<International Circulation>: Professor Mancia， thank you for speaking with us today.  Could you tell us what the highlights of the conference for you have been so far?

　　Professor Mancia: Well there have been several interesting things， the program is extremely wide ranged.  It goes from basic science to clinical science， new diagnostic aspects， even new treatment aspects.  I think what has been of particular interest has been the treatment attitudes towards combination treatment in hypertension because the majority of the patients need combination treatment and also to start combination treatment as the first step of treatment.  Evidence says that this may add to cardiovascular protection in high risk individuals but also it favors less discontinuation of treatment later on.  This means of course better blood pressure control and new incidence of cardiovascular events.  In this meeting， the emphasis has gone from the need of new drugs to better use of the drugs we have.  This is different because for example， if we can use drug strategies that favor adherence to treatment， and low adherence is a devastating problem in hypertension， this may help public health quite substantially.

　　《国际循环》：Mancia 教授感谢你接受《国际循环》的采访。您认为目前来说本届大会有何亮点？

　　Mancia教授：本届大会的日程涉及范围非常广泛，包括基础科学、临床科学、新诊断方法、新治疗方法等各个方面，有很多亮点。鉴于大多数患者需要进行联合治疗甚至是起始联合治疗，我认为最受关注的应该是高血压治疗向联合治疗理念的态度转变。有证据显示，联合治疗能为高危人群带来心血管保护作用，还能降低后续的停药率。这意味着能实现更好的血压控制，降低心血管事件的发生率。在本次大会上，关注的重点已经从降压治疗新药向如何更好地应用现有药物转变。依从性较差对高血压的治疗而言是个非常严峻的问题，而本次会上与众不同的关注和寻求更好的现有药物治疗方案，则有助于我们选用治疗依从性较好的药物治疗策略，对改善公众健康有重要意义。

　　<International Circulation>: Is combination therapy the best way to approach this?

　　Professor Mancia: Yes. it is of course not the only way.  I think combination may be favored by physicians with good doctor patient relationships but perhaps by a change in the way we screen and diagnose hypertension， making better use of nurses who may help patients with lifestyle changes for example， and explain having a greater time and disposal of what we need to do.  But of course using the proper drug treatment strategy is important.

　　《国际循环》：联合治疗是否是实现这种策略的最佳方法？

　　Mancia教授：是的，但它并不是唯一的方法。我认为，联合治疗必定受到具有良好医患关系的医生的喜爱。但是，我们还可通过在高血压筛查及诊断方面做出改变，更好地发挥护士的作用来帮助患者进行生活方式改变并向患者耐心解释需要做些什么来实现对现有药物的更好应用。当然，选用适当的药物治疗策略也是非常重要的。

　　<International Circulation>: What is your opinion on the effects of renal denervation on resistant hypertension after the SYMPLICITY HTN-3 trial?

　　Professor Mancia: I think SYMPLICITY HTN-3 trial was in a way an important study because it is the only study in which there was a very appropriate control group.  It is a study which may have had some problems.  These problems are currently under discussion， whether they are real problems or not， for example the fact that a number of centers enrolled in this trial were na?ve to renal denervation procedure， the number of ablations was less than that normally done， and the changes in treatment both in the control group and the renal denervation group was much more common than was predicted by protocol.  Whether this was responsible for the results we do not know， but I think these are elements to consider.  In this meeting there has been presentations， and I gave the presentation of the registry data from renal denervation of the first 1000 consecutive patients undergoing renal denervation. The registry plans to go on up to 5000 patients.  In the registry there is a substantial reduction in office blood pressure and in ambulatory blood pressure.

　　《国际循环》：在SYMPLICITY HTN-3研究后，您如何看待肾脏去神经术治疗难治性高血压的疗效？

　　Mancia教授：我认为，SYMPLICITY HTN-3研究是一项非常重要的研究，因为其是迄今为止设立了最恰当对照组的研究。当然该研究也存在一些问题，例如参与该研究的很多中心都是新开展肾脏去神经治疗手术，所实施的消融数量少于通常实施的数量，而且肾脏去神经治疗组及对照组的治疗方案的改变率要显著高于预期。目前，我们正在就其存在的上述问题进行讨论，这些问题是否是研究未能得到预设阳性终点的原因所在，我们尚不得而知。但是，我认为在对结果进行分析时我们应该考虑上述因素。本次大会上也有相关内容，我本人发表演讲，介绍了使用肾脏去神经治疗的前1000例连续患者的初步注册数据。我们的注册研究计划入选5000例患者，对现有患者数据的分析显示，肾脏去神经治疗可显著降低诊室血压及动态血压。

　　<International Circulation>: What are the favorable strategies with renal denervation for resistant hypertension in patients under the current situation?

　　Professor Mancia: Well I do not think the SYMPLICITY 3 study closes a chapter.  I think additional evidence is needed， I think evidence is needed on whether or not the procedure improves outcome in relation to some prognostically valid intermediate endpoints such as for example left ventricular hypertrophy， a reduction in the number of arterial plaques， and things like that.  I think if the procedure stops， this would be unfortunate because the rationale is quite strong.  Some of the data has been extremely positive， of course not all patients respond and it is very important evidence to be collected in whether we can predict responders versus non-responders for the procedure.  In this context， in the registry study there were factors which predicted the response; the number of ablations for example， male sex， level of blood pressure， things like this. More studies are needed.

　　《国际循环》：目前，选用肾脏去神经术治疗难治性高血压时应坚持怎样的合理策略？

　　Mancia教授：我并不认为SYMPLICITY HTN-3研究意味着肾脏去神经治疗的终结。相反，我认为我们还需要其他证据来确定肾脏去神经治疗究竟能否改善患者的结局如左室肥厚、动脉斑块数量减少等经验证的间接预后终点。鉴于从理论上来说，肾脏去神经治疗应该具有较强的降压作用，我认为目前不应该停止对该治疗方法的探索和研究。虽然并不是所有的患者对该治疗方法都有很好的反应，但有些数据显示其还是具有非常积极的降压作用的。现在最重要的是收集相关证据，确定我们是否能够和如何预测患者的治疗反应性。在此背景下，我们开展了上述的注册研究，结果发现，消融数量、男性、血压水平等因素对治疗反应具有预测价值。当然，该领域尚需开展更多的研究。

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