<International Circulation>: Could cardiovascular risk be reduced in the hypertensive patient by the management of hyperkalemia?
　　Prof.Ruilope: Absolutely. The problem with hyperkalemia is that patients are at risk of developing hyperkalemia because they are using RAS blockers or they have diminished renal function. This diminution of renal function is probably the most important factor particularly where the GFR is <15ml/min and in those cases the fact that you are suppressing the system is not that important. The risk of hyperkalemia impedes the use of RAS suppressors so the protection of these patients is not what should be available to them as a consequence. We are very much looking forward to a new product which is coming. Currently we have Kayexalate， but this new compound from Relypsa has the difference that it can be maintained chronically and according to the available data with very good tolerability. This means we will be able to very much improve the treatment of these patients with a necessary therapy without the risk of hyperkalemia.

　　《国际循环网》：高血压患者通过管理高钾血症能否降低心血管风险？
　　Ruilope教授：当然能。高钾血症的问题在于患者发生高钾血症的风险增加，因为他们在应用RAS阻断药物或者肾功能下降。肾功能的下降可能是最重要的因素，尤其是当eGFR<15 ml/min时，在这些患者抑制RAS系统就不是那么重要了。发生高钾血症的风险限制了RAS阻断药物的应用，因此这些患者也没法接受他们本来应当得到的保护。我们非常期待一个新药的出现。目前我们有聚苯乙烯磺酸钠（Kayexalate），但是Relypsa公司生产的这一新药有所不同，它可以长期应用，现有数据显示该药耐受性良好。这意味着我们应用必要的药物在相当大的程度上可以改善这些患者的治疗，同时又不增加高钾血症的发生风险。 
　　<International Circulation>: What concerns are there that diuretic-induced changes in serum potassium may have an adverse effect on hypertensive patients?
　　Prof.Ruilope: There are different types of diuretics. The most commonly used diuretics are the thiazide-like diuretics and what happens with potassium with these types of drugs is that they can cause hypokalemia rather than hyperkalemia. They induce a situation of secondary hyperaldosteronism and a higher amount of potassium is excreted in the urine which causes hypokalemia. This hypokalemia complicates the control of hypertension making it more difficult. What we need to do is pay attention to this and try to correct this hypokalemia which can be achieved using potassium supplements and by other means and then the control of the patient will be very much facilitated. On the other hand， the other types of diuretics which are distal diuretics like aldosterone blockers or drugs interfering with aldosterone like Amiloride can produce the opposite， hyperkalemia， when they are used. These types of diuretics are those that have a particular concern when renal function is decreased when eGFR <30ml/min.

　　《国际循环网》：我们担心利尿剂所诱发的血清钾变化可能对高血压患者有哪些不良影响？
　　Ruilope教授：利尿剂有几类。最常应用的是噻嗪类利尿剂，应用此类利尿剂时血钾的变化是发生低钾血症，而不是高钾血症。噻嗪类利尿剂诱发继发性高醛固酮血症，尿液中排除更多的钾离子，导致低钾血症。这使得高血压的控制复杂了，血压更难控制了。我们需要做的是注意这些，尝试纠正低钾血症，这可以通过补充钾或其他方法来实现，之后患者的血压控制就能得到明显改善。另一方面，影响远端肾小管的利尿剂（例如ARB）或干扰醛固酮的药物（例如阿米洛利）会导致相反的情况，即高钾血症。当肾功能下降至eGFR<30 ml/min时，需要特别注意上述类型的利尿剂的使用。
 

　　<International Circulation>: Should the clinician be concerned about serum potassium levels when initiating hypertension treatment with diuretics?
　　Prof.Ruilope: If renal function is normal， there is no reason to be concerned when using diuretics. If renal function is normal you need to be more concerned about hypokalemia if using thiazide diuretics or loop diuretics. If renal function is decreased and you try to use an aldosterone blocker or other types of diuretics interfering with aldosterone， then the risk of hyperkalemia is there.

　　《国际循环网》：当临床医生以利尿剂作为高血压的初始治疗时，是否需要考虑血钾水平？
　　Ruilope教授：如果肾功能正常，应用利尿剂就无需担心血钾水平。在肾功能正常的情况下，应用噻嗪类利尿剂或袢利尿剂时需要更多关注低钾血症。如果肾功能下降时尝试应用ARB或干扰醛固酮的其他利尿剂，有发生高钾血症的风险。
 

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