Aim. To compare spirapril and amlodipine effects on circadian blood pressure (BP) profile, quality of life (QoL), and psychological status (PS) in patients with arterial hypertension (AH).

Material and methods. This open, randomized, comparative crossover study (spirapril and amlodipine courses lasting for 4 weeks each) included 24 patients with Stage I-II AH (mean age 54,2 10,5 years; mean AH duration 12,3 10,2 years). After 7 days of no antihypertensive therapy, the participants were randomly assigned either spirapril (6 mg/d) or amlodipine (5 mg/d). In case of inadequate effectiveness, hydrochlorothiazide (25 mg) was added and/or amlodipine dose was increased to 10 mg/d; spirapril dose was unchanged. Twenty-four BP monitoring (BPM), PS and QoL assessment (MMPI, Marburg University Questionnaire) were performed. Statistical analysis was performed in SAS 6.12.

Results. Mean BP level was achieved for both medications; individual target BP levels were achieved in 17 patients receiving spirapril and 18 participants receiving amlodipine. No significant difference was observed for main 24-hour BPM parameters. Spirapril was more effective in reducing nighttime BP. Effect uniformity was similar for both agents: systolic/diastolic BP smoothness index was 0,55/0,45 (р 0,05) for spirapril and 0,65/0,56 (р 0,05) for amlodipine. Both medications did not affect QoL or PS in AH patients. Spirapril also improved socialisation, self-control, optimism, and general energy level.

Conclusion. Spirapril is a highly effective antihypertensive medication, improving not only circadian BP profile, but also PS parameters among AH patients.

Aim. To study eight-week bisoprolol therapy effects on peripheral hemodynamics and microcirculation (MC) parameters.

Material and methods. The study included 34 patients with stage II arterial hypertension (AH): 18 men, 16 women; median age 47 years. At baseline and after 8 weeks of bisoprolol therapy (10 mg once a day), all participants underwent 24-hour blood pressure monitoring (BPM), peripheral hemodynamics and MC assessment.

Results. Eight-week bisoprolol therapy (10 mg/d) was associated with target BP level achievement in 74% of the patients. In 76%, circadian BP profile had been normalized. Bisoprolol treatment also improved peripheral hemodynamics and MC parameters. Significant reduction in total peripheral vascular resistance and pulse wave velocity was observed in 95%, normalization of these parameters - in 54%. MC parameters normalized in 67% and improved in 94%.

Conclusion. Bisoprolol demonstrated high antihypertensive activity and beneficial effects on peripheral hemodynamics and MC parameters.

Aim. To assess the effectiveness of fixed-dose combination of enalapril maleate (20 mg) and hydrochlorothiazide (12,5 mg) - Enap NL 20, comparing to arbitrary combinations of two antihypertensive medications (АНМ), in patients with Stage I-III arterial hypertension (АН) and resistance to previous antihypertensive monotherapy.

Material and methods. In 200 patients with high-risk АН and resistance to previous antihypertensive therapy, effectiveness of fixed-dose combination Enap NL 20 and arbitrary АНМ combinations was compared in an open, randomized, controlled parallel-group study Therapy effectiveness was assessed by 24-hour blood pressure monitoring (BPM).

Results. Fixed-dose combination Enap NL 20 was more effective than arbitrary combinations of two АНМ for systolic and diastolic BP (SBP, DBP) reduction: -17,3% vs. -10,3% and -13% vs. -5,3%, respectively (p<0,05). Respective pulse BP reduction was 22,6% and 17,3%. T/P index was significantly better in Enap NL 20 patients: 81,2±6,6% vs. 53,1+5,1% in those receiving arbitrary АНМ combinations. Morning SBP surge rate reduction was more pronounced in Enap NL 20 group than in arbitrary АНМ combination group: - 47,7% vs. -19,9% (p<0,05).

Conclusion. Enap NL 20 provided better BP control than arbitrary АНМ combinations in patients with high-risk АН and monotherapy resistance. Comparing to arbitrary АНМ combinations, Enap NL 20 more effectively improved 24-hour BPM parameters, also demonstrating better cardio- and angioprotection. Thiazide diuretics in arbitrary АНМ combinations affected the levels of uric acid, creatinine, blood glucose and potassium to greater extent than Enap NL 20.

