International Circulation: I’d like to know we have some updates on the guidelines being talked about and discussed here at the meeting.  First of all what are some perhaps some new content what is being updated and your view on that.

Prof. Staesson:  There has been an update of the guidelines here at the meeting
but basically what has been done has been a confirmation of the previous guidelines that was published in 2007.  I think one important concept of these guidelines is that we do not treat hypertension as an isolated risk factor but really go for risk assessment in all patients and we try to treat absolute risk.  So it is more than treating hypertension or high blood pressure， we evaluate the risk in the patients and we try to have multiple risk factor interventions so the old idea of just treating hypertension is gone.  We are treating risk.

国际循环：我们想知道这次会议上所讨论的一些关于指南的更新，首先，可能会出现哪些新的内容？您觉得有哪些内容会更新？请您谈谈您的观点。

Staesson教授：这次会议上指南会有一些更新，但是基本上之前得到肯定的内容都已经出版在2007年的指南中了。我认为这些指南中的一种重要的观念是不能把高血压作为一种独立的危险因素来进行处理，而是需要对所有患者进行风险评估，并尝试去处理绝对的风险。所以这不仅要求对高血压进行治疗，还要评估患者的风险，并尝试对多种风险进行干预。因此仅仅治疗高血压的旧观念已经过时了，我们还要对危险因素进行处理。

International Circulation:  As far as the United States goes， it has been quite some time since the JNC 7 guidelines and now there will be the JNC 8 guidelines coming out.  I know we don’t have it yet but what do you foresee?  Do you think the European guidelines and the new JNC 8 will be quite similar and have you had any discussions or exchange perhaps with the Americans?

Prof. Staesson:  Well I was at the ASH (American Society of Hypertension) meetings in May， I am not sure what will be in the new guidelines but some of the concepts that have been in the previous guideline JNC 7 are obviously wrong.  For instance， I’ll just give one example， in the old American guidelines， doctors were told that secondary prevention of stroke is a compelling indication for ACE inhibitors or inhibitors of the renin system.  Now if you look at the evidence that has been published there is not indication what so ever that secondary prevention of stroke， or prevention of stroke recurrence is compelling evidence for ACE inhibitors.  So I really hope this will change， I hope that it will not be in the new guideline anymore and I hope that the American guidelines as the European guidelines put more emphasis on the individual patient.  For instance in the American guidelines you always have to prescribe or start treatment with a diuretic.  This is quite different from the European guidelines where actually the doctor faces the patient and takes up his or her responsibility and intiate treatment with a drug that he or she thinks will be most good for the patient， I hope this will change for the American guidelines.

国际循环：在美国，JNC7指南已经出版较长一段时间了，JNC8指南也很快要出版了。JNC8指南尚未正式出版，您对此有没有什么预见？您认为欧洲指南和新的JNC8指南会很相似吗？关于这一指南，欧洲与美国之间有讨论或者交流吗？

Staesson教授：我5月份参加了美国高血压学会（ASH），我并不清楚新的指南内容，但是在之前的JNC7指南中，有一些观念是明显错误的。比如，我举一个例子来说，旧的美国指南告诉医生们，对卒中的二级预防需要强制使用ACE抑制剂或肾素抑制剂。但是现在，如果你看已经发表的证据，会发现对卒中的二级预防中并没有再提到这一点或者预防卒中再发生是ACE抑制剂的证据。因此，我其实很希望这些能有所改变，我希望新的指南将不再出现这个，希望美国指南能与欧洲指南一样更加强调患者个体。比如在美国指南中，你在开处方或治疗患者时总是要从使用利尿剂开始。这与欧洲指南的差异很大，欧洲指南中，医生直接面对不同的患者，考虑如何治疗对患者最好来选择合适的治疗方法。我希望，在这一点上，美国的指南可以有所改变。

International Circulation:  As far as the European guidelines go， you mentioned ACE inhibitors what about the role of calcium channel blockers in the new guidelines?

Prof. Staesson:  Well just for the NICE guidelines in the UK and actually if you read the NICE guidelines for people younger than 55 years they propose inhibitors of the renin system and ace inhibitors in the first place and if patients who are ACE intolerant ARBs， and for patients who are older than 55 years the first choice drug is diuretic or calcium channel blocker.  I think calcium channel blockers are really the most powerful drug to lower blood pressure and they should have a first order position in treatment of high blood pressure.

国际循环：在欧洲指南中您提到了ACE抑制剂，那么新指南中关于钙通道阻滞剂的功能如何？

Staesson教授：英国NICE指南中，对55岁以下的年轻患者建议首先使用肾素系统抑制剂和ACE抑制剂，如果患者对ACE抑制剂不耐受，则使用ARBs。对55岁以上的患者，首选的药物是利尿剂或钙通道阻滞剂。我认为长效二氢吡啶类钙通道阻滞剂是降低血压最有效的药物，在治疗较高的血压方面具有首选地位。

International Circulation:  And in those cases where there would be preferred calcium channel blockers the difference in the action or perhaps have you seen any improvements in more steady actions.  IN that area what have you seen as improvements and what is the current status in the choice of different agents?

Prof. Staesson:  If you look within drug classes there is a big difference within drugs of a given class and I think within a given class， drugs that have a long duration of action are the ones that are preferred.  I know that within each class there are several agents that I think each doctor should choose  within the class one or two drugs that  positive effects and we should not switch from one to the other because it is impossible to remember all the drugs within a class so just go to each unique class and go for one or two drugs and go for long acting drugs.  Drugs that are long acting just on their own， not by putting them together in a slow release capsule， I think if you have drugs which innately are long acting without having to do anything to the formulation I think is better.

国际循环：在这种情况下，钙通道阻滞剂是首选，因为它的作用更加稳定。在这一领域中，钙通道阻滞剂有那些改善？当前在不同药物的选择上情形如何？

 Staesson教授：如果你看用药类别，你会发现他与推荐的类别是有差异的，我认为在推荐的药物类别中，作用持续时间长的药物优先。对于每一类药物，医生都会熟悉其中的一、两种药物，熟悉他们的药代动力学、药效动力学和潜在的副作用。那些自身的长效药物优于那些需要采取特殊工艺来延长药物作用时间的药物。

International Circulation:  What about this year’s meeting， we are not completely finished yet but what have you seen as the most important topic being covered this year or some new research you have seen or some things presented here at this meeting which you think are really key to focus on?

Prof. Staesson:  That is a very difficult question.  I think what is going to change the future probably in the treatment of hypertension and cardiovascular medicine in general is the new non invasive techniques of assessing left ventricular mass and left ventricle function.  I think the new techniques of tissue Doppler imaging looking at left ventricular strain and strain patterns looking at biomarkers to predict are going to change the future.

国际循环：虽然今年的会议还没有结束，但是您认为今年的会议最重要的主题<