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[ISH2010]各国高血压指南差异——Simon Rabkin教授专访

作者:  SimonRabkin教授   日期:2010/9/28 16:47:07

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各国高血压指南各有特色,但对于有些问题仍存在较大差异,ISH 如何看待这些差异?

    <International Circulation>:What do you see as some of the key sessions that are going to be presented at ISH 2010?

  《国际循环》:Rabkin博士,我想最先讨论的范围较广泛些,我知道,会议才刚刚开始,但到目前为止,你也看到了一些重要专场都将在今年的大会中举行。您作为大会的执行委员,您也一定密切参与这些专场会议。因此,你指出今年大会将会提出许多好的科学理念 ,那么您为什么这样认为呢?
    Simon Rabkin:We start off on Monday with “Uncontrolled Hypertension: A Global Health Problem” where we have the perspective from China, Africa, Canada, other developed countries, and Malaysia. Then we follow that up with a public health and policy session on how to implement policy. What we are finding is that a number of the messages have been the same for many years but what is happening is that it is not being translated so we have an increasing prevalence of hypertension in many countries. They know the information but they are not getting it out in public policy. Therefore, we are having a session on public policy to see what has been successful in various countries in the world and the WHO is speaking and they are going to try to implement ideas for public policy. Also, we have a bridging of the gap symposium where we have ministers of health coming and those ministers will be making statements we hope will translate into public policy. We have some global sessions on integrating across risk factors. In addition, we have many sessions on the basic mechanisms of obesity and hypertension. Obesity is a major factor producing hypertension and if we can deal with some of the basic mechanisms of obesity then we can start decreasing hypertension risk. There are sessions on adolescents and I think that is a major area. We are talking about how adolescents become obese and get hypertension and what we can do to stem the tide of obesity in adolescents. There are also sessions on guidelines across the world. For instance, we are comparing European, Canadian, American, and WHO guidelines to try to get to a common guideline if possible. There are some countries that can only afford a small amount on drugs and other countries that can afford larger amounts on drugs and we have to be able to solve that problem. Furthermore, we have an enormous amount of basic science research such as how the artery signal tells the artery to constrict and that constriction produces hypertension. Other sessions include the brain and hypertension and what happens with various receptors in the brain and how that might be the trigger for hypertension. We have sessions on heart failure that include how hypertension produces heart failure, which is a key and growing issue around the world. Specifically, how you interfere with the link between hypertension and heart failure. This is not only impairment of how the heart contracts, but how the heart relaxes. Thus, we have a whole session on how the heart relaxes and relaxation induced heart failure. In addition, there are sessions on the kidney and how hypertension affects the kidney. Novel treatments for hypertension are also covered. For instance, how we use electrical stimulation of the arteries in the neck to decrease blood pressure, which is new state-of-the-art information. Furthermore, there are many sessions on salt including a basic understanding of how salt is bad for hypertension and bad for the heart, how you can decrease salt content in food, and statements on reducing salt both globally and specific statements from Canada, the U.S, and Latin America. There is a Latin American group, the U.S CDC, and the Canadian public health agency are going to be here speaking. We have major sessions on clinical trials, what are the current best drugs and what are the new drugs coming out. Today there is going to be a symposium on one of the new drugs that is coming out and how effective it is in treating hypertension. Throughout the week there are going to be big sessions on some of the drugs that are already out, how good they are, and should they be used in combination or not. We have the dangers and benefits of drugs and how you weigh those benefits against adverse effects. In the area of physiology and mechanisms there is an important symposium on sleep and sleep disorders, particularly how sleeping blood pressures relate to outcomes and what can be done about it and also the whole area of sleep regulation of blood pressure.   

    Rabkin博士:可能因为我说话的语气,我很期望参加这些专场。至于为什么会有这么多专场,主要是因为是周一的会议是围绕高血压防治这一全球性问题,所以我们必须从中国的角度,非洲的角度,加拿大及发展中国家如马来西亚的角度来讨论,因此须对专场进行排序。随后我们将就公众健康和政策等及如何执行政策举行专题会议。你知道的,我们发现多年以来高血压的报道内容都是一样的,但是,这并不单纯的复制。许多国家的高血压患者数量都在逐增。
    但是这些信息并不是从公共政策那获得的。所以,通过公共决策专场,我们可以了解加拿大和澳大利亚及其它各个国家在高血压防治方面所取得的成功。WHO已经在发言,随后他们将努力将这些理念落实到公共政策中。我们将把各个会议桥接起来,届时将请各个卫生部长在会议的间期发表声明,我们期望能将大会的提议纳入到公共政策中去。我们还有一些针对高血压的综合性交叉性危险因素的全球性专场会议,因此,各个国家人民的肥胖程度,及按照不同种族分析哪个群体更具肥胖的易感性及肥胖与高血压的相关性都将会从中获得。

    大会设了许多针对肥胖和高血压机制的专场。肥胖是高血压最主要的一个诱因,若从肥胖的机制开始进行干预将会降低高血压的风险。因此,关于这方面研究的专场有一大堆。大会也设置青少年肥胖问题专场,我认为这是一个很大研究领域,青少年是如何肥胖然后导致高血压?我们如何阻止青少年肥胖这一趋势?此外还有高血压指南的专场会议,我们有世界各地不同国家的高血压防治指南,如果可能的话,我们可以把我们欧洲的指南与加拿大的,美国的,WHO的指南进行比较,并设法制定一个共同的准则。
    早上我们也谈论到,一些国家只能负担得起某些药物,而其它国家则可以负担大量的药物,因此我们必须调查清楚。需进行大量的基础科学研究。动脉信号是如何指挥动脉进行收缩,从而导致血压上升?大会设置了大脑和高血压的专场会议,大脑内各种受体是如何工作,它们又是如何引发高血压的?心力衰竭专场则主要讨论高血压是如何产生心衰这个世界性地不断增长的关键问题。而且,你如何精确干预高血压与心衰之间特异性联系?不能只研究心脏收缩功能的受损还得包括心脏的舒张;因此还有专场分别针对心脏舒张和心衰及肾脏。有许多研究是探讨高血压如何影响肾脏。
    高血压治疗专场将公布有新的降压治疗方法,通过电刺激劲动脉来降低血压。找到刺激点并依次刺激这些动脉都是一种艺术,这样才不会导致肾脏收缩,这是一种先进的降压方法。我们还有许多专场是关于盐,为何盐可诱导高血压,不利于心脏,如何减少食物中盐的含量等基础知识。如何控制盐摄入量是全球性议题,届时加拿大研究者会就其减少饮食中盐摄入量措施发表评论,美国也会就此作特别报告。
    此外还有一个针对拉丁美洲国家减少盐摄入量的小组专场。美国疾病控制中心将在大会上做报告,加拿大公共健康机构也将就加拿大的心血管疾病防治计划发表报告。我们还有一个大型专场是针对发展中国家和非洲国家高血压防治的,包括一系列小型非洲高血压会议专场,当前的研究状况是如何逆转这些国家的高血压发病率。此外,还有临床试验研究专场,目前最好的药物有哪些,有哪些新药将会出来。今天将有一个座谈会是讨论一种即将问世的新型降压药及其降压效果。
    本周也将有个大型专场,其内容包括已经问世的新型药物,这些药物的优点、生理意义和机制,能否联合用药,这些药物的益处和危害,如何权衡两者的关系。此外还有个针对睡眠障碍的座谈会,睡眠状态下的血压关系到患者的预后,如何解决睡眠障碍,探讨睡眠对血压调节的能力。

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高血压指南差异高血压Simon Rabkin教授

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