<International Circulation>: There was a topic entitled “The benefits of olmesartan-based combination therapy to control hypertension” chaired by Prof. Guiseppe Mancia. So what’s the difference between olmesartan-based combination therapy and other ARBs-based combination therapy? And what are the special benefits of olmesartan-based combination compared with other ARBs-based combinations?
　　《国际循环》：ESC 2010年会期间G. Mancia教授主持了一项主题为“基于奥美沙坦的联合治疗”的专题会议。基于奥美沙坦与基于其他ARB制剂的联合治疗相比有何不同？基于奥美沙坦的联合治疗有何特殊益处？
　　Prof. Wang Ji Guang: The advantages of combination therapy or combination tablet is to enhance the blood pressure lowering effect of antihypertensive treatment. If you use a combination of olmesartan and with other antihypertensive drugs you may reduce blood pressure more efficiently and you may achieve a higher proportion of patients achieving controlled blood pressure which means below 140/90mm/Hg. But if you compare this combination tablet with other drugs for instance other ARBs with either calcium channel blockers or hydrochlorothiazide (HCTZ) which is a thiazide diuretic， olmesartan combination therapy is probably a little bit more effective in lowering blood pressure. The difference would not be very big such as 2 or 3mm/Hg compared to the others， but 2 or 3 mm/Hg can have a very big influence on the proportion of patients with controlled blood pressure below 140/90m/Hg and may also have a very large influence on the outcome of events. For instance， 2 or 3mm/Hg may produce a 10 or 15% reduction in the risk of stroke and about 7-10% decrease in the risk of myocardial infarction. This is why we need to use more combination therapies in hypertensive patients， especially stage 2 and 3 hypertensive patients. We should also use more effective and more efficacious combination treatments such as the combination of olmesartan with either a calcium channel blocker or a diuretic or with HCTZ or in the future with other diuretics.
　　王继光教授：联合治疗或复方制剂的优势是增强降压效应。如果使用奥美沙坦联合其他抗高血压药物，你可以更有效地降低血压，并取得更高的血压控制率（<140/90 mmHg）。当与其他ARB和CCB或HCTZ的联合进行对比时，基于奥美沙坦的联合治疗降压可能更有效。这种差异可能并不很大，较其他联合降压幅度多出2~3 mmHg，但2~3 mmHg的微小差异对患者血压控制（<140/90 mmHg）率和事件结局却有着巨大影响。例如，血压进一步降低2~3 mmHg可使卒中风险降低10~15%，心肌梗死风险降低7~10%。这就是为什么我们需要更多地使用联合降压疗法，尤其是对2、3期高血压患者。我们还应该选用更有效的联合治疗，如奥美沙坦和CCB或HCTZ的联合，将来还可能与其他利尿剂联合。

　　<International Circulation>: If a patient has a blood pressure which is difficult to lower what olmesartan based combinations would you recommend?
　　《国际循环》：如果1例患者血压难以控制，您建议应用那种基于奥美沙坦的联合治疗方案？
　　Prof. Wang Ji Guang: For the moment we should use combination tablets for stage 2 and 3 hypertensive patients. Probably mainly for patients with very high cardiovascular risk， for instance those patients with cardiovascular disease and with target organ damage. In those patients we probably should start them on single therapy but not necessarily with a single drug but single therapy of several classes of antihypertensive drugs when they are needed.
　　王继光教授：当前对2、3期高血压患者我们应使用复方制剂。主要是心血管极高危如合并心血管疾病或靶器官损害的患者。对此类患者应以简化治疗作为初始疗法，但简化并非单药，而是在必要时采用几种抗高血压药物的简单联合。
　　<International Circulation>: What kind of patients do you think will benefit most from olmesartan based therapy?
　　《国际循环》：您认为那些患者从基于奥美沙坦的治疗中获益最为显著？
　　Prof. Wang Ji Guang: Olmesartan is a very efficacious ARB and so this drug should be used in patients with diabetes mellitus， proteinuria and with left ventricular hypertrophy. It means  particularly those patients with small vessel disease， olmesartan and probably other ARBs can produce more benefits compared to other classes of antihypertensive drugs such as diuretics or beta-blockers. This is the major use of ARBs in hypertensive patients and that is probably the target population of this class of therapy including olmesartan.
　　王继光教授：奥美沙坦是非常有效的ARB，应该用于糖尿病、蛋白尿以及左室肥厚患者。特别是存在小血管病变的患者，奥美沙坦或其他ARBs与其他抗高血压药物如利尿剂、β受体阻滞剂相比，可带来更多获益。这是在高血压患者中ARBs的主要用途，也是包括奥美沙坦在内的疗法的主要目标人群。

　　<International Circulation>: Some studies have shown the efficacy of olmesartan in lowering inflammatory factors level and increasing circulatory endothelial progenitor cells leading to endothelial function improvement， as well as reversion of atherosclerotic progression. In addition， data from ROADMAP proved that olmesartan can reduce risk of MAU in T2DM patients. All of the above are either risk factors or predictors for CVD. According to these findings can we conclude that treatment with olmesartan will bring us more promising benefits in reducing CVD risk?
　　《国际循环》：一些研究表明奥美沙坦可降低炎症因子水平、增加循环中的内皮祖细胞，从而改善内皮功能、逆转动脉粥样硬化。此外，ROADMAP数据证实奥美沙坦可预防T2DM患者发生MAU。上述因素均为CVD危险因素或预测因子。根据这些发现，我们是否可以得出结论，即奥美沙坦治疗可以带来显著降低CVD风险的获益？
　　Prof. Wang Ji Guang: As I said before all ARBs should be used in patients with diabetes. This was the population which was involved in the ROADMAP Trial. The ROADMAP trial clearly suggests that in diabetic patients if you use olmesartan you may prevent the new onset of MAU and so this is one of the major target populations which is the diabetic patients. This is already in the guidelines and already established knowledge for the management of hypertensive patients with diabetes or one step further patients with diabetic nephropathy， MAU and macroalbuminuria. So， this is one of the major populations， but of course ARBs can be used in any hypertensive patients because of their very good safety profile and also quite effective in lowering blood pressure. But， of course you have 5 classes of antihypertensive drugs we sometimes have to choose the best for specific patients. I have to be assured as to what I said: the major targeting population or populations should be diabetic patients， patients with nephropathy， patients with MAU and patien