International Circulation: Could you give us what you think are the main advantages and the main limitations of renal denervation?
　　Dr Schmieder: The excitement about renal denervation stems from the fact that we now have another treatment to treat those patients who are not controlled by non-medical combined with medical therapy. Now we have another tool or strategy to control hypertension. When we look at the data for example， we can see that after six months， 40% are below 140mmHg and another 40% are below 160mmHg compared to six months previously where 100% had been above 160mmHg. So we have a very good response rate of approximately 84% but nevertheless this means that 1 in 6 do not respond and this is also a matter of ongoing research on non-responders. This is an open question and we need to address that. As I mentioned， the sympathetic nervous system not only has an influence on blood pressure but also modifies the degree of organ damage so the question is raised whether we can more effectively treat this organ damage by cutting sympathetic innervations to the kidney and thereby decreasing the overall activity. The limitations are that we cannot predict who will respond; five out of six are responders. We have the best evidence now from the Medtronic device with two great studies published in The Lancet， and we also have safety data for at least three years where we have not done any harm to patients overall. The limitation is that we cannot tell you what will happen in five years or ten years and， for example， which population benefits most from the procedure. There is a hypothesis out that maybe diabetic patients are specifically the best responders but we don’t know yet. It is still a young method. The first patient treated is now three years older so our experience is limited but it is exciting. This is， I think， an advantage for those patients whose hypertension has not been controlled. We asked these resistant patients in a questionnaire how they feel. After more than thirty years in this field， I was surprised to learn that these resistant hypertensive patients have a high level of stress， a high level of anxiety which is not very encouraging for the scientific community and therefore we are now very happy that we have a new strategy we can use to treat these patients and bring their blood pressure under control thereby preventing the strokes， myocardial infarctions， heart failure， renal failure and so on.
　　International Circulation: What are the main questions that you think delegates at this meeting who will take this away with them to their clinics should have regarding renal denervation?
　　Dr Schmieder: I think they should go home with a feeling that this is really an attractive option in those patients whose blood pressure is not controlled despite their best efforts. And secondly， they should go home knowing it is a safe procedure so far even though our experience is limited to the past three years. They should go home with an understanding of who their true hypertensive patients are. True hypertensive patients are those treated for hypertension with confirmed elevated blood pressure under ambulatory conditions having ruled out types of pseudo-hypertension and any white coat effect.
　　《国际循环》：您能谈谈肾脏去神经术最主要的优点和缺点是什么吗？
　　Dr Schmieder：肾脏去神经术令人兴奋的方面是我们现在有了另一种治疗方法来治疗那些非药物治疗联合常规降压治疗血压仍不能被控制的高血压患者，也就是现在我们有了一种新的手段和方法来治疗高血压。从肾脏去神经术疗效的数据来看，例如我们会发现在治疗后6个月，接受去神经术治疗的患者有40% 血压在140 mm Hg 以下，还有 40% 血压在160 mm Hg以下，而这些患者6个月之前血压全部高于160 mm Hg。因此患者对肾脏去神经术的反应率很好，达到84%，尽管如此仍然意味着每6个患者中还有1一个对此手术无反应，这些去神经术无效的患者也是以后需要进行的研究方向。这是一个悬而未决的问题，并且应该得到我们的重视。同时我还提到，交感神经系统不仅对血压有影响并且还影响着靶器官的损害程度。因此新的问题是我们是否能通过切断支配肾脏的交感神经并因此降低交感神经的整体活性，从而更有效地治疗这种靶器官损害。这种手术的缺点是我们不能预测哪些患者会有效，因为6个患者中有5个是有效的。我们现在从美敦力公司的两项大规模试验中获得了最好的证据，这些结果已经发表于Lancet杂志，同时研究显示这一手术是安全的，所有患者至少3年内不会发生不良反应。缺点是我们不能确定5年或10年后会出现什么情况，例如哪类患者人群从这种手术中的获益更多。有一种假设认为糖尿病患者可能对肾脏去神经治疗有很好的反应性，但是我们还没有确凿的证据证明这一点。这种手术方法还是一种刚刚起步的治疗方法。第一例治疗的患者现在也才术后3年，因此我们的经验虽然令人欣喜但是也有局限性。我认为，对于那些高血压不能被控制的患者来说，这种手术是一种很好的治疗方法。我们曾用问卷的方式调查了一些顽固性高血压患者的感受。我研究这一领域30多年了，我对这些患者的情况感到惊讶。顽固性高血压患者的压力更大，焦虑程度更高，这些方面令科学界无奈，现在我们很高兴的是有了新的方法来治疗顽固性高血压患者，使他们的血压降至正常从而预防卒中、心肌梗死、心力衰竭和肾功能衰竭等并发症的出现。
　　《国际循环》：您认为此次大会的与会者们回到他们的临床工作后会如何认识肾脏去神经术？
　　Dr Schmieder：我认为他们回到临床后应该感觉到，这种治疗方法对于那些不管他们如何努力血压仍不能得到控制的患者来说是个非常有吸引力的选择。而且另一点是他们回到临床工作后应该知道这种手术方法据目前所知非常安全，尽管我们的经验仅限于过去的3年。他们应该理解谁是他们真正的高血压患者。真正的高血压患者是那些被动态血压监测证实血压升高的患者，需要排除假性高血压和白大衣性高血压。