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　　　<International Circulation>: ROADMAP was the 1st and unique primary prevention clinical trial proving that olmesartan can reduce microalbuminuria (MAU) in patients with type 2 diabetes mellitus. What do you think are the implications for clinical practice of this study?  I want to discuss the recent exciting developments in ARBs， which has been a very hot topic at this conference. The recent ROADMAP and ORIENT studies have shown very exciting effects of ARBs. Professor Mancia， can you comment on the significance of these studies?
　　《国际循环》：ROADMAP是证明奥美沙坦可减少2型糖尿病患者微量白蛋白尿（MAU）发生的首项且惟一的一级预防临床试验。您认为该研究对临床实践有何意义？另外，近期ARB相关进展令人兴奋，成为本届会议热点话题之一，最近的ROADMAP和ORIENT研究显示了ARB奥美沙坦使人兴奋的作用。可否请Mancia教授对这些研究结果的意义做一点评？

　　Professor Guiseppe Mancia: The ROADMAP Study is a very interesting study because it goes into the direction in which cardiovascular prevention is moving. For many years we have had trials looking at high risk individuals and trials based on events and trials based on events need high risk individuals because they need to collect a relatively large number of events within a relatively short time. Now we have realized there is another area to approach this， namely the earlier phase of prevention in which the successfulness of treatment means prevention of organ damage. This has been addressed in ROADMAP that is the prevention of the appearance of MAU which is of well documented prognostic and clinical significance. The study provides interesting data on earlier markers of cardiovascular risk as compared to previous studies.
　　Guiseppe Mancia教授：ROADMAP研究是一项令人非常感兴趣的研究，因为它是沿着心血管预防前进的方向。很多年来，我们已经有了许多观察高危个体的试验和基于事件的试验，而基于事件的试验需要纳入高危个体，因为他们需要在相对较短的时间内收集到相对大量的事件。 现在我们已经认识到，有另外一个领域可达到这一点，即早期预防阶段，这一阶段成功的治疗意味着可预防器官损害。ROADMAP研究解决了这一问题，有效预防了已被证实具有明确预后和临床意义的MAU的发生。与以往研究相比，ROADMAP提供了关于心血管风险早期标志物的令人感兴趣的数据。

　　Professor Zhang Wei Zhong: I agree with the ideas of Professor Mancia. In terms of the treatment for hypertension the earlier the better， particularly in the subclinical organ damage stage such as MAU. The ROADMAP Study has proven that ARB olmesartan can significantly reduce MAU development by 23% which is very important. This may show a regression in subclinical  target organ damage.

　　张维忠教授：我同意Mancia教授的观点。高血压治疗越早越好，尤其是在亚临床器官损害阶段如MAU。ROADMAP研究已经证明，奥美沙坦能显著地预防或阻止糖尿病患者发生，这非常重要。这可能显示了亚临床靶器官损害的逆转。

　　<International Circulation>: There was a topic entitled “The benefits of olmesartan-based combination therapy to control hypertension” on the satellite symposium chaired by Prof. Mancia. So what’s the difference between olmesartan-based combination therapy and other ARBs-based combination therapies? And what are the special benefits of olmesartan-based combination compared with other ARBs-based combination?
 

　　《国际循环》：在教授担任主席的卫星会上有一项主题名为“奥美沙坦为基础的联合治疗控制高血压的益处”。那么基于奥美沙坦的联合治疗和基于其他ARBs的联合治疗有何差异？与基于其他ARB的联合治疗相比，基于奥美沙坦的联合治疗有何特别获益？

　　Professor Guiseppe Mancia:First of all combination therapy is the backbone of antihypertensive treatment because we know that a large proportion of antihypertensive treatment originates from blood pressure lowering per se no matter how it is obtained. Therapeutic strategies should aim to control blood pressure; that might not be easy with monotherapy and so combination treatment is much more effective. The second point is that there is consensus now at least in high risk individuals one should consider combination treatment as the first step. This in order to provide the so called early blood pressure control which can be important in individuals in which the chances of having an event can materialize in weeks or months. Finally， several combinations are available which have been highlighted in the recent reappraisal of the European guidelines by the European Society of Hypertension. There is no question that a combination including an angiotensin receptor antagonist is good particularly if the partner is a diuretic or a calcium channel blocker because this has complimentary mechanisms of action. Furthermore， ARBs introduce in the combination an optimal tolerability profile.

　　Guiseppe Mancia教授：首先，联合治疗是抗高血压治疗的基石，因为我们知道抗高血压治疗的获益大部分源自血压降低本身，无论采用何种手段控制血压。治疗策略应以控制血压为目的；单药治疗可能不易做到，而联合治疗更为有效。第二点，目前已达成共识，至少在高危个体中，应考虑将联合治疗作为初始治疗。这是为了达到所谓的早期血压控制，这对数周或数月内会发生事件的个体非常重要。最后，近期的ESH指南再评估中，强调了几种可用的联合。毫无疑问，包括一种血管紧张素受体拮抗剂的联合是非常好的，尤其是与利尿剂或钙通道阻滞剂的联合，因为其作用机制互补。另外，ARBs使联合治疗有最佳的耐受性。

　　<International Circulation>:  Is there a particular preference you have in terms of which combinations?
 

　 《国际循环》：对选择何种联合治疗方案您有无特殊倾向？

　　Professor Guiseppe Mancia:I do not think we should stick to one combination， the greater number of options the better. The recent European guidelines list a number of combinations which have been successfully used in trials and other aspects favorable to treatment. There is a combination of a blocker of the renin angiotensin system with a diuretic， there is also a combination with a calcium antagonist with a diuretic which has been used in trials and there is of course the combination of a blocker of the renin-angiotensin system， beta blocker， angiotensin receptor antagonist with a calcium antagonist. Some of these combinations have been used successfully in trials in terms of prevention of metabolic and dysmetabolic effects or even events.

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