International Circulation: Professor Li， perhaps you can give us your view on that specifically and also generally on the current situation of ARB use in China.

    《国际循环》：李教授，请您谈谈这方面的看法？及中国使用ARB的现状。

    Professor Li:  ARB use in China is most commonly used in hypertension but in heart failure cases there are many patients using ARBs， especially if they do not tolerate ACE inhibitors. Also， many heart failure patients take ARBs in combination with ACE inhibitors.  Since ACE inhibitors usage is more commonly associated with cough， ARB is somewhat more popular than before as a treatment in clinical practice. 

    李教授：在中国，常使用ARB治疗高血压，也有很多人用它治疗心衰，尤其是当患者不能耐受ACE抑制剂时。此外，许多人也将ARB与ACE抑制剂联合使用。由于ACE抑制剂常引起咳嗽，导致ARB在某种程度上更普及。

    Professor Clealand: In the United Kingdom also， I would agree， there are a lot of people that do prefer the ARB over the ACE inhibitor for hypertension. I think there are two reasons for that， first of all we have to say that the clinical trials for ARBs in hypertension have given us much clearer answers and， in fact， we don’t have many great studies， or at least not until recently have we had great studies of ACE inhibitors， but these have been relatively recently that the good studies of the ACE inhibitors coming out in hypertension. In fact， the ARBs were there first when it came to the evidence. The other reason， I agree， is cough. In the European population we find that it is particularly women who cough with a much higher incidence than in men， sometimes a general practitioner will use an ARB in women and an ACE inhibitor in male patients. I was going to ask， in China do you find that there is a difference between men and women with regard to cough?

    Clealand教授：我赞同。在英国也有很多人更喜欢用ARB，而不是ACE抑制剂，来治疗高血压。我认为有两个原因，首先ARBs治疗高血压的临床试验给出了更为明确的回答，实际上目前还没有足够大的ACE抑制剂的研究，但最近将要启动一项ACE抑制剂治疗高血压的好研究。实际上，ARBs是首次获得相关证据支持的药物。另一个原因是（ACE抑制剂）可导致咳嗽，我同意李教授的观点。我们发现，欧洲人群尤其是女性咳嗽的发生率要高于男性，有时临床医生会对女性患者使用ARB，而对男性则使用ACE抑制剂。我将要问的是，在中国您发现的咳嗽问题是否有性别差异？

    Professor Li:  No， we don’t find a difference between genders but Chinese people also have a higher incidence of cough when compared to European Caucasians. In hypertension ARBs are the most effective drugs and in the heart failure， it is also one of the effective drugs.  It should be tried because you use the dosage up to 150mg per day， just more than in the 100mg per day for others. Professor Clealand， what do you think about the dosage?

    李教授：没有，我们没有发现性别方面的差异，但是中国人较欧洲高加索人的咳嗽发生率高。ARBs是最有效的治疗高血压的药物，也是治疗心衰的有效药物之一。应该尝试使用每日150 mg的剂量，这仅较其他药物每日100 mg多一点。Clealand教授，您对剂量有何看法？

    Professor Clealand:  It is very interesting， when we look at the dose ranging studies in heart failure like the ATLAS and NETWORK studies; we saw not so much of a difference in terms of dose response with ACE inhibitors.  When we look at ARBs we see something different.  Certainly with the Candesartan program， one of the early trials of Candesartan suggested that there was a quite strong dose response relationship.  We should remember that the dose of Valsartan in the VAL-HEFT trial was 160mg bid， a huge dose. In the CHARM trial the target dose was 32 mg daily， which， even for Europeans， is a big dose of Candesartan.  It is these large doses of ARBs that seem to be as good as an ACE inhibitor but maybe with more evidence that you do need substantial doses to make sure you get the same benefit. In the Chinese population you have a lower body mass than American and Europeans， especially Americans， and so maybe you don’t need quite as high of a dose as we do but I would encourage you not to use the very small doses that we sometimes find.  In China， what would be a usual dose of Candesartan or Losartan?

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