International Circulation：Dr. Sica， do you think there is a significant racial difference for the application of anti-hypertensive drugs?

Domenic A. Sica: One of the things about racial differences is to realise there are population and then individual differences. So， in a population， generally you may see blunting of the action of certain drugs. For example， in black hypertensives， ACE inhibitors or angiotensin receptive blockers may have a blunted or attenuated effect compared to Caucasians or Asians. On the other hand， if you look at the individual patient， the population demographic or response may well not apply to the individual patient， who may have a different host of factors controlling or having led to their hypertension. So， I think when we look as population-based therapies， unfortunately they always have to be individualized – maybe unfortunately is the wrong word， fortunately should be the word – they have to be individualized

International Circulation：Dr. Sica，您是否认为降压药物之间存在显著的种族差异性？

Domenic A. Sica: 种族差异性应包括种群差异和个体差异。在种群层面，通常可见到对某些药物反应欠佳。例如，黑人高血压患者相对于高家索人或亚裔人群，对ACEI或ARB的反应性欠佳或更弱。另一方面，对个体患者而言，种群的统计学或反应性结果可能并不适用于个体患者，后者具有不同的高血压诱发因素或控制因素。所以，我想对以种群为基础的治疗，“很不幸”总是采取了个体化治疗——选用“很不幸”这个词或许是错误的，“幸运”可能更合适——而这些治疗应该采取个体化。

International Circulation：But， is race taken into consideration for that individual treatment?
Domenic A. Sica: Ah， race is sometimes taken into consideration， but maybe not as often as one would think， so we do not preclude certain therapies in somebody because we presume they are not going to work in a general population. So， I think it is overblown to a degree， but it is just a way to figure out， I mean， and some of it becomes marketing in nature， someone markets one drug versus the other in a particular class. So I think there is a lot evolving thinking in this， but you use what works， and I do not think there should be an a priori belief that something is not going to work on somebody until it is proven not to work.

International Circulation：但是，个体化治疗时是否需要考虑种族因素？
Domenic A. Sica: 有时需要考虑种族因素，但并非总是如此。对于某个人，我们并不能因为假定某些治疗对一般人群反应欠佳而预先排除使用。因此，我想在某种程度上（种族因素）被过分夸大，我的意思是这仅是一种想法，本质上部分源于销售因素，某些人将某种药物与其他药对比，而向特定阶层推销。因此，我认为这里有大量需要思考的东西，但对您提出的药物效果问题，在药物证实无效之前，我不认为应提前假定其对某些人无效。

International Circulation：When you say marketing， then， are there marketing tests done on particular populations?
Domenic A. Sica: Yeah， I think a lot of times， particularly for example the black patients， every drug that comes on the market has to have a specific study conducted in black hypertensives， so you end up gathering that information and then you do with it what you may. So that is refinement of a specific population base to study them. That is really one of the few areas in which we see that. Now， on the flip side， you often see based on the country， and where the drug is and how it penetrates in a country， a study to have been done in that country， in order to meet regulatory requirements in the country. So， you might get an angiotensin receptive block studied in Japan， or China， or Korea， and then you would say what is its effect in the Korean， Chinese or Japanese population. But that is a regulatory issue and not as much an ethnicity issue. The gene pool within the Pacific Rim is not remarkably different. Certainly， when you look at the gene pool between Caucasians and blacks， there are some distinctive differences. When you get to different sectors of the country， there is a more homogeneous gene pool， still different but somewhat more homogeneity.

International Circulation：您谈到了销售，是否有对特定人群销售的研究？

Domenic A. Sica: 是的，我思考了很久，特以黑人患者为例，入市的每种药物均需对黑人高血压患者进行特定研究，所以您会完成信息收集，然后尽所能进行处理，最后得出对所研究的特定人群加工后的东西。而这只是我们能看到的一部分。另一方面，现在经常能够见到以国家为基础的研究，那么药物是如何出入一个国家和确定其地位的？一项研究之所以能在那个国家进行，是为了满足该国规则的需要。因此，您可以得到日本、中国或韩国的ARB研究，随后您会问该药对韩国、中国或日本人群的效果如何。但这是一个关于制度的话题，而与种族无关。环太平洋地区的基因库不存在明显差异。当然，对比高加索人与黑人的基因库，会有某些显著性差异。同一国家的不同地区，基因库更加同质化，虽然有差异但同质性更多。

International Circulation：Thank you. At ACC 2009， some novel approaches to anti-hypertensive therapies were introduced， such as Rheos baroreflex hypertension therapy system， and catheter-based renal denervation with satisfactory primary results. What is your opinion about these， and any other innovative techniques?

Domenic A. Sica: Well， the first is what is called  baroreceptors activation therapy， it is an implantable device， which has a pulse-generator and wires issuing forth from the pulse generator， which is inserted in a pocket in the upper chest area. And， ultimately， those wires are each part of a process of enwrapping or surrounding the bear receptor and the carotid artery bi-laterally， in order then to be able to stimulate that receptor by programming the device. So you have got a pulse generator and you have got a programmable device， and when you have got the programmable device， you can change the voltage on one side， or both sides， pulse wave amplitude and pulse wave width， so there are a lot of changes in how you stimulate the receptors there. Study today in resistant hyper-tension has to find by three-drug therapy， max doses， one of which is a diuretic， being still with elevated blood pressures， above 0.60 systolic. The feasibility study that was done in the US and Europe with very promising results， a pivotal trial is now underway in the United States with about 65% of full enrolment and results are beginning to come in from that. There is no active control in the current study and it is a 2 to 1 randomization process with active turnout therapy versus placebo therapy. I think it is going to be of note， funding and how the Federal Government will support and pay， what do you do once the device is in because it is in for life， what happens to the device as to who programs it or not， so once this device gets onto the general market there are going to be a lot of issues that have to be worked through carefully. The second device is not a device， but it is a procedure and it is called radio frequency oblation of the renal nerves. The renal nerves are found on both arteries on the outermost portion of the wall of the artery， and if you turn a catheter or an oblation device – or radio frequency device is a better phrase – into the renal artery at a certain juncture along the length of the renal artery， you blitz – or you use frequency oblation – you can actually knock the renal nerves out to both kidneys， and that has had somewhat promising results. I choose the word somewhat because they are still preliminary results in small numbers of patients， so we are yet to figure out who is going to be the right patient， what type of resistant hyper-tension is most suitable for that， are there going to be long term anatomic consequences of this， are there goin