人，但他们有重度高血压且往往盐摄入量高，有很多靶器官损害和糖尿病—— 我认为，在中国，由于西方饮食的流行，糖尿病是一个越来越严重的问题。