International Circulation:  And when we specifically talk about the valsartan amlodipine combination in antihypertension therapy， can you give your view?  Are there advantages of that combination?

《国际循环》：在抗高血压治疗中，对缬沙坦/氨氯地平联合您有何看法？这一联合的优势有哪些？

Professor Unger:  The combination of valsartan with amlodipine .  The ARB， valsartan，  gives you more or less complete inhibition of the rennin-angiotensin system depending on the dose ， and the calcium antagonist， amlodipine， acts in a complimentary fashion because it blocks L-type calcium channels which are directly involved in vasoconstriction.  So there are two ways to attack the vascular smooth muscles in terms vascular dilatation. This combination makes sense.  And there is something in addition to that.. With higher doses of amlodipine such as10 mg or more per day ，，  amlodipine may cause ankle edema since calcium channel blockers dilate preferentially the precapillary arterioles but not the postcapillary venoles..  When an ARB like valsartan is added to amlodipine， there is less danger of ankle edema because now the venous side is also opened up so there is no need for the fluid to escape into the extravascular tissue causin edema.  In several studies it has been shown that there is less ankle edema if one combines amlodipine with an inhibitor of the renin-angiotensin system.

Unger教授：依据剂量大小不同，ARB缬沙坦能提供或多或少的对肾素血管紧张素系统的抑制。而钙通道阻滞剂氨氯地平则以一种的方式发挥作用，因其阻断直接参与血管收缩的L型钙离子通道。因此，就血管舒张而言，有两种途径来攻击血管平滑肌。这种联合是有意义的。另外还有其他的优势。更大剂量的氨氯地平如10 mg/d或更多可能导致踝部水肿，因为钙通道阻滞剂优先扩张毛细血管前微动脉而不是毛细血管后微动脉。当在氨氯地平应用基础上加用ARB譬如缬沙坦时，踝部水肿的风险降低，因为静脉也被扩张，因此体液无需逸出至血管外组织导致水肿。几项研究已经显示，联合氨氯地平和肾素-血管紧张素系统抑制剂可减少踝部水肿的发生。

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