International Circulation: Professor Kanstam， in the area of heart failure and specifically the HEAAL trial， we have seen several large scale trials looking at ARBs including HEAAL. What is the difference between HEAAL and other trials looking at ARBs and heart failure? What is the significance of this difference?

《国际循环》：Kanstam教授，我们看到在心衰领域的一些大型试验都在观察ARBs，包括HEAAL试验。HEAAL试验与其它试验有什么不同？这些差异的意义何在？

    Professor Kanstam:  HEAAL is the only trial which compared outcomes with different doses of an angiotensin receptor blocker and， in fact， is really one of the few trials ever performed comparing doses with outcome endpoints， powered to look at outcome endpoints for any cardiovascular drug. It is based on the point that most of the trials that have demonstrated benefit with ARB have used fairly high doses of ARBs. One study， the ELITE II study， used only a moderate dose of Losartan and was unable to show superiority over captopril when 50 mg were given. On the basis of that it left uncertain what the relationship is between dose of an ARB and outcome effect and justifies the premise behind the HEAAL study.

    Kanstam教授：HEAAL试验是唯一对比不同剂量血管紧张素受体阻断剂的研究，也是少数对比终点剂量的研究之一，试图探讨任何心血管药物的临床终点。其创新点在于多数试验证实了ARB有效，而该研究则证实大剂量ARBs的疗效。ELITE II研究仅使用中等剂量氯沙坦，无法证实50 mg 氯沙坦要优于卡托普利。此外，（ELITE II研究）也无法确定ARB不同剂量间的关系及临床影响，它为之后的HEAAL 研究做了铺垫。

    Professor Huang:  I think there are two differences， one is that the supportive results for the primary endpoint from the HEAAL study compared to ELITE II， VAL-HEFT， and CHARM studies.  This data adds more evidence for the use of ARB treatment for patients with chronic heart failure.  Second， this data shows that the high dose of ARB is more effective compared to the low dose and is a new idea for RASS.  Of course we know that in the treatment of the patients， if we sometimes need to use higher doses but this study give supportive evidence for this.

    黄教授：我认为有两点不同：其一，与ELITE II、VAL-HEFT和CHARM研究相比，HEAAL研究对于主要终点事件是支持性的结果。这些研究数据为ARBs治疗慢性心衰患者提供了更多的证据。其二，这些数据显示高剂量ARBs比低剂量更有效，对于RAS系统抑制剂的应用也是一个新思路。当然对某些需要使用较大剂量的患者，这项研究为此提供了支持证据。
 

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