<International Circulation>: ARBs have long been considered beneficial for diabetic nephropathy. How should we properly use ARBs in hypertensive patients with diabetic nephropathy?

　　Prof. Sica: We should dose according to the package guidelines up to the top-end dose recommended which is 300mg irbesartan or 100mg losartan. They should not be used as primary therapy at the exclusion of other drugs to lower blood pressure i.e. the drugs themselves have but a modest effect in blood pressure reduction. A very important component of therapy is blood pressure reduction so these drugs have to be accompanied by other appropriate drugs， be they diuretics， calcium channel blockers and drugs of a similar ilk. But you have to get the blood pressure to goal most importantly. If the question asked is， is it better to give the drug and not control blood pressure， then the answer is no. The drug is only as good as its blood pressure reduction and then it confers additional benefits from there. The absence of blood pressure reduction with these drugs is problematic and if it is not reducing pressure then that is where most attention needs to be paid.

　　《国际循环》：ARBs有益于糖尿病肾病，在合并糖尿病肾病的患者中，我们应该如何正确使用ARBs？

　　Sica教授：在合并糖尿病肾病的患者中，我们应该根据指南来应用ARBs。目前指南推荐的厄贝沙坦及氯沙坦的最大剂量分别是300 mg和100 mg。应用时应与其他具有适度降压效应的其他药物联用。治疗的重要目的是降低血压，因此这些药物应该与利尿剂、钙离子拮抗剂等其他适当的药物联用。但必须使血压达标，这一点是最重要的。如果问题时是否给ARB药物要优先于血压控制，答案是否定的。ARBs的降压作用有限，在降压作用之外，为患者带来额外获益。不关注降压药物的降压作用是有问题的；只有在满足降压目标之后，才应关注其额外获益。

　　<International Circulation>: In the treatment of hypertension， compared with free combination therapy， what are the advantages of a single pill combination?

　　Prof. Sica: The advantages of single pill combinations are generally that compliance rates improve slightly and it compels the physician to be more aggressive in management where therapeutic inertia is not uncommon for treating physicians. Two medicines in one pill gets people more drugs at the same time and is a no-brainer you could say， i.e. it becomes easier. Starting with one drug and then waiting a period of time before adding a second drug becomes a problem， so the availability of these drugs makes it easier to start two drugs when they are supposed to be started rather than writing two separate prescriptions.

　　《国际循环》：治疗高血压时，与自由联合治疗相比，单片复方制剂的优势有哪些？

　　Sica教授：单片复方制剂的优势主要是依从性略高，有助于医生更积极地进行高血压管理，不易发生治疗惰性问题。将两种药物融在一片制剂中能使患者每次同时服用更多的药物，使患者服药更简便。先应用一种药物，然后等一段时间在加用第二种药物，这种服药方法非常不方便。而与开具两个单独的处方相比，单片复方制剂则使两种药物同时治疗更为容易和方便。