Aim. То study education effects on the prevalence of main risk factors (RFs) of coronary heart disease (CHD) and GHD incidence in climacteric women.

Material and methods. This cross-sectional study included 961 women aged 28—64 years (median age 51 years), who attended an out-patient menopause-related consultation. Educational level was assessed via questionnaire survey. The examination also included anthropometry, blood lipid profile assessment, diagnostics of arterial hypertension (AH), CHD and chronic heart failure (CHF). Previously documented strokes, transient ischemic attacks and myocardial infarctions were also registered.

Results. A half of the women had higher education (n=481), 27 % — secondary education (n=260), and 23 % — vocational training (n=220). Comparing to secondary education, higher educational attainment was associated with lower odds of AH, CHD and other cardiovascular events, as well as abdominal obesity and depression.

Conclusion. Higher education was linked to reduced odds of cardiovascular events and decreased social burden of cardiovascular pathology.

Aim. То investigate the features of target organ damage in patients with stress-induced arterial hypertension (AH).

Material and methods. The study included 329 men, aged 29—55 years, with Stage I-II AH. Group I consisted of 197 individuals with workplace AH (WAH), Group II — of 132 patients with essential AH (AH); mean age was 41,3±1,4 and 42,5±1,5 years, respectively. All participants underwent Doppler echocardiography and brachiocephalic (BC) duplex scanning.

Results. Left ventricular hypertrophy (LVH) was diagnosed in 38,1 % and 28,1 % of the patients from Groups I and II, respectively. Concentric LVH (CLVH) prevalence was 12,3 % higher in WAH individuals than in AH patients (χ²=7,9; p=0,05). Type I diastolic dysfunction (DD) was registered in 87,3 % and 62,1 % of the patients from Groups I and II, respectively. DD prevalence was 25,2 % higher in WAH subjects than in AH participants (χ²=28,5; p=0,001). In Groups land II, increased thickness of common carotid artery wall was observed in 47,2 % and 34,1 %, respectively; its prevalence was 13,1 % higher in WAH patients comparing to people with AH.

Conclusion. In WAH and AH patients, DD and LVH were the most typical manifestations of TV damage. DD was more prevalent in WAH than in AH. LVH prevalence was similar in both groups, but CLVH was more typical for WAH than for AH. The same tendency was observed for BC atherosclerosis.

Aim. То study the prevalence of normal weight, overweight (OW) and obesity (O) in patients with arterial hypertension (AH) — contract military servants. To assess the impact of body weight variants into AH pathogenesis, risk factors (RFs) and associated clinical conditions (ACC) in this group of patients.

Material and methods. In 349 AH patients, young and middle-aged males working as contract military servants (mean age 40,2±0,32 years), height (m) and weight (kg) were measured, with body mass index (BMI) calculation. Total cholesterol (TCH) level retinopathy and left ventricular hypertrophy (LVH) by Sokolov-Lyon index were also assessed. The control group included 665 contract military servants without AH.

Results. In the main group of AH patients, OW and О were registered in 82,8%, significantly more often than in the controls. О was associated with significantly higher levels of systolic and diastolic blood pressure and TCH, comparing to those levels in AH patients with normal body weight.

Conclusion. Among young and middle-aged men with AH and O, the majority of the patients were at high cardiovascular risk.

Aim. То study microcirculation (МС) and its role in arterial hypertension (AH) pathogenesis among elderly patients.

Material and methods. The maingroup (MG) included 39 patients with Stage I-III AH (meanage 75,1±0,8 years). All participants underwent rheovasography (RVG), conjunctival biomicroscopy, and Doppler ultrasound ofbrachial and femoral arteries. The control group (CG) included 24 healthy people (mean age 27,7±1,5 years). Velocity offast, slow and volume blood filling (FFV, SFV VFV), as well as pulse wave velocity (PWV), was measured

Results. In patients with Stage I-II AH, forearm FFV was decreased, but VF remained normal, due to increased blood filling time (BFT). Stage III AH was characterised by reduced VF in fast and slow phases. CalfVF, independently of AH stage, was similar to that in controls, while SF was 2,5 times lower, due to reduced blood filling velocity and unchanged BFT In elderly AH patients, microcirculation vessels are filled normally in the FF phase, while VF is decreased in the SF phase, due to reduced blood influx from large arteries. PWV did not affect VF The timing of the additional wave at main RVG dicrote coincided with additional oscillations at Doppler ultrasound. Therefore, this wave could be explained by diastolic aortal damping of the small pulse wave.

