International Circulation: As a traditional antihypertensive agent， diuretics do not reduce the central blood pressure or blood pressure variability. How do you assess the position and prospect of diuretics in antihypertensive treatment in the future?
Cameron: Diuretics do reduce blood pressure， mainly by natriuresis， a fact well understood by doctors and they are relatively cheap. For these reasons they are considered first line drugs in some situations but in other guidelines as appropriately following other classes such as RAAS inhibitors or calcium channel blockers. It is generally considered that both ACEIs and CCBs have at least some positive side-effects on cardiovascular outcome independent of the observed effect on measured brachial blood pressure. Probable beneficial effects of non-diuretic classes of antihypertensives involve disproportionally reduced central blood pressure and possibly reduced arterial stiffness.
Overall the most important issue for all hypertensive patients is the achieved reduction in blood pressure however in my opinion the evidence strongly supports beneficial effects of CCBs and ACEIS over diuretics in most patients， particularly when there is other co-existing risk including aging or known atherogenic disease. Although it is very difficult to quantify the additional benefit of ACEIs or CCBs， or to be sure of the mechanism， it does seem very reasonable in individuals with essential hypertension even without other co-morbidities， that they should start treatment on either an ACEIs or CCB with diuretics used in combination as second or third line agents.
　《国际循环》：利尿剂这一类传统的降压药物不能降低中心静脉压或血压变异性。你如何看利尿剂在未来高血压治疗中的地位和前景？
　Cameron教授：利尿剂确实能够降低血压，主要是通过促进尿钠排泄，医生们对这一点都很了解，另外利尿剂价格便宜。基于这些原因，某些情况下利尿剂被作为一线降压药物。但是，一些指南中推荐RAAS阻断药物或CCB。通常认为ACEI和CCB至少对心血管转归具有有益作用，同时此种作用独立于降压作用之外。利尿剂以外降压药物的可能益处包括不成比例地降低中心动脉压，还有可能降低动脉僵硬度。总体上来说，所有高血压患者最重要的问题是降低血压。在我看来，有强有力的证据支持在大多数患者应用CCB和ACEI比利尿剂能够带来更多益处，尤其是在患者高龄或有已知动脉粥样硬化疾病等其他心血管风险时。尽管对ACEI或CCB的额外益处进行定量或确定其获益的机制非常困难，但对于高血压患者，甚至是没有其他并存疾病的高血压患者，初始治疗应用ACEI或CCB非常合情合理，利尿剂可被用于联合治疗，作为二线或三线药物。