《国际循环》：也就是说这些不会影响您在诊所对患者的治疗方法？
　　Dr Mancia： 不会。这个结论的启示是什么？启示并不是说我能在几年后利用我所知的就诊变异性这种测量方法。我不会跟患者说，“你的就诊变异性不是很好，我很遗憾。”这个启示是一种概念性的东西。也就是你必须在每次就诊时就关注血压值。不要低估了遗漏任何特定就诊时血压控制的作用，因为这可能是很重要的事情。我认为在这一领域还有其他的证据。例如，我们在循环杂志发表的一篇文章对ONTARGET试验中的26000例患者进行了事后分析，结果显示不良事件和就诊前血压值之间有明显的相关性。这也能解释为何没有很多人测量血压变异性，因为测量需要时间，但是也加强了应该通过在每次就诊时设立对照从而获得一致性的概念。考虑到机制，这可能仅仅是对治疗依从性差的案例。我们知道对治疗的依从性越低，不良事件的发生率就越高，并且这种关系已经被多次证实。这也许是对治疗依从性差的预后意义的另一个案例，只是从不同的方法来评估罢了。
　　International Circulation: So this would not affect your treatment in the clinic in any way?
　　Dr Mancia： No. What is the message? The message is not that I can make use of this measure as I know the visit-to-visit variability after a few years. I will not tell the patient， “Your visit-to-visit variability was not good. I am sorry for you.” The message is a conceptual message. You have to be concerned about the blood pressure value at every visit. Don’t under-estimate lack of blood pressure control at any given visit because it may be important. I think there is some other evidence in this direction. For example， we published in Circulation a post hoc analysis of ONTARGET with a huge number of patients (26000) and there was a clear relationship between events and the blood pressure value in the immediately preceding visit. This is consistent with the concept that it is important to not so much have a measure of variability which takes time， but to enforce the concept that consistency should be obtained by having control at each and any visit. Concerning the mechanisms， this could simply be a case of poor compliance to treatment. We know that the lower the compliance to treatment， the greater the number of events and this has been shown many times. This may be another case of the prognostic importance of poor compliance to treatment， but determined through a different measure.
 

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