Conclusion. In elderly patients with early AH stages, forearm VF remained unchanged, with changes only in time and volume parameters, while Stage III AH was characterised by reduced VF CalfVF, due to SF phase, is reduced regardless of the AH stage. Unchanged VF in the FF phase and reduced VF in the SF phase demonstrated that arteriole spasm could not be an explanation of increased peripheral vessel resistance and elevated blood pressure.

Aim. То assess endothelial function (EF) and lipid peroxidation (LPO) in patients with arterial hypertension (AH) and its cerebral complications.

Material and methods. In total, 49 patients with ischemic stroke (IS), 37 patients with uncomplicated essentialAH (EAH) and 25 blood donors as controls were examined. NO concentration (its stable metabolites, nitrates and nitrites) was measured by Griss method; citrulline (C) and malonic dialdehyde (MDA) levels were assessed with photocolorimetric method. Desquamated endotheliocytes (DE) were counted according to the method by J. Hladovec. LPO and plasma antioxidant activity (AOA) were studied with biochemiluminescence analysis.

Results. In IS patients, NO and C concentrations were lowerthan inAH patients and controls, while DE numbers were higher in the former. These parameters were combined into one factor, “integral index of endothelial dysfunction” (IIED), with values of -0,86±0,19, 0,12±0,09, and 1,21±0,23 units in patients with IS, AH and in controls, respectively (p<0,005). LPO intensity was higher in IS individuals than in the controls; the same was true for MDA levels. AOA in IS subjects was similar to that in the control group. IIED was significantly correlated with LPO intensity and MDA concentration in IS patients.

Conclusion. UncomplicatedAH was characterised by compensated endothelial dysfunction, while NO-endothelium system was decompensated in stroke. IIED parameter, representing EF in general, encompassed NO and C concentrations as well as DE count. In stroke patients, LPO activation was not associated with compensatory increase in AOA Endothelial dysfunction and LPO were strongly correlated.

Aim. То compare the effects of different two-component antihypertensive therapy (AHT) variants on endothelial dysfunction (ED) and albuminuria (AU) in patients with arterial hypertension (AH).

Material and methods. The study included 140 AH patients (mean age 57,0±8,9 years): 28,6 % men and 71,4 % women. Inclusion criterion was ineffective AHT in anamnesis. Endothelial function (EF) was assessed by ultrasound, AU — by turbidimetry, and glomerular filtration rate (GFR) — by MDRD formula. All participants were randomised into 4 groups, containing 35 persons each. The treatment phase lasted for 12 weeks.

Results. Most AH patients demonstrated ED symptoms, including paradox vasoconstriction. The most severe ED variants were observed in patients with diabetes mellitus. A significant reduction in blood pressure level was achieved in all groups, while АНТ benefits for EF were observed only in Groups A, В and C. Comparing to Group D, perindopril combination more effectively reduced AU. A small, but significant increase in GFR was achieved in patients receiving lisinopril and amlodipine. The combination of bisoprolol and amlodipine did not show any significant effects on ED and AU.

Conclusion. Twelve-week combined АНТ (perindopril + indapamide retard, amlodipine + indapamide retard, lisinopril + amlodipine) was associated with significantly improved EF. The most effective combinations included ACE inhibitors. The combination of bisoprolol and amlodipine was not effective in patients with reduced GFR and microalbuminuria, as it did not improve EF.

Aim. То study heart remodeling features in arterial hypertension (AH) patients with normal glucose metabolism or Type 2 diabetes mellitus (DMT).

