<International Circulation>: What do you expect will be the final indications for renal sympathetic denervation?
　　Prof. Bakris: The way things are going right now， from its inception clinically， there have been major inroads in understanding the effects of sympathetic denervation. We had Symplicity HTN-1 which is really proof of principle that it works. Then we had a more formal trial， Symplicity HTN-2， published in The Lancet and clearly showing that it does work but even though there was some attention paid， there was not a lot paid to what medicines were patients on， were they given appropriate doses of these medicines and the nuances of what hypertension specialists pay attention to. So Symplicity HTN-3， since I am not only the co- principle investigator but have had a lot of input into the protocol development， I made sure all of those bases were covered. You could not get into the trial unless you have a 24-hour ambulatory monitor that clearly shows you are hypertensive on maximal doses of appropriate medications including agents like spironolactone which has been shown to be highly effective in obese people. If you meet the criteria of blood pressure >160mmHg on three or more meds， you are in. You can’t change the medications for six months， which was also true in Symplicity HTN-2 but in Symplicity HTN-2， while they were on a number of medications that were appropriate， the reality is that the doses were unclear as to whether they were on maximal doses. This is really going to be the group of resistant hypertensives which by the way， in the US， from the best estimates we have from the most recent epidemiology， is only about 10% of all hypertensives. So we are talking about 7.5 million people. That is not a small number but these are the people we are talking about. I think the trial is going to be positive. I don’t think it is going to be as dramatic as the other groups. I think people have the wrong impression. From what I have heard from the Europeans (where it is approved)， this is viewed by the lay public as a cure for hypertension. It is not a cure for hypertension. It is a way to get your blood pressure controlled on maybe one or two fewer medicines but the goal is not to get rid of the medicines， the goal is to get your pressure controlled so you don’t have a stroke or kidney failure or heart failure. That is really the goal. Do I think it is going to be positive? Yes. Do I think it is going to be as dramatic as the other studies? No. But I do think it is going to meet the endpoint and I think it is going to have a key role in the subset of people who you either cannot control on multiple medicines or， for whatever reason， can’t tolerate maximal doses of multiple medicines to get their blood pressure controlled. I think in those settings， there is no question about it that it will be very useful.

　　《国际循环》：您认为肾去交感神经术的适应证有哪些？
　　Bakris教授：自出现到现在为止，我们对肾去交感神经术有了更深的理解。Symplicity HTN-1为其有效性提供了真实的证据，发表于《柳叶刀》的Symplicity HTN-2则表明其确实有效但有需要的注意事项。虽然欧洲业外人士认为，肾去交感神经术是高血压的治疗方法，但实际上其并不能治愈高血压。它仅能辅助药物治疗来控制血压，其目的并不在于去除高血压的发病机制，而是控制血压以减少卒中或肾衰竭及心力衰竭的发生。肾去交感神经术对多药治疗无法控制或因无法耐受最大剂量的药物治疗而控制无效的高血压患者而言可能具有一定的疗效。

　　<International Circulation>: What is your opinion about “blood pressure lowering is the absolute principle”?
　　Prof. Bakris: Blood pressure lowering is the absolute principle because when whoever designed us， we were designed with a number of regulatory mechanisms to keep us within a range and as our arteries get older that range shifts and goes up， but in the subset that is obese and the subset that has diabetes and the subset that is genetically predisposed to kidney disease or hypertension， they are going to develop high blood pressure much earlier than the normal history. There is an edict that we published in JNC7 that said that if you are normotensive at age 55 you have a 90% chance of being hypertensive at age 80. It is a disease of vascular ageing and that is the bottom line. At the end of day， should you keep your blood pressure at 120/80mmHg? Well no， that is not what nature meant either， but you should， from all of the evidence that we have， keep your pressure below 140mmHg and you will be in pretty good shape. If you are healthy and doing all of the right things， and if you can keep your pressure hovering around 130-132mmHg， you are going to be in great shape. The notion that 120/80mmHg is appropriate for a seventy or eighty year old is ridiculous. That is the equivalent of buying a car， driving it normally， adding 100000miles on it and expecting it to look exactly like new and that you have never driven it and have no wear and tear on the engine. It is ridiculous. If you took care of the engine， then the engine would look a lot better. I think this is what it is all about. People don’t understand that your body is your vehicle and if you chose to blow it off then it is going to be a problem and high blood pressure is one of the manifestations of a body that has not been well cared for unless you have a genetic predisposition.

　　《国际循环》：您如何理解“降压是硬道理”？
　　Bakris教授：降压是硬道理，这是因为正常情况时我们能够通过一系列的调节机制确保我们的血压在一定范围内波动。随着年龄的增长，这个范围将上升。但在肥胖、糖尿病及易患肾病或高血压的人群中，与一般人群相比，易更早发生高血压。我们发表的一篇文章显示，如果55岁时血压正常者，80岁发生高血压的几率有90%，这主要是由于血管老化所致。那是否应该每天将血压控制在120/80 mmHg？当然不必要，但是所有证据显示需要将血压控制在140 mm Hg 以下以保持良好的状态。如果你是健康人且具有健康的生活方式，则应尽量将血压控制在130～132 mm Hg。将70岁或80岁患者的血压控制到120/80 mm Hg的概念是荒谬的。这就像买汽车一样，我们要正常驾驶十万英里却希望它和新的一样没有任何的磨损是不可能的。如果很好的照顾发动机，则发动机就会好很多。人们不理解你的身体就像你的车一样，如果你将它关闭，就会出问题，高血压便是身体的表现之一。

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