International Circulation: Professor Kanstam， Professor Huang just mentioned ELITE II and there the dosage of Losartan was 50 mg daily compared to captapril 150 mg daily and was comparable in reducing morbidity and mortality in elderly patients with heart failure when looking at left ventricular ejection fraction. Now we have the results from HEAAL and when we look at the efficacy of a higher dose of Losartan compared to an ACE inhibitor， when we look at that comparison how does that change things in terms of the use of an ACE inhibitor?

    《国际循环》：Kanstam教授，黄教授刚提到了ELITE II研究，通过测量左室射血分数发现，氯沙坦50 mg每天对比卡托普利150 mg每天有相似的降低老年心衰患者死亡率和发病率的作用。HEAAL研究对比大剂量氯沙坦和ACE抑制剂，使用ACE抑制剂是否带来任何改变？

    Professor Kanstam:  First of all， the HEAAL study being a comparison of two doses of Losartan does not specifically address the efficacy of any ARB， including Losartan， to an ACE inhibitor. The trial was not designed to specifically inform that.  If you look at the entirety of data one can make a case that with this class of drugs compared to the ACE inhibitors， one can make a case that the potential efficacy of an ARB is comparable to an ACE inhibitor.  That is open for discussion and cannot be proven but one can certainly make that case.  The point of the HEAAL study is that if you are prescribing Losartan for the treatment of heart failure， you will get improved outcome effects with 150mg daily compared to 50mg daily.

    Kanstam教授：首先，HEAAL研究对比两种剂量氯沙坦，没有特别对比任何ARB与ACE抑制剂。研究设计中没有包括这方面的内容。如果注意一下整体数据就会发现，这类药物要优于ACE抑制剂。可以公开对此进行讨论。HEAAL研究的意义在于，150 mg氯沙坦每天较50 mg每天更能改善心衰患者的结局.

    Professor Huang:  In the ELITE II study， Losartan 50 mg daily is the same as captapril 100 mg daily.  In the HEAAL study it was concluded that the high dose of 150mg of Losartan was better than the low dose of 50 mg daily of the same drug. If we compare these two studies we could probably say that 150 mg of Losartan is better than 150 mg Captapril for treating heart failure. I have to say that both ACE inhibitor and ARB are useful and effective for treating heart failure.

    黄教授：ELITE II研究中，氯沙坦每天50 mg与卡托普利每天100 mg相似。HEAAL研究证明，150 mg大剂量氯沙坦较50 mg低剂量更优越。如果对比这两个研究的结果就会发现，150 mg氯沙坦要优于150 mg 卡托普利。必须说明的是，ACE抑制剂和ARB对心衰都很有效。

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