<International Circulation >: Can you expand on that with some further comments?
Dr Ruschitzska:We have done a lot of studies trying to evaluate whether endothelin antagonists provide benefits in heart failure， but unfortunately they do not. They also do not provide benefits in hypertension. While they lower blood pressure quite well， this comes at the cost of side effects—fluid retention in particular. Actually， the future of the darusentan program is uncertain. Also， the combined receptor antagonist bosentan has never really been pursued for essential hypertension.
《国际循环》：您能否为我们详细讲解一下？
Dr Ruschitzska:实际上，我们开展了很多试验来观察内皮素受体拮抗剂是否带来益处或至少不是无效的，但未能证实；用于高血压治疗，同样未证实其有益。因为，内皮素拮抗剂降低血压是以不良反应为代价的。最近我们发现内皮素A（ETA）受体拮抗剂的一些不良反应，尤其是液体潴留。实际上，探索内皮素受体拮抗剂标准用药方法的研究已经停止。现在我们对这一治疗还不是很确定，前景不明。目前还未尝试在原发性高血压患者联用内皮素受体拮抗剂。
<International Circulation >: What is the proper target level of hypertension in diabetic patients?
Dr Ruschitzska:It is less aggressive than we previously thought. The ACCORD trial taught us that when we go below approximately 140/90mmHg then it is probably fine. We do not go as low as we once thought we should go and I personally do not go below 130/80mmHg. There were even times when we thought that when the patient had renal failure that we should go below 120/70mmHg and I do not do that anymore. ACCORD taught us that approximately 135mmHg systolic may be just fine.
《国际循环》：糖尿病患者降压治疗的目标值是多少？
Dr Ruschitzska:这是一个很关键的问题。目前糖尿病患者的较我们先去预想的要保守。ACCORD试验启示我们，降到130/90 mmHg是适宜的，但是不需要降得像我们过去所想象的那么低。糖尿病患者不要降至130/80 mmHg以下。曾经我们认为肾功能不全患者应当将血压降到120/70 mmHg以下，但是我们现在不这么做了。ACCORD试验启示我们收缩压降至135 mmHg可能是合适的。
<International Circulation >: There has been talk of lowering the diagnostic criteria for hypertension; can you comment on that?
Dr Ruschitzska: The pre-hypertension criteria? The results of ACCORD further question the prehypertension hypothesis. Quite frankly， we do not even have good outcome data for patients with stage-1 hypertension， i.e. below 160mmHg.
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