International Circulation:  The ACCOMPLISH study is the first study comparing the effect of a single-pill combination (SPC) RAS blocker/CCB and RAS blocker/diuretic in patients with hypertension and high cardiovascular risk. Do you feel that the results encourage the general application of the SPC RAS blocker/CCB in antihypertensive therapy?

《国际循环》：ACCOMPLISH研究是第一个在心血管疾病高风险的高血压患者中对比单片联合（SPC）RAS抑制剂/钙通道阻滞剂（CCB）和RAS抑制剂/利尿剂效果的试验，您认为该研究结果是否会推动SPC RAS抑制剂/CCB在抗高血压治疗中的广泛应用？

Dr. Dusing:  Well I really do. You have to look at this in a somewhat broader context. JNC 7 recommends that whenever dual therapy is needed， a diuretic should be part of it. Accordingly， in previous years， there was a general preference that in any dual compound therapy diuretics should be part of the therapeutic regimen. ACCOMPLISH， with the result that the RAS blocker plus CCB revealed better results than the RAAS blocker plus diuretic really will change this preference and therefore will change the way how we look at the treatment of hypertension at present. The question is what conclusions do you really draw from that study? Looking at the Australian guidelines， they stated that there now should be a general preference to a RAAS blocker plus a CCB because of the ACCOMPLISH data. I think what is probably more appropriate is that a differential therapy should be employed.  Here is a new option but I think there are still patients who could profit from a RAAS blocker plus diuretic combination. The majority of the patients， the high-risk patients， the coronary risk patients， they will probably be better off with a CCB combination.

Dusing教授：我确实这样认为。我们应该从更广泛的范围来审视这一研究。JNC 7推荐，当需要两种药物联合时，其中之一应是利尿剂。相应地，在前些年，有这样一种普遍的偏好，即在任何两种药物联合复方治疗中利尿剂均应该是治疗策略的一部分。ACCOMPLISH研究结果显示，RAS抑制剂加CCB优于RAS抑制剂加利尿剂，这一结果将改变这种偏好，并因此改变我们目前看待高血压治疗的方法。问题在于，你从这一研究真正得到了什么样的结论？澳大利亚指南中陈述，因ACCOMPLISH研究数据，目前应普遍优选RAS抑制剂加CCB。我认为，可能更适合的是提供有差别的治疗。这是一种新的选择，但我想仍有患者可以从RAS抑制剂加利尿剂联合治疗中获益。大部分患者、高危的患者和有冠状动脉疾病风险的患者很可能应用RAS抑制剂加CCB联合更佳。

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