International Circulation:  We are always interested in guidelines for various societies around the world.  In 2009 there was a reappraisal of the European guidelines on hypertension management and the anti-hypertension concept changed from “lower is better” to “earlier is better”.  I’m sure at this 2010 meeting we will also be discussing that opinion.  What is your general opinion of that strategy and the concept of early intervention?

 《国际循环》：我们一直对全世界各种协会的指南感兴趣。2009年欧洲高血压治疗指南作了再评价，抗高血压概念从“越低越好”转变为“越早越好”。我相信在本次2010会议上，我们还将会讨论这一观点。您对这一策略和早期干预的概念有何看法？
 

    Prof. Kjeldson:  I would say that the 2009 paper from the European Society of Hypertension really isn’t a new guidelines paper but one reminding us about the guidelines that is a development of the time.  So we called it a reappraisal of the 2007 guidelines.  Most likely we will issue new guidelines in 2011 and they should be done by the annual meeting in Milan next year.  Coming back to the question， which is an important one because we have seen through observation data， not as a randomized part of clinical trials， but we have seen that if we lower blood pressure too much we could in fact tend to increase the risk again.  We have seen this in the VALUE trial， TARGET， INVUS， and probably there in the HOPE trial as well.  In many studies with higher risk hypertensives that if you lower blood pressure below 120/70 mmHG it appears as a kind of J-shaped curve.  These are just observational data and should give us something to think about.  These are not randomized data and we have to be very careful.  Because of that we are a little bit careful about too aggressively lowering blood pressure， particularly in the high-risk group.  When it comes to early treatment we can see from the same clinical trials that if you get blood pressure under control relatively early it appears that we improve the prognosis.  These are again observational data and not part of the randomized analysis， but we are carefully taking a closer look at this until we get more properly randomized data.

    Kjeldson教授：我想说的是，欧洲高血压协会2009文件实际上不是新的指南文件，但是是一个提醒我们指南是随时代发展的文件。因此我们称之为2007指南的再评价。很可能我们将在2011年发布新的指南，且应该在明年米兰的年会前完成。回到这个问题上来，哪个是重要的，因为我们已经认真了解过观察性数据，虽不是作为临床试验的随机部分，但我们已经看到，如果我们将血压降得太多，实际上我们可能会有再次升高风险的趋势。我们已经在VALUE试验、TARGET、INVUS试验中观察到这一趋势，且很可能在HOPE试验中也会。在很多较高危高血压患者的研究中，如果你将血压降低至低于120/70 mm Hg就会出现一种J型曲线。这些仅仅是观察性数据，应该给我们带来了一些需要思考的问题。这些不是随机数据，因此我们必须非常谨慎。因此，我们对过于积极地降低血压有点小心，尤其是在高危组。当谈及早期治疗，我们从相同的临床试验中可以看到，如果你相对早期地控制住血压，看来我们是改善了预后。这些还是观察性数据，不是随机分析的部分，但我们正在小心地对此进行深入观察，直至我们获得更多正确的随机数据。