International Circulation: I would like to thank you for accepting this interview with International Circulation today.

International Circulation: In your paper “Systolic Pressure is All That Matters”， which has been published in the Lancet in June 2008， you mentioned that systolic blood pressure should become the sole defining feature of hypertension and key treatment target for people over the age of 50. Why do you say that? Do you agree that we should try our best to achieve systolic blood pressure targets regardless of what the diastolic blood pressure is?

《国际循环》：您在2008年6月《柳叶刀》上发表的一篇文章《Systolic pressure is all that matters》中提到，对50岁以上人群应根据收缩压单独定义高血压和作为关键的治疗目标。请问您为什么这样认为？是否同意应尽量使收缩压达标而不管舒张压如何（是否过低？）？

Professor Williams: I think that the important thing is that most of the evidence that we have now is that most people become hypertensive over the age of 50. So， 75% of the people who have high blood pressure are over the age of 50. Of those people， the vast majority just have systolic hypertension. One of the problems in the community is that doctors and patients are confused that they keep getting told 2 numbers-systolic and diastolic. There has been a lot of confusion about which is the more important to lower， and if you speak to people， they still believe it’s diastolic. We were just being a little bit radical and trying to get people to recognize that if they are only going to treat one thing， they should treat systolic and not diastolic. The other thing that is important is that as you get older your systolic rises and your diastolic falls， so the points at which you are at higher risk， which is when you’re older， the diastolic pressure is actually falling. So there is little logic to use that as the target of treatment. It’s the systolic pressure that is the most powerful risk factor and it is the systolic pressure that’s the most difficult to control and that’s probably why doctors generally focus on the diastolic because it’s easier to treat.

Williams教授：我认为最重要的是现有的证据绝大部分表明大多数人在50岁以后才发生高血压。所以，75%有高血压的人年龄在50岁以上。在这些人中，绝大部分仅有收缩期高血压。社区中其中一个问题是医生和患者都感到困惑，他们一直被告知两个数值－收缩期的和舒张期的。关于降低哪一个数值更重要还有很多困惑，如果你问人们，他们依然相信舒张压更重要。我们是有一点急进，想要让人们认识到如果只打算处理一个因素，应该处理收缩压而非舒张压。另外一点也很重要，随着年龄的增长，收缩压升高，舒张压下降，所以有更高风险的数值，随着你年龄增长，舒张压实际上是不断下降的。所以以此为治疗的对象是不符逻辑的。收缩压是最有力的风险因素，收缩压最难控制，这有可能是为什么医生们通常关注舒张压的原因，因为舒张压比较容易控制。

International Circulation: Have you found any difference when the there is either a larger or smaller difference between the systolic and diastolic?

《国际循环》：您觉得收缩压和舒张压之间或大或小有无差别？

Professor Williams: I think the important thing is that as you get older the relationship between the two widens， so the diastolic falls and the systolic rises. Certainly， once you are over the age of 60， most people have a relatively normal diastolic or even a low diastolic and then it becomes completely irrelevant. The issue is under the age of 50 where diastolic hypertension is still important because younger people with hypertension generally have an increase in vascular resistance and older people generally have an increase in arterial stiffness. There are different pathologies in play， but the important thing to remember is that most people with high blood pressure are over 50; they are not under 50. Therefore， we wanted to emphasize that if you are going treat anything， you should focus on systolic. It’s a bit tongue in cheek， because in reality there are clearly some people even in their 50s， 60s， and 70s who have diastolic hypertension， but it’s very rare. The problem is that there is still a lot teaching， even in medical schools， that the diastolic is the most important and it clearly isn’t.

Williams教授：我觉得重要的是随着年龄增长，两者之间的距离增加，舒张压降低，收缩压升高。当然，当年龄超过60岁时，大多数人的舒张压相对正常，甚至偏低，变得完全不相关。50岁以下的人收缩期高血压也很重要，因为年轻的高血压患者血管阻力通常会增加，而老年高血压患者通常是动脉僵硬度增加。这里面有病理学的不同，但要记住的是大多数高血压患者年龄超过50岁，而不是50岁以下。所以，我们想强调的是如果要加以干预的话，应该将焦点放在收缩压。事实上有一部分人在50岁、60岁甚至70岁还会有舒张期高血压，但这种情况很罕见。问题是仍然有很多讲授，甚至在医学院校，认为舒张压最重要，但其实并非如此。

International Circulation: So you made a really bold statement to focus attention so people would take notice?

《国际循环》：所以您阐述了一个相当大胆的说法来引起人们的关注？

Professor Williams: Yes， that’s correct. To be honest， I think if we had written anything less the Lancet probably wouldn’t have published it and the press wouldn’t have taken much interest in it. If we had said that systolic hypertension is the most important in most people then that really wouldn’t quite capture as much attention.

Williams教授：是的，没错。老实说，我想如果我们的内容少一些的话，柳叶刀杂志可能不会发表，媒体也不会对此产生兴趣。如果我们说收缩期高血压在多数人中最重要，这就不会引起很大的关注。

International Circulation: The ASCOT-LLA trial demonstrated the significant benefits of adding atorvastatin to hypertension treatment in adults with three or more risk factors for heart disease. For the hypertensive patient with three or more risk factors for heart disease， or hypertension with target organ damage without CVD， what is the most appropriate time to start statin therapy? What is the greatest benefit with combined statin therapy?

《国际循环》：根据ASCOT-LLA试验结果，证实高血压治疗基础上加用阿伐他汀，能够使有3种以上心脏病危险因素的患者明显获益。高血压合并三个或以上危险因素，高血压合并靶器官损害，尚未发生CVD，在什么时候起动他汀治疗最合适？以及联合他汀主要带来的获益是什么?

Professor Williams: I think in the ASCOT trial that we did， the issue there was we were trying to find out that if you take high-risk patients whose cholesterol value is not at a level that would normally be treated， simply adding a statin routinely to their treatment in a relatively low dose-atorvastatin 10mg， would that make any difference to outcomes. What we found was a 35-36% reduction in coronary events and a 27% reduction in stroke， even in people with well-controlled blood pressure. The importance of that is to emphasize that you don’t need high cholesterol to benefit from statins， you just need high risk， at least in the hypertensive population. Therefore， what we should be doing is that when we make the decision to treat blood pressure， we should also be considering initiation of statin treatment. The other interesting thing was that when we looked at how rapid that benefit was， within 90 days we were already seeing significant differences in the primary endpoint. It was clear by 90 days. The effects were very rapid. I think what generally happens is people start blood pressure treatment and they think you can come back and we will sort that out and we might put you on something for your cholesterol. The reality is that the two approaches combined are incredibly effective. Calculating the baseline risk of our po