<International Circulation>: Could you please briefly introduce the design of the ESH-CHL-SHOT trial? How is it progressing at present?
Dr Zanchetti: The SHOT trial was designed conjointly by the European Society of Hypertension and the Chinese Hypertension League and it tries to respond to some questions that the European Guidelines， for instance， have left unsolved. The problem is that because there is no evidence as far as lowering blood pressure below 130mmHg being beneficial， that does not mean it is not beneficial. So， we have to do studies to show whether it is or is not beneficial and those studies should be very specific. Probably the first study should be done in high-risk patients who strongly need to be controlled or to be better controlled to be better protected against the higher risk of recurrent events. Patients with a previous stroke， patients with a previous ischemic event are at higher risk of a recurrence and they deserve to know whether lowering blood pressure further than is usually done is beneficial or not. Even if it is not increasing risk， giving more drugs without any benefit would be useless， so we must know. The SHOT trial is trying to understand whether lowering the blood pressure below 140mmHg or 130mmHg or 125mmHg in these patients as well as the use of more or less statins for lowering cholesterol， is of benefit. Another very important challenge in the future is not only preventing cardiovascular events， but particularly in elderly patients， preventing cognitive decline. In the elderly， lack of cognition and dementia is a very important challenge not only for the individual but also for their families and society and so on. We know very little as to whether the vascular protection obtained by better lowering of blood pressure or more intensively lowering cholesterol is going to be beneficial in these patients. The SHOT trial is aimed at getting information about that. Any trial that proves positive gives a lot of impetus to the practice of medicine.
《国际循环》：您能否简要介绍一下ESH-CHL-SHOT试验的设计？目前的进展如何？
Zanchetti教授：SHOT试验是由欧洲高血压学会与中国高血压联盟共同设计的，旨在解决欧洲指南所未解决的一些问题。目前的问题是，虽然尚无证据显示将血压降至130 mmHg以下能为患者带来获益，但这不意味着一定就没有获益。因此，我们需要进行相关研究来确定其究竟是否能为患者带来获益。而且这些研究应该是非常具体的。第一，应在亟需控制或更好的血压控制来降低复发事件高发风险的高危人群中进行。既往伴有卒中病史、缺血性事件的患者存在较高的复发风险，应该知道与通常的降压目标相比进一步降压治疗能否为患者带来获益。即使其不增加风险，也没有必要让患者更多地应用没有任何获益的药物，这一点是我们必须要知道的。SHOT试验旨在确定将血压降至140 mmHg、130mmHg或125mmHg以下以及应用他汀类药物降低胆固醇能否为上述患者带来益处。未来我们还面临另一个非常重大的挑战，那就是我们不仅需要预防心血管事件，还要预防认知功能的下降，尤其是在老年患者中。在老年人中，认知功能下降及老年痴呆症是患者个人、家庭及社会所面临的共同的重大挑战。但我们对更好的血压控制及更强化的降脂治疗能否为患者带来获益知之甚少。SHOT试验旨在提供上述相关信息。任何试验如果能够得出阳性结果，都将极大地推动药物在临床实践中的应用。
<International Circulation>: What is the significance of this study to clinical practice， especially for the management of cerebrovascular diseases? We know it involved 5000 Chinese patients， so for the Chinese or other Asian populations， what is the special significance for them?
Dr Zanchetti: The trial involved both European and Chinese patients so the data certainly can be analyzed separately to focus on the two types of populations. Both suffer from cardiovascular disease. Cardiovascular disease has a very high incidence in the Western population and has an increasing incidence in China as more and more Chinese people are westernized to some degree in their habits. There are some differences in cerebrovascular disease between the West and the East. In the Far East (China and Japan and so on) there is more stroke than coronary disease and vice versa in the West. Also these things are going to progress and change. So in Europe there is an ageing population for whom stroke is increasing compared to coronary disease and in China with changes in lifestyle， coronary disease is increasing to balance with stroke. There are some differences in that hemorrhagic stroke seems to be more prevalent in China and the Far East than in the West so the SHOT trial will try to show this possible advantage over one type of stroke or the other in different types of population.
《国际循环》：该研究对临床实践尤其是脑血管疾病的管理方面有何意义？该研究入选了5000例中国患者，那对中国或其他亚洲人群而言，其有哪些特殊的意义？
Zanchetti教授：试验既入选了欧洲患者也入选了中国的患者，因此其数据肯定可以对两个人群进行单独的分析。欧洲及中国均正面临着心血管疾病的困扰。欧洲人群中心血管疾病的发病率非常高，随着越来越多的中国人生活方式及生活习惯的不断西化，中国心血管疾病的发病率也在不断增加。但东西方的脑血管疾病情况存在一些差异。在包括中国及日本在内的远东国家，与冠心病相比，卒中的发病率更高。而在西方国家则正好相反。此外，上述情况也在不断地发生着变化。欧洲老龄化进程加剧，与冠心病相比，老年人的卒中发生率增加；而中国随着生活方式的改变，冠心病也不断增加至与卒中相抗衡的水平。还有一点差异就是，与西方相比，中国及远东地区的出血性卒中更为流行。因此，SHOT试验还旨在探讨欧洲与中国人群中不同类型卒中的发病情况。
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