Guido Grassi
DEPARTMENT OF INTERNAL MEDICINE， UNIVERSITY OF MILAN BICOCCA. SAN GERARDO HOSPITAL MONZA ， MONZA-ITALY

<International Circulation>:  We know that the prevalence of metabolic syndrome is high， and the mechanism is complicated and the progression is insidious. In the PAMELA population， glucose and lipid values were independently related to blood pressure. The value of the blood pressure is easy to obtain. What is you opinion about home blood pressure detection?

Prof. Grassi:  Home blood pressure detection is something relatively new.  We know that there is screening blood pressure， there is 24 blood pressure and it is increasing the use of whole blood pressure.  I think there are two good reasons for monitoring home blood pressure because it closely correlates with targetory damage and second because it can be easier to obtain than 24 hour blood pressure monitoring or easy for the doctor but also easy for the patient.  There is also another reason that if you perform home blood pressure， you involve the patient in the treatment of hypertension because usually patients understand that it is important to have lower blood pressure.

《国际循环》：我们都知道代谢综合征的发病率很高，发病机制复杂且进展隐匿。PAMELA人群研究表明血糖和血脂值与血压具有独立相关性。而血压值是我们比较容易获得的。您对家庭血压监测有什么观点？

Grassi教授：家庭血压监测的出现相对较新，我们知道，筛检血压即对24小时动态血压值进行筛查，这样可以提高对家庭血压监测的应用。应用家庭血压监测有两个非常好的理由，一是因为它与靶器官的损伤密切相关，二是无论对医生还是患者来说，家庭血压检测远比24小时动态血压监测更容易实施。此外，还有一个原因，如果对患者进行家庭血压监测，就意味着患者已经参与到高血压的治疗中，因为通常情况下，患者进行家庭血压监测的同时就已经领会到降低血压的重要性了。

<International Circulation>: When you involve the patient more as far as home blood pressure monitoring， I do not know how much evidence there is here but do you feel that that improves compliance in other areas such as taking their medication or other things?

Prof. Grassi:  Well there is some evidence suggesting that if you ask the patient to measure home blood pressure you can have some better blood pressure control.  Obviously there is some reverse side of the coin， namely the fact that the measurements of blood pressure do not need to  disease safe so patients will take their blood pressure measurements every ten minutes or every hour.

《国际循环》：当入选患者进行家庭血压监测时，同时也是增加了患者其他方面的依从性的，比如服药，那么是否我们就不知道从中能得到多少与家庭血压监测相关的证据了？

Grassi教授：有些证据已经表明如果你要求患者测量家庭血压，你就能获得更好的血压控制效果。很显然，任何事物都存在它的两面性，换句话说，家庭血压检测这件事情本身不要成为患者的“疾病”，因为它需要患者每隔10分钟或一小时就对自己的血压进行测量。

<International Circulation>:Blood pressure elevation and glucose and lipid abnormalities are three main characteristics of metabolic syndrome.  Which one of these factors do you think most likely plays a causal role?

Prof. Grassi:  Well this is an important question; we do not yet have an answer because there is a so called chicken and egg question.  Does the blood pressure increase come first or does the glucose abnormality or lipid abnormality come first?  Probably there is a mixture between the two but I think there is some evidence that blood pressure elevation may precede the glucose and lipid abnormalities.  This has been show n for example in some populations in the prehypertensive patient but still it is largely unknown.

《国际循环》：血压升高、血糖和血脂异常是代谢综合征的3个主要特征，您认为哪一个起主导作用呢？

Grassi教授：这是个重要的问题，正像先有鸡还是先有蛋的问题一样，我们仍没有得到一个肯定的答案。究竟是血压升高先出现，还是血糖异常、血脂异常先出现呢？很可能两者是一个混合体。但是我认为，一些证据说明了血压升高发生在血糖和血脂异常之前。比如在一些高血压前期的人群研究中有这样的表现，但是有很多方面仍然不清楚。

<International Circulation>: When we talk about lipids and also blood pressure， in the United States next Spring they will see the JNC 8 guidelines coming out we will also see some new lipid guidelines coming out as well.  There has been some exchange between those two groups， how about in Europe?  When we talk about lipid guidelines and hypertension guidelines how much exchange is there in the creation of those guidelines?

Prof. Grassi:  The last one was the 2007 guidelines.  There was a group compromise between lipidology and people working in hypertension because there was a close collaboration between the European Society of Cardiology and some members working specifically on dyslipidemia and so maybe the difference between American and European guidelines will again some clear.  There are some big differences about treatment， some big differences about target blood pressure they use， and there is probably some difference about target rates.

《国际循环》：我们讨论血脂同时同时总会提到血压，明年春天我们将看到美国JNC8指南出版，我们也能看到一些新的血脂指南出台。这两个小组之间已经有一些交流。那么在这一方面欧洲的情况如何？在建立指南的过程中，血脂指南和高血压指南小组之间的交流有多少？

Grassi教授：上一次交流是关于2007的指南。脂质学和高血压的人员之间有一个中间小组，因为在欧洲心脏病学会和血脂异常专业研究人员之间合作非常密切。也许欧洲指南和美国指南又会一些很明显差异。在治疗上有一些比较大的差异，对于目标血压水平的要求存在一些差异，可能对目标心率的要求也有所不同。

<International Circulation>: What is new as far as the updates of those 2007 guidelines here at the meeting?

Prof. Grassi:  Today will be the presentation of those updates.  I would not anticipate anything but two concepts I think that will come clearer， the first one are they need to obtain a blood pressure goal and also they need to use more combination drug treatment.

《国际循环》：与2007年指南相比，这次会议上会有哪些更新呢？

Grassi教授：今天的会议将介绍这些更新。我预测有两个概念将会更加清楚，一是需要将血压维持在一定的目标水平，二是在治疗过程中需要联合用药。

<International Circulation>: What is the status as far as specific medications or categories， like Calcium Channel Blockers for instance?

Prof. Grassi:  Calcium channel blockers are particularly long acting antagonists and are good antihypertensive agents and they are mentioned and indicated as treatment in one of the class of antihypertension drugs to be used for hypertension.  You know that the hypertension guidelines do not make any steps - first choice， second choice – because the aim of the antihypertensive approach according to European guidelines is to lower blood pressure with one of the five available classes of drugs， so it does not make a difference initially.  There is a big difference according to cardiovascular risk for target organ damage， presence of associated cardiovascular disease and in this context the position of calcium antagonists for sure is accepted.

《国际循环》：特殊药物或药物类别的应用形势如何，比如钙通道阻滞剂？

Grassi教授：钙通道阻滞剂作为独特的长效对抗药物，是很好的抗高血压药物。指南指示将其作为抗高血压药物分<