<International Circulation>: The ACCORD study gives us some impressive conclusions related to lipids and hypertension and also created a lot of debate around the results of the study. Will the target blood pressure and glucose level for diabetes patients maybe continually change in the future?

    Prof. Smith: The ACCORD study gives us valuable information about blood pressure. One of the critical points I have made here however， is that ACCORD was done in North American hospitals only – only patients with diabetes from Canada and the United States were recruited. ACCORD showed no benefit when blood pressure was lowered to less than 120mmHg compared to a level of around 135mmHg in North American patients. In North America， the ratio of heart attack to stroke is 2:1. The combination of the two is the leading cause of death and disability. ACCORD did show in that population of patients， a reduction in stroke as a secondary endpoint， almost 50%. Now here we are in China， where the population of this single country is three to four times the population of both Canada and the United States combined and there is a reversal of the prevalence of stroke and heart disease. Here， stroke is twice as frequent a cause of death as is heart disease. We have a very important question on our hands. What happens if you take data from ACCORD into a population where stroke is more important than heart disease? This finding of a reduction in stroke may drive a decision that further lowering is important. I think that there is hypothesis-generating evidence in ACCORD. One of the points I tried to make in designing this conference， was that we must start to consider potential ethnic differences and in our randomized clinical trials， try to be as broadly inclusive as possible. There are clearly differences in hypertension in Asia and the United States， and also differences in the causes of cardiovascular mortality， so I don’t think we can take the findings of ACCORD and say that we would necessarily see the same results if we repeated that study in China.

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