Prof. Morgan:目前指南的重要性在于它是细致严谨的研究问题的方法。根据重要性,列出一、二、三类推荐。然后提供基于参考文献的证据。这是非常重要的信息来源。在评估哪些患者应当治疗和管理方面的改变很小,尽管指南讨论了不同的终末器官参数和其他危险因素的重要性。通过出色的参考文献来源给了它很好的定义。
<International Circulation>: The long expected European Hypertension Guidelines have been released this year at this ESH conference. Compared to the 2007 guidelines and the 2009 reappraisal version, Professor Morgan, may I ask are there any changes in cardiovascular risk assessment, initiate times, or goals of antihypertensive therapy?
Professor Morgan: The importance of present guidelines is they are a meticulous way to study a problem. They now make recommendations: one, two, or three, they are in the importance of a recommendation. They then give the evidence on which this is based and the references really. This will be an extraordinarily important source of information. There is really very little change in the assessment of who should be treated and who should be managed though they do talk about the importance of the different end organ parameters and the other risk factors. And this is really very well defined in an outstanding reference resource.
《国际循环》:期待已久的欧洲高血压指南已经在本次ESH大会上公布。和2007年指南及2009年再评估版相比,在心血管危险评估、降压治疗的起始时间和治疗目标方面是否有变化?
Prof. Morgan:目前指南的重要性在于它是细致严谨的研究问题的方法。根据重要性,列出一、二、三类推荐。然后提供基于参考文献的证据。这是非常重要的信息来源。在评估哪些患者应当治疗和管理方面的改变很小,尽管指南讨论了不同的终末器官参数和其他危险因素的重要性。通过出色的参考文献来源给了它很好的定义。
<International Circulation>: Dr. Yan, what is your opinion on the impact of the update of the 2013 European hypertension guidelines for Chinese clinical practioners?
Dr. Yan: In the new guidelines, they are recommending, for the high normal blood pressure, they don’t recommend the drug treatment, just recommend lifestyle modification,so it is different from 2007 recommendations.
Professor Morgan: This is a very important edition because previously the high blood pressure,if you just risk factors alone, might not be treated so there is a very definite recommendation: if it’s above 160 mm Hg, you should consider treatment. If it’s above 180 mm Hg, you should definitely treat no matter what the risk score.
Dr. Yan: I think in the Asian population, I do not know if it is totally the case. Because in our country, the cardiovascular event, about more than 80% are stroke.
Professor Morgan: I agree with this and that is really where the blood pressure itself is so important for it is so much more to associate with stroke, particularly in China with hemorrhagic stroke. When treating them, the level of blood pressure is extremely important.
Dr. Yan: Yes. In our some emerging new data,they showed in our hypertension patients, we treat the blood pressure target to 130/80 mm Hg is much better than 140/90mm Hg. Maybe in Asian population,with the high prevalence of stroke, the control of blood pressure even to a relatively lower target is reasonable. In China, we are accumulating the evidence of this aspects.
《国际循环》:严教授,您对2013指南更新对中国临床医生的影响有何看法?
严晓伟教授:新指南对正常高值血压不推荐进行药物治疗,而仅推荐进行改善生活方式的治疗,这与2007年的推荐不同。
Prof. Morgan:这个版本很重要,因为血压升高,如果仅有危险因素,可能不需要立即治疗。而有一些是有明确的推荐:如果高于160 mmHg,就需要考虑治疗,如果高于180 mmHg,则无论危险评分如何都需要治疗。
严晓伟教授:我不清楚在亚洲人群中是否同样适用。因为在中国,心血管事件中,80%以上为卒中。
Prof. Morgan:我同意这点。这就是高血压受重视之处,因为高血压和卒中关系密切,尤其是在中国,和出血性卒中关系密切。治疗这些疾病的时候,血压水平非常重要。
严晓伟教授:是的,在我国高血压人群的研究数据显示,我们将血压治疗目标定为130/80 mm Hg显著优于140/90 mm Hg。可能在亚洲人群中由于卒中高发,对于其血压控制至相对更低的目标值是合理的。在中国,我们正积累这方面的证据。