International Circulation:  What about in higher risk patients? 

《国际循环》：针对更高危患者您又如何看待这一问题？

Professor Unger:  Higher risk patients may be different and that goes back mainly to the VALUE trial.  In the VALUE trial， valsartan- was compared to amlodipine treatment in high-risk hypertensives， and both weretitrated up within months to the actual target doses of the trial.  Blood pressure reduction， in the beginning and throughout the study， was less in the valsartan group than in the amlodipine group.  In the first three months， there were more cardiac problems， especially myocardial infarctions， in the valsartan group than the amlodipine group.  That was probably related to the lowering of blood pressure which was less in the valsartan group.  It was concluded from this study that it is important in high risk hypertensive patients  to induce a faster blood pressure reduction and reach target in a shorter period of time than in low-eisk hypertensive patients.

Unger教授：对于更高危的患者可能不尽相同，这主要追溯到VALUE研究。VALUE研究中，在高危高血压患者中对比了缬沙坦和氨氯地平治疗，两种药物均在数月内滴定至该研究实际的目标剂量。缬沙坦组在初始时以及整个研究中血压的降低低于氨氯地平组。在最初3个月中，缬沙坦组较氨氯地平组出现了更多的心脏问题，尤其是心肌梗死。这很可能与血压降低有关，而缬沙坦组血压降低较少。从该研究得出结论，与低危高血压患者相比，在高危高血压患者中诱导更快的血压降低及在更短的时间内达标至关重要。