由欧洲高血压学会（ESH）主办的第十七届欧洲高血压科学年会于2007年6月15??19日在意大利米兰隆重举行。本届年会是自大会创办以来规模最大、内容涵盖最广的一次高血压领域的科学盛会，开设了高血压基础研究、临床试验、临床诊治及用药、流行病学、遗传学及高血压相关疾病（如内分泌、心血管、脑血管等）专题论坛，邀请欧、亚、非等各洲多个国家的高血压及相关领域的顶尖专家参会，对高血压病学进行了世界范围内的全方位的探讨和交流。《国际循环》特派记者奔赴米兰，特邀参会专家畅谈高血压防治最新进展，深入解读新指南。更多会议视频、音频及幻灯资料，尽在《国际循环网》“ESH 2007”专题网站（http://esh2007.icirculation.com）。

《国际循环》现场直击，权威专家深度访谈

《International Circulation》: It was mentioned for the first time that b blockers are no longer preferred as a routine initial therapy for hypertension in British Hypertensive Society Guidelines 2006. How to comment the current status of b blockers in hypertension treatment?

Guy G.de Backer(比利时Ghent大学医院)
欧洲心脏病学学会（ESC）副主席
Prof. de Backer: I think that there has been indeed a lot of controversial publications in Lancet and other papers. Again， there are two points. First of all， b blockers are definitely of great preventive value in patients after myocardial infarction. So in patients who suffered from myocardial infarction and have hypertension， they still should be treated with b blockers. Now in the other hand， we also know that in the large majority of our patients with hypertension， that we’ll never reach the goals that we accept now with one drug. So the question whether we start with one and then add another one is， I think， not so relevant. Anyhow， we’ll have to use different classes in most of our patients， and then to decide if we start with a b blocker and then we add a diuretic or start with a diuretic and then add a b blocker， I think it’s not so relevant， so for the clinician， it is not such an important question. I think that indeed， some classes of  drugs， like in the elderly，  are preferred. In diabetic patients we’ll use  more  ACEI and ARBs than b blockers . So we always have to think at the whole picture of the patient and think of the co-morbidities. Most of our patients are elderly patients not with one disease， not only with hypertension， with a lot of co-morbidities and dependent of these co-morbidities we have to make the choice of the drug we are using.

《International Circulation》：In recent years， the limitation of brachial blood pressure for BP-lowing evaluation has been known， while the obvious relationship between pressure gradient and cardiovascular events is found according to recent studies， some scholars have suggested that the Arterial Stiffness should be one important index for blood pressure evaluation and medicine selection. How to view this opinion? Which the objective standards can be used to evaluate high blood pressure and anti-hypertensive drugs?

Stéphane Laurent （法国巴黎popidou 医院）
Prof. Laurent: This is a very important question. We measure blood pressure at the arm. The blood pressure which is measured at the arm does not reflect in all patients the blood pressure which is the most important and which is available at the site of the aorta， coronary arteries， kidney and brain. Indeed， there is an amplification phenomenon between the arm and the carotid artery (or the aorta). Directly measuring central blood pressure， for instance carotid systolic blood pressure， enables you to determine exactly the load on the left ventricle， the brain， or the kidney. The stiffer the aorta， the higher of the central blood pressure. For the time being， we recommend in the new guideline to measure carotid-femoral pulse wave velocity which means aortic stiffness， because we have good evidence that it has an independent predictive value for cardiovascular events. We didn’t recommend for the moment to measure central blood pressure because we have not enough evidences that it is an important determinant， and whether it has some predictive value beyond brachial blood pressure.

《International Circulation》：Would you please to outlook the direct renin inhibition in the future? What should we do to get more information about this?

Giuseppe Mancia(意大利米兰Milan-Bicocca大学)欧洲高血压学会(ESH)主席
Pro.Mancia: Well， no question that renin inhibitors are a new class of agents， promising agents. The mechanism by which they block the renin-angiotensin system is different. It up-stimulate the cascade of events leading to angiotensin II formation. There is evidence that Aliskiren which is the drug， on which clinical data are available， it’s capable of lowering blood pressure alone and in combination. There is also pre-clinical evidence of the favorable effect on proteinuria for example. Of course， being a new drug， more data are needed and once that will be available for clinical practice， there will be， for sure， many new data. The promise of these drugs is also connected to the fact that we have begun to understand that renin may have effects independently on the formation of angiotensin II to the traditional pathways. If these would demonstrate that， then there would be an even stronger rationale to use renin inhibitors alone or in combination.

《国际循环》：如何评价联合抗高血压药物治疗是否经济合理呢？

Krzysztof Narkiewicz (波兰Gdask医科大学） 欧洲高血压学会(ESH)秘书
Narkiewicz 教授：药物的成本-效果分析是很重要的，我们应该根据国家、个人的经济状况决定我们的治疗方案，这涉及内科医生的知识更新及选择最优的治疗方案。目前有证据表明，在年轻患者中，我们能够预防高血压早期并发症的发生。为了尽力延长高血压患者无事件生存期、避免心室肥厚进展、肾功能衰竭的发生等情况，我们应该尽量根据卫生系统、政策及个人情况调整我们的治疗方案和目标。目前还没有联合治疗的经济学相关评价，但是不论从经济学的角度考虑，还是从联合应用药物角度考虑，长远来看联合治疗都是值得的。患者的依从性会更好，我们能够预防很多心血管事件。如果这些患者发生了心血管事件，用于治疗心脏病或短暂性脑缺血的花费会相当多。

《International Circulation》：Should patient with hypertension and diabetes be given as many drugs as to get hypertension as low as possible?

Peter M. Nilsson（瑞典Clinical Sciences Medicine University Hospital）
Prof.Nilsson：We have to separate the situation with the established diabetes situation from the one with the pre-diabetes situation， the metabolic syndrome. In established diabetes， I think we can use all the drugs， in different combinations， we should not be afraid of diuretics that can be combined with renin-angiotension blockers， ACE inhibitors. We should not be afraidβblockers used in diabetes patients with angina， ischemic heart disease. On the other hand， if we have the metabolic syndrome， pre-diabetes， abnormal diabetes， we know that high dose ofβblockers， thiazide diuretics， especially combination， could make these patients even more hyperglycemic and provoked diabetes. In my view， they can蒸 by magic trick， have diabetes out of nothing. And hyperglycemia is something bad because that can harm you. I wonder if you have concept on the EVA syndrome， early vascular aging， this is exactly what阵 going on，