<International Circulation>：I want to begin with the ADVANCE trial . It was hot line yesterday. The fixed combination of perindopril and indapamide achieved quite good result in type 2 diabetes， with 14% relatively risk reduction of total mortality and 18% relatively risk reduction of cardiac death. And the benefits were not dependent on baseline blood pressure and previous treatment. What^，s your interpretation of this result?

Prof. Nilsson: I think the ADVANCE trial is the most important intervention trial in diabetes ever since the UKPDS almost ten years ago.It was a placebo controlled trial.And it shows this benefit.So I think it^，s another lesson to be learned that hypertension should be more vigorously treated in type 2 diabetes. Of course， we don’t know whether this drug combination is equally effective as another active treatment because this was a placebo controlled trial. But I think many drugs can achieve good results in diabetes. Another lesson is using combination therapy. This combination with perindopril and indapamide， is an ACE inhibitor and a diuretic. In the PROGRESS trial， perindopril and indapamide was shown to be useful also for secondary prevention of stroke. This is another risk group. I welcome this result and it will be very much debated.

<International Circulation>：Shall we use antihypertensive therapy in diabetic patients with relatively normal blood pressure?

Prof. Nilsson: In diabetes，we know there are different stages， we have prediabetes，we have early new-detected diabetes，we have more long-standing diabetes. I think it’s very important we start treatment very early on before we have this arterial stiffness going on. So we should enforce effective blood pressure control， and even treat more or less normal blood pressure in patients with diabetes，especially those with microalbuminuria， this is another risk factor. In my view，early vascular aging is a new and important topic. Early vascular aging，the so called EVA syndrome，is something new and important. European Society of Hypertension in the new guidelines advocates that we should measure，for example， pulse wave velocity， and other aspects of arterial stiffness. And many of the patients in ADVANCE trial，I guess，had early vascular aging going on，that’s why it makes sense to lower blood pressure especially in these subjects. So if you add blood pressure elevation with diabetes and vascular aging， this is exactly the group we should target. One aspect of vascular aging is increased pulse pressure. You can imagine even some people with more or less normal blood pressure have a tendency for increased pulse pressure. So this is a very early sign that something risky is going on. And I guess in the future，there will be new techniques and devices to more easily measure arterial stiffness and vascular aging. I have been told there is a certain device (tonometer) carried around the wrist here for measuring ankele-branchial index，This is one reflection of arterial stiffness，ankele-branchia index. But we also know there are some devices for measuring pulse wave velocity over the aorta， between carotid and femoral artery. So coming back to the ADVANCE trial， what we can learn is，for the future， it’s simple to learn that hypertension and diabetes are two bad companions，but we should try to learn more about vascular aging.

<International Circulation>：Yes， it’s a wonderful explanation，very interesting， but we still need time to find a good way to detect the EVA syndrome.What do you think the target of BP control is now for diabetes? Should it be a little bit lower?

Prof. Nilsson：According to the guidelines， we should bring blood pressure below 130/80 mmHg. In addition we should at least try to find if there is an elevated pulse pressure and we should decrease it.

<International Circulation>：Concerning the combination therapy，what if we change it to other combinations，such as ACE inhibitors and CCB， will it bring the similar result as perindopril and indapamide?

Prof. Nilsson：Well，I hope so， but we will know more next year， the ONTARGET trial will be presented， and then we will learn that because this is the largest trial right now in hypertensive risk patients (n= 25 000) randomized to either an ACE inhibitor， and angiotensin II receptor blocker or the combination of both drugs.

<International Circulation>：To find diabetes as early as possible is very important. How does this to be done in Sweden? What about OGTT in cardiology department?

Prof. Nilsson：Well， one thing would be to do is screening studies. You can start to do OGTT in the coronary care unit at hospitals after or at discharge， however to do that in the population is not feasible. But my idea is to focus on families with very high risks of diabetes and coronary vascular disease. When inviting family members， if there is strong family risk， it is generally very accepted to do screening in family members. I think it’s very important. OGTT is not normally used， but it is going to be used more and more for departments of cardiology， and also for pregnant women， this is another group where we use OGTT. I hope it will be more used in the future to really detect very early the risk patient. We discussed early vascular aging. And I hope we can find very simple ways to detect both hyperglyceamia and early vascular aging.

<International Circulation>：Like bedside machine?

Prof. Nilsson：Yes， yes， Something like that.

<International Circulation>：Ok， it^，s very interesting. Thank you very much.

Prof. Nilsson：Thank you， and I send greetings to all Chinese colleagues interested in these fascinating new topics.