《国际循环》：肥胖相关高血压的管理是目前的研究热点之一。该领域的大多数研究针对药物治疗和胃绕道术。在这一领域有哪些进展？患者治疗的依从性如何？

    <International Circulation>:  Management of obesity-related hypertension is a hot research area and most studies focus on pharmacotherapy and bariatric surgery. Can you tell us about some of the progress in this area and discuss treatment adherence in those patients?

    Sharma教授：肥胖是高血压重要的危险因素。我们知道，超重和肥胖会导致血压升高，减轻体重能够降低血压。针对超重的很多生活方式干预措施（例如饮食控制和锻炼）有助于降低血压。不幸的是，对于很多患者来讲，生活方式干预的作用并不持久。对普通人群进行生活方式干预减轻体重的作用有限，这通常意味着需要药物来治疗高血压。我刚才提到，有很多有力的证据支持 RAS阻断药物的应用。在今天早上的会议中，Jordan教授在演讲中指出，我们经常谈到的是容量依赖性或钠依赖性高血压患者，也有很强的证据支持利尿剂的应用。在治疗这些患者时，我经常联合应用RAS阻断药物和利尿剂。

    Prof. Sharma:Obesity is an important risk factor for high blood pressure; we know that being overweight and obese can increase peoples’ blood pressure， we also know that reducing your body weight can also reduce blood pressure. We know that there are many lifestyle measures that are used for treating excess weight like diet and exercise also have quite beneficial impacts on blood pressure， unfortunately these lifestyle changes for many people are not sustainable， and the amount of weight loss that you can get with lifestyle interventions in the average person is really quite modest， and this often means that you are going to have to resort to pharmacotherapy for hypertension in these patients. Having said that， there is a strong case to be made for the use of agents that block the renin-angiotensin system; we heard this morning from Dr. Yorden that very often we are talking about patients here that have volume overload and patients who have volume-dependent or sodium-dependent hypertension， so you can also make a strong case for the use of diuretics， and in my own clinical practice I often use a combination in these situations.

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