[ESH2007]瑞典的Nilsson教授：预防高血压——从胎儿做起 -国际循环网

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[ESH2007]瑞典的Nilsson教授：预防高血压——从胎儿做起

作者:国际循环网日期:2007/8/3 17:28:00

Pro. Nilsson Member of the Swedish Medical Association, 1984-. Member of the Swedish Association for General Medicine, 1990 (steering committee 1995-98). Member of the Swedish Hypertension Society, 1987 (steering committee 1993-2005, president 1999-2001). Member of the European Society of Hypertension, 1992 (ESH Council member in 2006). Member of the Swedish Society for Diabetology, 1992 (steering committee 1994-2003, secretary 1994-99). National Diabetes Register outdata committee 2001-. Member of the Hypertension in Diabetes Study Group of the EASD, 1995 (steering committee 1995-2001, 2002-). Member of the Hypertension in Diabetes Working Group of the ESH, 2002 (steering committee 2002-). Member of the European Group on Insulin Resistance, 1996 (steering committe 2001-03). Member of a working subcommittee of the Swedish Council for Planning and Coordination of Research (FRN), 1996-99, focusing on self-rated health and the individual. Member of a committee on the evaluation of smoking cessation programmes of the Swedish Council on Technology Assessment in Health Care (SBU), 1995-98. Co-author of the publication of the final report on methods for smoking cessation in 1998 (SBU-series 138).

《International Circulation》：First of all, thank you very much, Mr. Nilssen, and I represent International Circulation in China to interview you, thanks your opportunity. My first question is how you consider the gender difference seen in anti-hypertensive therapy and in the epidemiology hypertension. In your opinion, does the hypertension in women need more attention to care?
首先，非常感谢您，Nilssen先生。我代表来自中国的《国际循环》杂志对您进行采访，非常感谢您给予这次采访机会。我的第一个问题是您如何看待高血压治疗和高血压流行病学调查中的性别差异？以您的观点来看，女性高血压患者需要更多的关照和治疗吗？
Prof.Nilsson：Yes, the most common patient with hypertension in Europe is elderly woman with hypertension, so we should take this into consideration to screen ant to treat. Then we know that especially thiazide diuretics and calcium antagonists are very well proven in the elderly women, for example, systolic hypertension, we have several trials. And in addition, we know thiazide diuretics can prevent osteoporosis, especially in northern Europe, there is a lack of sunshine, so some elderly women have osteoporosis, and we have to protect them.
在欧洲最常见的高血压人群就是老年女性高血压患者，所以我们很有必要将这一问题好好研究，期待能够完善筛查和治疗。我们知道噻嗪类利尿剂和钙离子拮抗剂在老年女性患者中的应用得到了证实，比如收缩期血压，我们有若干个临床试验。另外，我们知道噻嗪类利尿剂能够预防骨质疏松，特别在欧洲北部，那里缺少阳光，所以老年女性常患有骨质疏松，因此我们必须关注她们。

《International Circulation》：And my second question is for most patient with hypertension, they should take the anti-hypertensive drugs all their lives, now the pharmaco-eonomics has been an important part of hypertension research, what should we consider to assess real cost-effectiveness of anti-hypertensive drug, and how should we guide our clinical guidelines?
我的第二个问题是对于大多数高血压患者而言，他们都需要终身服用抗高血压药物，而且目前药物经济学已经成为高血压研究与治疗中非常重要的组成部分，我们是否应该认真评价一下抗高血压药物的经济合理性，另外如何知道我们的临床指南呢？
Prof.Nilsson：The cost of drugs is only one cost, then we have cost in disease, cost of complications, and even we have little expensive drugs that can prevent the event because of effectiveness, I think we need combination therapy in many many patients, and the higher risks of the patients, the more we have to treat, in some cases we use the more expensive drugs, that examples of diabetes with hypertension and obesity, this is dangerous situation because if we don’t treat this patient, that would be end stage renal failure and need dialysis, and this would cost tremendous money, so in specific high risk patients, I think we should also use more expensive drugs. On the other hand, in the lower populations, we can use cheap drugs, according to cost therapy. So the cost of drug is only one aspect.
药物的花费只是其中的一项花费，我们同时也在疾病本身上花费，并发症花费，但是如果我们仅用了一点昂贵的药物，但是却预防了很多并发症的发生，其效价就体现出来了。我认为我们应该需要对很多病人实施联合治疗，病人的风险越大，我们就应该给予越多的治疗，有些情况下我们应用稍昂贵的药物，比如糖尿病合并高血压和肥胖的病人，这种情况十分危险，如果我们不予治疗，病人会发展为终末期肾衰竭并需要透析治疗，这会花费更多的钱。所以，对于某些高危病人而言，我想我们应该适当应用一些较昂贵的药物。另外一方面，对于经济欠佳的人群，我们应该尽量使用便宜的药物，同时达到最好的效果。因此，药物价格只是其中的一个方面而已。

