<International Circulation>: Is there much a difference between patients with diabetes type I versus those with type II in terms of cardiovascular risk with regards to combination therapy?

　　Prof. Ruilope: Type I have， no doubt， cardiovascular risk with time. It takes longer， probably， to appear. Blood pressure is not that high in this group， because they are younger when diabetes appears. Many of them are normal-tensive. When diabetes II appears， on the other hand， many of these patients are already hypertensive. Cardiovascular disease appears with a high prevalence， and cardiovascular death is probably the most important cause of death， together with diabetic neuropathy， together with diabetes I and II patients， which are particularly prevalent.

　　《国际循环》：1型糖尿病与2型糖尿病患者的心血管风险是否有差异？

　　Ruilope教授：1型糖尿病的心血管风险会毫无疑问地随时间增加，但其心血管风险显现可能需相对更长时间。其血压通常不会太高，因为糖尿病发病时其通常更年轻，很多人的血压处于正常范围。而很多2型糖尿病患者在发病时已伴高血压，心血管疾病患病率较高，心血管死亡可能是其最重要的死亡原因，更多伴有糖尿病神经病变。

　　<International Circulation>: Poor medication compliance of hypertensive patients leads to their blood pressure problems; however， SPC is well complied and tolerated. How do you evaluate SPC on the treatments for hypertension?

　　Prof. Ruilope: Evaluation of compliance is really difficult. In daily medical practice， the best way to evaluate this is the number of pill containers that you have supplied to the patient. The prescription must have a periodicity， and you know that a patient， if you prescribe a medication with 30 pills， and they are to be taken daily， then 30 days later the patient must come back. If he shows up 15 days later， than you know he is not complying. That’s the only way to do it in clinical practice. In my opinion， it’s extremely important to talk with the patients and explain to them that cardiovascular disease is a disease of responsibility. Most of the reasons for cardiovascular disease are from lifestyle changes: increasing weight， amount of salt， smoking， alcohol， inadequate diet -- everyone is responsible for himself. To this， you must add absence of physical activity. So you must explain to the patient that this is your responsibility. You can do whatever you wish. But if you don’t take the pills， don’t come back here. It’s a waste of time. If you decide to live your life within the frame of risk of cardiovascular disease， it’s your decision. It’s simple.

　　And then， of course， compliance is facilitated by the lower the number of pills. In my opinion， the best thing to do is take all the pills in the morning， and the rest of the day， you don’t have to worry. When you leave you’re home， you’re ready， you’re done.

　　《国际循环》：高血压患者的用药依从性较差是其血压控制面临的重要挑战。而单片复方制剂（SPC）具有良好的依从性和耐受性，您如何评价SPC在高血压治疗中的作用？

　　Ruilope教授：依从性很难评估。临床实践中，评估依从性最好的方法是查看提供给患者药片的剩余数量。为患者周期性定期开具处方。如果你向一例患者处方了30片药，让其每天服用1片，30天后复诊。复诊时如果他还剩15片药，你就可以知道他的依从性较差。这是临床实践中评估患者依从性的唯一办法。在我看来，与患者进行交谈，向他们解释心血管疾病危害非常重要。大多数心血管疾病的病因来自生活方式改变，包括体重增加、钠盐摄入量、吸烟、饮酒、饮食不当及缺乏体力活动，这些都是患者可自行控制和改变的。你必须向患者解释这些危险因素，这是医生的责任。你可让患者选择任何他愿意进行的改变，但不服药的话就不要再来复诊。不然的话，就是浪费时间。并告诉患者如果他愿意处于心血管疾病风险之中，那是他的决定。这其实是非常简单的一件事。当然，患者复诊时所剩药片数量越少其依从性就越高。在我看来，最好让患者在清晨服药，这样的话不论患者是否要离开家在一天中的剩余时间里就无需担忧了，因为早上已经把药服完了。

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