Material and methods. Questionnaire survey and analysis of medical history, electrocardiography and echocardiography data was performed in 120 patients with AH and DM-2, taking into consideration heart remodeling types and left ventricular (LV) diastolic function.

Results. The combination of AH and DM-2 was characterized by higher prevalence of LV hypertrophy (LVH), with typical concentric and eccentric LVH as heart remodeling variants, and LV diastolic dysfunction (LV DD), comparing to AH patients with normal glucose metabolism. Eccentric LVH was associated with Type II LV DD.

Conclusion. Higher prevalence of more adverse LV remodeling variants in patients with AH and DM-2 increases their cardiovascular risk.

Aim. То study possible mechanisms of glycemia changes in patients with coronary heart disease (CHD) and progressing coronary insufficiency.

Material and methods. In total, 108 men aged 48,7±6,5 years were examined: 19 with progressing angina without previous myocardial infarction (MI), 74 with acute MI (AMI), and 15 healthy men as controls. After diagnosis verification, glucose and insulin levels were measured by glucosuric and radio-immune methods, respectively. According to glycemia level, clinical course, outcomes, insulin resistance (IR) and insulin production were analysed.

Results. Acute coronary syndrome development was associated with increased IR and compensatory increase in insuhn production, up to five-fold elevation of the latter. AMI development was characterized by hyperglycemia (HG) in 44,4 % of the patients, which correlated with myocardial damage severity and adverse prognosis.

Conclusion. HG could be regarded as a metabolic marker of myocardial energy deficit severity and myocardial endocrine dysregulation, possibly due to increased IR in ischemia. Long-term non-corrected IR decreases compensatory potential of insulin production, increases intracellular insulin deficit and cardiomyocyte death. This process is reflected by transient HG in AMI patients. Therefore, in CHD patients, glycemia could be an informative diagnostic criterion of myocardial energy metabolism in progressing coronary insufficiency and MI development.

Aim. То study myocardial infarction (MI) mortality and its links with selected risk factors (RFs) in an non-organized population of 40-59-year-old men followed up for 25 years.

Material and methods. The baseline examination was performed as a cross-sectional epidemiologic study in a representative sample from Tashkent City male population (1979-80). Up to 2005, during 25 years of the follow-up, mortality certificates of all previously examined 40-59-year-old men were analyzed.

Results. Over 25 years, among 1528 40-59-year-old men, examined at baseline, 257 (16,8%) MI deaths were registered. MI deaths accounted for 32,2% and 56,8% of all-cause and cardiovascular disease (CVD) mortality, respectively. During the follow-up period, MI mortality increased from 4,4 to 10,5 deaths per 1000/year.

Conclusion. RFs, particularly, hyperlipidemia, arterial hypertension and smoking, were associated with higher risk of MI death. Increased number of RFs was linked with higher risk, especially for 4 RFs or more.

Aim. То assess the effects of an anti-ischemic medication trimetazidine on necrosis area size, lipid peroxidation (LPO) and membrane phosphohpids in thrombolytic therapy (ТLТ) of acute myocardial infarction (AMI).

Material and methods. The study included 79 AMI patients. Coronary artery recanalisation was achieved by intravenous bolus administration of streptase (750 000 Units). All patients received anticoagulants, disaggregants, beta-adrenoblockers, nitrates, and ACE inhibitors, according to the relevant indications and contraindications. The control group (CG) included 39 patients. Before TLT the main group (MG; n=40) was administered trimetazidine 40 mg/kg per os, followed by the dose of 60 mg/day. Myocardial ischemia severity was assessed by QRS-index and total creatine phosphokinase activity (CK) in plasma. LPO activity was assessed by serum levels of malonic dialdehyde (MDA). PhosphoUpid (PHL) profile of ted blood cell membranes was measured by thin layer chromatography method.

Results. Trimetazidine administration (60 pg/day per os) in reperfusion period was associated with significant decrease in anginal attack number, daily nitrate dose, reperfusion myocardial damage severity, and serum MDA concentration, comparing to the controls. In red blood cell membranes, concentrations of phosphatidyl chohne, phosphatidyl serine and sphingomyelin were significantly higher in the MG than in the CG, which points to trimetazidine impact on these metabolites in myocardial reperfusion. Simultaneous reduction in phosphatidyl ethanolamine level could be due to its involvement in phosphatidyl choline and phosphatidyl serine synthesis, stimulated by trimetazidine.

