International Circulation: Professor Clealand， in the area of heart failure we have seen some trials comparing ACE inhibitors and ARBs such as the VAL-HEFT trial and CHARM trial， we’ll also have the results from the HEAAL trial coming out soon.  What do you think the position of the use of ARBs will be in heart failure therapy?

    《国际循环》：Clealand教授，我们看到在心衰领域的一些试验将ACE抑制剂与ARBs进行对比，如VAL-HEFT试验和VAL-HEFT试验，我们也已经有HEAAL试验的结果。您认为ARBs在心衰治疗中的作用如何？

    Prof. Clealand:  The key trial we need to look at when comparing ACE inhibitors and angiotensin receptor blockers (ARBs) is in fact the ELITE II trial.  The ELITE II trial compared quite a substantial dose of an ACE inhibitor， Captopril 50mg tid， with Losartan， just 50mg once daily. That was also pretty well replicated in post-MI patients in the OPTIMAL trial. In these two trials it didn’t look like the ARB was performing quite as well as the ACE inhibitor.  The question is were we comparing fair doses of the ACE inhibitor and the ARB and there is strong feeling in the clinical community that the ARB dose in the ELITE II and OPTIMAL was lower than the Captopril dose so we needed more research on what the optimal dose of ARB was.

    Clealand教授：实际上，对比ACE抑制剂和血管紧张素受体拮抗剂（ARBs）的关键性临床试验为ELITE II试验。ELITE II试验对比ACE抑制剂的真实剂量，卡托普利 50 mg每日3次和氯沙坦 50 mg每日1次。这种研究结果同样在心肌梗死后患者的OPTIMAL试验中得到再次证实。在这些试验中，ARB的疗效要低于ACE抑制剂。问题在于，我们对ACE抑制剂和ARB的剂量是否进行了公平的比较，而ELITE II 和 OPTIMAL研究中的 ARB剂量要低于卡托普利的剂量，因此还需要做更多的研究来探讨ARB的合理剂量。

    International Circulation: So now， what to do you think the efficacy is of a higher dose of Losartan is in heart failure compared to an ACE inhibitor now that we see what the results from the HEAAL trial?

    《国际循环》：因此，在看到HEAAL试验的结果之后，您认为与ACE抑制剂相比，较大剂量氯沙坦将对心衰产生什么影响？

    Prof. Clealand:   With the results of the HEAAL trial it appears that higher doses of ARB do produce greater benefits for patients. I think it reopens the issue that if we had used an ARB， would it have been at least as good or perhaps a bit better than if we had used an ACE inhibitor， appeared in both the ELITE II and OPTIMAL trials. We can’t answer that for certain but certainly it explains some of the differences that we see， the trend for greater efficacy for the ACE inhibitor in these trials， partly explained by an inadequate dose of Losartan.

    Clealand教授：鉴于HEAAL试验的结果，大剂量ARB确实可以令患者更大获益。我认为，它再次引发了人们对是否使用ARB的讨论，ARB是否和ACE抑制剂具至少相当或更好的疗效，如ELITE II 和OPTIMAL试验。对此我们无法给出确切回答，但至少可以肯定它解答了我们发现的某些差异，这些试验中ACE抑制剂的疗效增加的趋势，部分的解释了氯沙坦剂量的不足。