ADVANCE研究摒弃高血压和正常血压的概念，其所选患者基线血压并非大多在130/70 mm Hg以下，但无论初始血压低于或高于130 mm Hg，治疗的有效性并无差异。提示我们血压和总体心脏事件危险之间的关联性是连续的，并无一个血压的界值，高于它即罹患高血压病。无论血压是多少，降压治疗的主要原因是总体心血管危险的增加而非单纯血压水平的异常。我们不提倡使用“抗高血压”这个词，而是使用“降低血压”的说法，这具有不同的涵义：举例来说，在伴糖尿病的高危患者中将收缩压从130 mm Hg降至更低，可能要比将无糖尿病的低危患者收缩压从160 mm Hg降低的获益更大。

ADVANCE研究对临床实践的意义在于，医生在面临糖尿病患者时，首先要考虑的是无论他们接受了哪些治疗，无论血压多少，均需要进一步的降压治疗。对于培哚普利/吲达帕胺复方制剂在降低危险因素方面的益处，ADVANCE为我们提供了直接证据，因此这项临床试验的结果几乎可以直接应用于临床治疗。

<International Circulation>:  Shall we use blood pressure lowering therapy in diabetic patients with relatively normal blood pressure?

Prof. Anushka: What ADVANCE trying to do is to get away from some of the ideas of hypertension and normal blood pressure. If we look at the association between the blood pressure and overall heart attack， it is a continuous association. There is no magic number for blood pressure above which you have hypertension， and below that you don’t have hypertension. No matter what blood pressure is， this suggests that we should take overall risk rather than the blood pressure level as the major reason for blood lowering treatment. We don’t use the term anti-hypertensive; we use the term blood pressure lowering. It has a different meaning. Lowering a systolic blood pressure level from 130 mm Hg in a high risk patient with diabetes might produce more benefits than lowering the systolic blood pressure from 160 mm Hg in a low risk patient without diabetes .

<International Circulation>: What do you think of the target of blood pressure control， as for diabetic patients?

Prof. Anushka:  ADVANCE was not designed to answer this question， because we don’t have the target， we choose any level of blood pressure and we just lower it， without specifying a target. I think it’s providing evidence about the different ways to approach blood pressure lowering.

<International Circulation>: Should it be a little bit lower?

Prof. Anushka: ADVANCE did not have large numbers of patients whose blood pressure is less than 130/70 mm Hg at baseline， but if you look at the group， there was no evidence of different effectiveness if the blood pressure was initially below 130 or above 130 mm Hg.

<International Circulation>:  What阵 the meaning of this study for the clinical practice?

Prof. Anushka: I think the meaning for the clinical practice is that， if a patient in front of you， with diabetes， what阵 the first step you think? No matter what the treatment they have， and no matter what the blood pressure， you should consider lowering the blood pressure further. In ADVANCE we have direct evidence about the balance of risk-benefit of perindopril and indapamide combination. Therefore the results of this trial are most directly applicable to this regimen.