Conclusion. Trimetazidine therapy in AMI patients increased TLT effectiveness, due to reduced LPO and cell membrane PL normalization, improved myocardiocyte viability and beneficial effects on post-MI myocardial remodeling.

Aim. То investigate the prevalence and the clustering of main metabolic syndrome (MS) components in children and adolescents.

Material and methods. In total, 22 children and adolescents (10 girls, 12 boys) aged 4-18 years (mean age 15,09±3,7 years), underwent arterial hypertension (AH) risk factor assessment, with exclusion of possible symptomatic AH causes, anthropometry (height, body mass (BM), waist and hops circumference), measurement of total cholesterol (TCH), high an low-density lipoprotein CH (HDL-CH, LDL-CH), triglycerides (TG), leptin, atherogenieity index (AI), Kerdo index, etc.

Results. Pregnancy complications, including gestosis, were identified in 36,4% of the MS children’s mothers. MS children and adolescents themselves were characterised by increased BM index (over 90%), AH (90%; mean blood pressure, BP, 143±11/83±12 mm Hg), heart rate of 76-120 bpm (70%), Kerdo index varying from -20,9 to +47,30, which pointed to increased sympathetic tonus, seven-fold increase in leptin level (21,4-185,6 ng/ml), decreased HDL-CH (0,16-1,12 mmol/l), as well as increased LDL-CH (1,48-2,65 mmol/l), TG (1,56±1,85 mmol/l) and IA (2,83±26,06) in 50% ofthe children

Conclusion. Diagnostic criteria of MS in children and adolescents included AH, increased sympathetic tonus, obesity, decreased HDL-CH and increased LDL-CH, TG, leptin and AI. Other MS predictors in children included pregnancy complications and gestosis in their mothers.

Beta-adrenoblockers (ВАВ) are widely used in coronary heart disease (CHD) management. The choice of specific ВАВ and their place in optimal schemes for CHD treatment are discussed. 

The role of statins in the treatment and secondary prevention of cardiovascular events and adverse outcomes among high-risk coronary heart disease patients is discussed, using well-known clinical trials on simvastatin as an example. Lipid-lowering and pleiotropic statin effects are analysed in detail, by age, gender, and clinical group.

The current evidence on causes, diagnostics and treatment of arterial hypertension (AH) in adolescents and young people is presented. AH features in these age groups, angiotensin receptor blocker potential in prevention of AH stabilisation, as well as early prevention of cardiovascular events are discussed. The authors present their original data on the prevalence oflabile AH, autonomous dysfunction, metabolic syndrome, abdominal obesity, and hyperleptinemia in adolescents with AH.

Recently, оnе of the leading approaches in the management of arterial hypertension (АН) and coronary heart disease (CHD) is reduction of sympathetic activity and оnе of its markers, heart rate (HR). HR is known as an independent predictor of cardiovascular risk. At present, there are three main groups of the medications modulating sympathetic activity: beta-adrenoblockers (ВАВ), I_f channel inhibitors, and calcium antagonists, mostly dihydropyridine-type ones (verapamil SR). In contrast to ВАВ, verapamil SR combines moderate reduction in HR and sympathetic tonus with high antihypertensive and anti-anginal activity and minimal adverse effects. Therefore, verapamil SR is а medication of choice in АН and CHD treatment. 

The article is devoted to arterial hypertension (AH) features in elderly patients. The results of 14 large-scale prospective, randomised clinical trials, conducted in the last 20 years and focused on antihypertensive therapy effectiveness in patients over 60 years, are analysed.

The review presents the studies on common carotid artery intima-media thickness in arterial hypertension patients with and without metabolic syndrome (MS). The authors discuss pathogenetic aspects and the risk factor effects on intima-media thickness in patients with and without MS.