International Circulation: What can you tell us about baroreflex therapy?
　　Dr Weil: We are starting it in our hospital as well. It is even more invasive than renal denervation. We are taking part in a clinical study with heart failure and the baroreflex but what we also want to do is if we have people who do not react to renal denervation therapy we can offer them this baroreflex pacemaker. Another important question that is often asked is can we perform denervation twice as we do in atrial fibrillation ablation? Nobody knows. But in AF the success rate is 60% on the first procedure which is very low compared to this procedure. Every question we have has to be included in a randomized clinical trial in order to get an answer.
　　International Circulation: There are still indeed a lot of unanswerable questions in this field. Because baroreflex therapy is a more invasive procedure， is it being considered as a second-line， third-line or even fourth-line therapy after renal denervation?
　　Dr Weil: As I see it， we have lifestyle， medication， renal denervation and then baroreflex therapy. It is very invasive although it is improving with smaller electrodes and they are getting very good success rates， over 90% at the clinical study level. It is another option. We have seen people in 24-hour ambulatory blood pressure monitoring with an average of 170mmHg. These people are at very high risk， so for these people who genuinely have therapy resistant hypertension， these procedures will be beneficial. It is a last resort but it is a resort.
　　《国际循环》：能否谈谈血管压力感受反射起搏器治疗？
　　Weil博士：我所在的医院正在开始这一治疗。此种治疗的有创性甚至超过了肾交感神经射频消融术。我们正在参加一项心衰和压力感受反射的临床试验，但是我们还想做的是，对于那些对肾交感神经射频消融术没有反应的患者，我们可以给他们装上血管压力感受反射起搏器。另一个大家经常提起的重要问题就是能不能在同一位患者二次实施肾交感神经射频消融术，就像房颤射频消融那样。没有人知道答案。但是，首次房颤射频消融的成功率为60%，与肾交感神经射频消融术的成功率相比是非常低的。我们所有的问题都得在随机、对照试验中才能够找到答案。
　　《国际循环》：在这个领域，还有很多悬而未决的问题。因为血管压力感受反射治疗是一个更为有创性的治疗，因此这一治疗被看作是肾交感神经射频消融术后的二线治疗、三线治疗甚至是四线治疗。
　　Weil博士：我们都知道，高血压的治疗手段包括生活方式干预、药物治疗、肾交感神经射频消融术和血管压力感受反射治疗。后者造成的创伤相当大，尽管随着体积更小的电极的应用，创伤性已经有所下降，成功率也相当不错，临床研究中观察到90%以上的成功率。血管压力感受反射治疗是一种治疗选择。我们接诊过24小时动态血压监测下平均血压为170 mm Hg的患者。这些患者的风险非常高，因此对于这些实际上难治性的高血压，新的治疗手段会对他们有所帮助。新的治疗手段是最后的选择，但也不失为一个办法。