《International Circulation》：Does pre-hypertension need additional drug treatment or only life style changes, according to your representation? And how do we prevent hypertension from pre-hypertension?
高血压前期的治疗需要药物治疗吗？或者只需要生活方式干预？我们如何预防高血压前期发展为高血压？
Prof.Nilsson：I think it’s necessary to keep in mind that we can not give up medications to millions of people. We have to improve their life styles and one message from my presentation was that we should not only focus on the adult people we should focus on children, adolescents and even before birth. Because the data has shown that a healthy start in life is depending on health pregnancies and avoidance of fetal growth impairment So when we talk about life style prevention, I must include the lifestyle intervention also on the pregnant mother, children and adolescents.
我想一定要记住我们不能放弃对这些患者的药物治疗。我们应该对这些患者的生活方式给予一定的干预，另外，我的演讲中也传达了一个信息，也就是我们不能只把眼光局限在成年人身上，我们同时还应该把精力放在儿童、青少年甚至还没有出生的胎儿。因为已经有数据显示健康的孕妇其婴儿生活会有健康的开始。当我们谈论生活方式干预时，我必须强调生活方式干预包括孕妇、儿童和青少年。

《International Circulation》：In this point, how to identify the high risk pregnant women are low risks?
那么如何区分高危孕妇是否高危或是低危呢？
Prof.Nilsson：We know that some women will experience hypertension when pregnant, that’s complications to pregnancy, Some other women are smoking, and some women already had children when glucose impairment. And if you know this fact, you can tell the women we have to be very careful for your next pregnancy. To safeguard, please come to medical controls, don’t lose contact with us, use ultrasound, keep an eye on the weight development and if you have a small group of underdeveloped child, please be careful not to over-feed the baby, because many will catch up in growth. Breastfeeding is good, balance feeding is good, that many women think they get a very small baby, they have to feed it, very very much, but I think the balance feeding is very important, because some many babies can’t tolerate too much protein, to much sodium, you see the proper. So the new way of thinking is that a life style intervention advice is not only something that only for the adult, okay?
我们知道有些女性会在怀孕期间发生高血压，这是妊娠并发症之一。有些其他的女性吸烟，有些女性，有些女性曾经糖耐量异常。如果你知道这些情况，则应告知这些女性患者再次怀孕时应多加小心。为了安全起见，一定要给予内科干预，不能与医生脱离联系，应用B超，对胎儿的体重变化进行监测，如果婴儿的发育不甚良好，务必要注意不要过度喂养婴儿，因为大多数婴儿会在日后赶上进度。母乳喂养很好，平衡饮食喂养也非常不错，有些女性朋友认为她们的孩子太小了，所以她们拼命地喂养孩子，但是我认为平衡饮食最为重要，因为很多婴儿不能耐受太多的蛋白质、盐类，一定要适可而止。所以对生活方式的干预的新的理解不应该局限于对成人的干预。

《International Circulation》：But, for women with, for example, a little older to be pregnant, especially for the first baby, is this dangerous? Is it a risk factor?
但是，对有些女性而言，可能怀孕的时间太晚了，特别是她们第一胎的时间，这危险吗？是一种危险因素吗？
Prof.Nilsson：Could be risk factors for fetal growth and fetal malformation, so in your example, some women don’t have their first child until they are 30, 35, and this is a risk situation. Of course, every pregnant woman should quit smoking, because smoking is so dangerous for the fetus, this is well known, you come from China, traditionally, people have been smoking a lot in China, I don’t know about women.
对胎儿的生长及营养而言是一种危险因素。在你的例子中，有些人直到30或35才要了第一个孩子，这是比较危险的情况。当然，每个孕妇都应该戒烟，因为吸烟对胎儿十分危险，这是大家众所周知的，你来自中国，我一直以为中国是个吸烟大国，不知道女性吸烟的情况。

《International Circulation》：Generally before, traditional women no smoking, but little and little, especially in Shanghai, Beijing and Guangzhou, big cities, and they accept foreign life style, and they smoking, especially the age from 20 to 30, 35. They think it’s fashionabl