International Circulation: ACE inhibitors and ARB have become the cornerstone of pharmacotherapy in heart failure management today. In A-HeFT trial， you showed a combination of isosorbide dinitrate with hydralazine achieved a better survival rate than placebo in African American population. Do you think to establish an optimal therapy for heart failure， we should integrate different methods which target independent mechanisms?
《国际循环》: 血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体拮抗剂（ARB）是心力衰竭（心衰）药物治疗的基石。A-HeFT试验表明非洲裔美国人硝酸异山梨酯联合肼苯哒嗪组的生存率要高于安慰剂组。为了建立最优的心衰治疗方案，您认为应该整合不同作用机制的各种治疗方法吗？
 

Jay Cohn:  It is terribly important to understand the mechanisms and attempt to interfere with selective mechanisms in selective patients.  The A-HeFT trial was carried out in an Aftican-American Black population and demonstrated a remarkable benefit when added to ACE inhibitors or ARBs.  That needs to be tested in a larger population， as well as in Caucasians and Asians in order to understand whether this is a mechanism which is important to inhibit in other populations.  The treatment of heart failure today has become poly-pharmaceutical.  That is， we are using multiple drugs to inhibit multiple mechanisms of left ventricular structural remodeling and I am confident that the drugs we use do not all need to be used in every patient.  However， since the trials are done in large populations and demonstrate a benefit then the drugs become advocated for everyone.  The nitrate/hydralazine combination has not yet been advocated for everyone even though the magnitude of the benefit was greater than with any other intervention that has been used.  That is because we studied a rather narrow population.  It is therefore very important that this study be expanded to other population groups.
Jay Cohn:  理解机制并用特定的机制干预特定的病人及其重要。A-HeFT试验是在非洲裔美国人中进行的，表明在ACEI或ARB基础上加用硝酸异山梨酯联合肼苯哒嗪后疗效显著。此疗效需要在更大的人群中进行验证，包括白种人和亚洲人，从而了解这种机制是否在其他人群中同样重要。现代心衰治疗策略是多种药物联合，也即用多种药物抑制多种左室重构的机制。但是我相信并不是所有患者都需使用所有药物。然而，若一种药物在大样本临床试验中被证明有效时，就会被鼓吹在所有人群中使用。尽管硝酸酯类/肼苯哒嗪联合的获益较其他使用过的干预手段都大，但由于研究的人群较窄，还没有被提倡人人使用，因此有必要将此研究扩展到其他人群。