Luis Miguel Ruilope教授  西班牙马德里12 de Octubre医院

　　<International Circulation>: The importance of combination therapy has been widely recognized for treatments of hypertension， and the new European guidelines also strongly recommend it. How do you think the combination therapy will improve cardiovascular events in patients with hypertension?

　　Prof. Ruilope: The new European Societies of Hypertension and European Societies of Cardiology Guidelines spell out the need for combination therapy. But what is the kind of patient that we want to start out combination therapy with? The patients that you want to start using combination therapy with are those whose increasing blood pressure are above 140 mm Hg and cannot be controlled with mono-therapy. So anything above， say 147 or 148， if you use mono-therapy， it’s going to be a failure. You can start with mono-therapy， but you will see， within two or three weeks， that you need to move to combination therapy. So， it’s better to start， as much as possible， with combination therapy from the beginning. Accomplished studies have proven that， by doing so， you can good control of high risk patients， which are normally the hardest hypertensive to control -- around 80 percent. We know by now， that the best thing for a doctor to do in these cases is to get control of their patients’ blood pressure within the first three months of therapy. So in three months time， that’s enough. So we can put patients on three drugs simultaneously， in adequate doses， and see if they correctly respond. By doing this， we will obtain a better control of blood pressure， and finally， in cases of hypertension， control of blood pressure is the best thing for the doctor and his patient to attain， independent of how to do it. Fixed combination therapy will facilitate the attainment of this goal.

　　《国际循环》：联合治疗在高血压治疗中的重要性已被广泛认可，欧洲新指南也对此强烈推荐。您认为联合治疗是如何改善高血压患者心血管事件的？

　　Ruilope教授：欧洲高血压学会（ESH）与欧洲心脏病学学会（ESC）联合发布的高血压指南强调需对患者实施联合治疗。对哪些患者需启动联合治疗？指南推荐，对收缩压高于140 mm Hg、单药治疗无法控制的患者需行联合治疗。当血压达140 mm Hg以上，如147或148 mm Hg时，单药治疗常会失败。你可以选择单药治疗，但通常会发现，治疗2或3周后，还是需转为联合治疗。因此，最好还是尽可能从一开始就启动联合治疗。大量研究已证实，起始联合治疗可实现对高危患者——最难控制的高血压患者群的良好控制，使其风险降低80%。现在我们知道，对这些患者而言，最好能在前3个月就将其血压控制住。3个月的时间已经足够。我们可同时让患者足量应用3种药物，观察其治疗反应。通过这样做，我们可以实现更好的血压控制，对高危患者而言，血压控制是最重要的。不论采用何种办法，只要将血压控制住就可以。而固定复方制剂治疗则有助于实现这一目标。

　　<International Circulation>: What do you think about how to manage special hypertension populations such as the youth， women， the elderly， and people with diabetes? And what exactly is the role of combination therapy for such patients?

　　Prof. Ruilope: Combination therapy can be used in any one of these special groups. Considering women and men， they are the same -- at least from the point of view of hypertension treatment. The elderly， of course， must be paid special attention to， especially above 70 years of age. With such a patient， we must be cautious to start this therapy. Combination therapy might be spaced out to three or four months instead of the normal two to three months. But combination therapy is used in 80 percent of elderly hypertensives.

　　In young hypertensives， if you need to control blood pressure， and you follow The National Institute for Health and Care Excellence (NICE) guidelines， they are really good in this sense: for young people， they make a calculation of lifetime risk. The presence of particular risk factors， in particular diabetes in the young， and the presence of target organ damage forces from hypertensive therapy. If that is the case， the great majority of them will also need combination therapy. In diabetes， for sure， you would need combination therapy in practically 100 percent of these cases.

　　《国际循环》：您认为对年轻、女性、老年人、糖尿病患者等特殊高血压人群应如何进行管理？在这些患者的治疗中联合治疗发挥怎样的作用？

　　Ruilope教授：上述特殊人群均可采用联合治疗。女性及男性的高血压治疗是相同的。对老年人而言，我们则需特别注意，尤其对70岁以上的老年人。对高龄老年患者开始治疗时应非常谨慎。与通常用2～3个月将血压控制住相比，在该人群中可能需用3～4个月更长的时间。目前，老年高血压患者中接受联合治疗的比例为80%。在年轻高血压患者中，则可按照国家卫生与临床优化研究所（NICE）指南，评估终生风险并进行降压治疗。如患者存在危险因素（如糖尿病及靶器官损伤），绝大多数需进行联合治疗。其中，100%的糖尿病患者需联合治疗。