<International Circulation>:You are an expert in the area of hypertension and diabetes. For patients with diabetes and hypertension do you routinely start off with combination therapy as initial therapy?

  《国际循环》：你是高血压和糖尿病领域的专家。对糖尿病合并高血压的患者，您是否常规性的把联合治疗作为初始治疗？

    Prof. Jennings: It is not something I do routinely and it is outside of the guidelines in the country where I practice. However， it is in the guidelines in the US， Europe， and some other countries and they are suggesting that if you know you are going to need more than one drug anyway then you might as well start with it. This could be in patients who have a need to lower their blood pressure by 20 mm/Hg or more. I think that more and more there will be earlier use of combination therapy if not first-line therapy.

    Jennings教授：我通常并不这样做，这是超出我所制定的指南范围的做法。但是，在美国、欧洲及其他一些国家的指南中，他们建议如果你知道你需要一种以上的药物，那么你可以联合使用。这些患者可能需要把血压降低20mmHg或更多。我认为早期联合治疗将会越来越多，即使不是一线治疗。

    <International Circulation>: Perhaps this has been somewhat limited in the US guidelines because they have not been updated recently? Do you foresee this may change in the upcoming JNC8 guidelines?

   《国际循环》：也许美国指南有其局限性，因为他们最近没有被更新，你是否认为这可能会改变即将制定的JNC8指南？   

    Prof. Jennings: I never like to second guess guideline committees but there is concern at the moment about whether the aggressive targets that we are reaching and the aggressive therapies that we need to achieve those targets are the right thing to do given a lack of really solid evidence. On the other hand， we know that of all the patient groups in the community that need antihypertensive therapy， diabetic patients rank number one and they are the ones in which we are having the least success. Therefore， I think it is very important point for us to consider.

    Jennings教授：我从来没有想猜测指南委员会，但因为缺乏确凿的证据，目前我们应该做的正确的事是判断我们是否已经达到目标，以及我们实现这些目标需要的积极治疗。另一方面，我们知道，社会上所有需要降压治疗的患者群体中，糖尿病患者排名第一，他们也是我们治疗最不成功的。因此，我认为这是我们考虑的重点。