International Circulation: The treatment of isolated systolic hypertension is a major problem in the field of hypertension therapy， in patients with diastolic BP less than 60mmHg but with systolic BP far above the standard， especially where accompanied by coronary artery disease. How can we manage this and which therapeutic combination do you prefer to use?
《国际循环》：单纯收缩期高血压的治疗是高血压治疗领域中的一个主要问题，在DBP低于60mmHg而SBP远远高于目标水平的患者中，尤其是在合并冠心病的患者中，我们应该如何处理？您推荐哪种药物联合方案？

Prof Nilsson: Isolated systolic hypertension is associated with low diastolic pressure and this means that the pulse pressure is elevated. This is in turn a marker for arterial stiffness and is in line with my concept of EVA， Early Vascular Aging. Calcium channel blockers and thiazide diuretics are well proven based on trial data and I think we need combination treatment. However， we should also be cautious not to lower pressure too far or too quickly in some susceptible patients. My organization， the European Society for Hypertension， recently published a reappraisal of the guidelines and we have stated that the evidence is lacking for a very tight blood pressure control in patients with established coronary heart disease and with long-standing diabetes. This is not to say that we shouldn’t be going for risk factor control， but for example during the early stages of diabetes it is not risky to have this ambitious approach but after long diabetes duration in a more susceptible patient， it may provoke some harm. I guess this is also the fact in coronary heart disease. Many years ago， for example， we had something called nifedipine capsules which are not used anymore because they have this peak of drug-induced vasodilatation. I have in my own experience seen patients who have suffered from coronary problems after taking such capsules and they have been abandoned. Now we have a slow release formula and that is much better. So I think isolated systolic hypertension is a marker of early vascular aging and should be addressed， not only by lowering blood pressure， but by risk factor control in general – glycemia， lipids and smoking.