<International Circulation>: For patients with nondipping hypertension， what should physicians do to regulate the circadian rhythm of blood pressure in addition to treating hypertension?
　　Prof. O’Brien: That’s a difficult question to answer but a good question. The situation is that patients who have a proven nondipping pattern have first to be identified and then their pressure needs to be normalized because we know that nocturnal hypertension is a very serious marker for future cardiovascular events. The evidence is not there yet but it will come in time， that by treating people with nocturnal hypertension and normalizing pressure， whether we will be doing good. But the logic is inescapable and certainly if I had nocturnal hypertension I would want my physician to be able to prescribe treatment to reduce my nighttime pressure as well as my daytime pressure. In fact， I would be more interested in my physician getting my nighttime pressure down to normal than getting my daytime pressure down to normal because the evidence is that nocturnal blood pressure is a very serious marker for future cardiovascular events.

　　《国际循环网》：对于非杓型高血压患者，除了治疗高血压之外，医生还能采取哪些措施来调节患者的昼夜血压节律？
　　O’Brien教授：这是一个难回答的问题，不过是个好的问题。首先，我们应当明确已经被确定为非杓型血压患者的情况，然后把血压降至正常，因为我们知道夜间高血压是未来发生心血管事件的一个非常重要的预测因素。目前还没有关于将夜间高血压患者的血压降至正常是否获益的证据，未来会有这方面的证据。但是，如果我有夜间高血压，我会希望医生给我开处方药物，降低夜间血压和白天血压，这是合乎逻辑的。事实上，我会对医生把我的夜间血压降至正常比把白天血压降至正常更感兴趣，因为有证据显示，夜间高血压是未来心血管事件发生的一个非常重要的预测因素。

　　<International Circulation>: So is controlling the nighttime pressure going to reduce those future events?
　　Prof. O’Brien: That I can’t answer. That is where we need more research but it seems to me， and I come back to the point that I made in my presentation here， you need to apply a certain amount of intuitive speculation on what the likelihood is going to be but getting the nighttime pressure down to normal is far better than not doing anything.

　　《国际循环网》：那么控制夜间血压有助于降低未来发生事件的风险？
　　O’Brien教授：还没法回答这一问题。我们需要开展更多的研究，不过我觉得会降低风险。说到我今天在这里演讲时所提到的观点，我们需要对可能性是什么凭直觉进行一定的猜测，而把夜间血压降至正常要比不降好得多。
 

　　<International Circulation>: What are some of the common points in the pathophysiology of nondipping hypertension?
　　Prof. O’Brien: Again this is an area that has been disappointing in many respects in terms of research. We don’t quite know why patients with a nondipping pattern have that particular pattern. It seems to be rather simple in some ways that when you go to bed at night (most of us anyway)， we cease activity and that is what determines the dipping or the nondipping pattern. The associations with circadian rhythms of hormonal changes are not very convincing. So a lot of work needs to be done in this area. My message would be however， let science get on with finding out how it happens and what causes it and as practicing physicians， what we need to do is acknowledge that it is a serious predictor of future cardiovascular events， so let’s get it down to normal whatever the mechanisms are.

　　《国际循环网》：非杓型血压共同的病理生理机制是什么？
　　O’Brien教授：从研究的角度来说，这是一个多方面让我们失望的领域。目前我们不知道非杓型血压发生的原因是什么。从某些方面来说，原因看起来相当简单，晚上上床睡觉时，大多数人会停止活动，这决定了血压是杓型或非杓型。血压类型与激素的昼夜节律变化之间的相关性还不是非常令人信服。因此，在这一领域还需要开展大量的研究。但是，我想说我们需要承认非杓型血压是未来发生心血管事件的重要预测因素，因此无论机制是什么，我们都得把血压降到正常。
 

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