Aim. To assess some aspects of Russian doctors' health.

Material and methods. The analysis included data on 2347 doctors from various Russian cities: 326 men, 2021 women; mean age 43,6±0,23 years; mean time of working in present speciality 18,2±0,3 years. The participants included 480 cardiologists (20,4%), 1241 therapeutists (52,9%), and 626 doctors of other specialties (26,7%).

Results. Awareness on cardiovascular disease (CVD) risk factors was relatively low: total cholesterol (TCH) level was unknown to 56,4% of men and 44,7% of women, glucose level was unknown to 38,4% and 28,8%, respectively. At the same time, high TCH level prevalence was 29,5% in men and 40,0% in women. High heart rate was reported by 15% of doctors; 16,6% of men and 20,5% of women had body mass index >30 kg/m2. Smoking prevalence was 36,7% in men and 10,6% in women. Russian male and female doctors suffered from arterial hypertension (AH) in 32,1% and 30,3%, respectively. Among male doctors with AH, only 61,7% took antihypertensives, with effective treatment in every fifth person; among hypertensive female doctors, these figures were 79,6% and 39,4%, respectively. Self-evaluated health was "very good" in 4,6% of men and 2,4% of women; "good" - in >40% and one-third, respectively; "fair" - in 50,1% and 61,6%; and "poor" - in 4% of males and 3,9% of females. Stress at workplace was experienced "almost all the time" in 32% of male doctors and 45,6% of female doctors, "sometimes" - by 60,8% and 51,3%, respectively. High stress level was reported by 27,3% of men and 42,3% of women.

Conclusion. Dear Colleagues, please take care of your health and treat yourself properly, because doctors' health determines their patients' health in the long run.

Aim. To compare 10-year fatal cardiovascular event risk in people with high and low-stress occupation. To analyze main determinants of cardiovascular disease (CVD) prognosis and assess 10-year absolute risk of ischemic events in people with high-stress occupation.

Material and methods. In total, 449 22-55-year-old men with high and low levels of professional stress were examined. Group I included 240 locomotive brigade workers (mean age 42,39±9,06 years), Group II - 209 workers with low level of professional stress (mean age 41,1±8,7 years). Study methods included CVD risk factor assessment: smoking, CVD in family history, systolic blood pressure, body mass index, glycemia, and total cholesterol  level. In Group I, lipid profile (LP) and C-reactive protein (CRP) level were measured; 10-year total CVD risk was calculated with SCORE scale and 10-year absolute risk of myocardial infarction - by PROCAM scale.

Results. In people with high-stress occupation, hypercholesterolemia prevalence was higher by 21,4%, and high 10-year total coronary risk prevalence was higher by 8,7% (p<0,05). In those aged 45-55 years, high total coronary risk was 1,6 times more prevalent in Group I, comparing to Group II. In Group I, LP disturbances were observed. According to PROCAM scale, high coronary risk was more prevalent (25,0%), comparing to SCORE scale assessment (15,8%). Among people with high-stress occupation, CRP level was 6,7±0,9 mg/l in high coronary risk subjects and 3,1±0,3 mg/l in low to moderate risk individuals. Heart rate (HR) was 84,0±4,1 bpm and 75,8±1,6 bpm, respectively.

Conclusion. PROCAM scale was more informative than SCORE scale in total coronary risk assessment among people with high professional psycho-emotional stress. CRP and HR should be regarded as additional CVD risk factors in people with high-stress occupation.

Aim. To study the effects of preventive education on modifiable cardiovascular disease (CVD) risk factors (RF) in elderly patients with arterial hypertension (AH).

Material and methods. Structured preventive education was performed 1-5 years (3,5±0,15 years) before studying the education effectiveness in AH patients aged ≥60 years (Group I; n=102). The effectiveness was assessed by mean blood pressure (BP) level, prevalence of effective antihypertensive treatment (BP ≤ 140/90 mm Hg), body mass index (BMI), plasma level of total cholesterol (TCH), and smoking prevalence, comparing to those in uneducated AH patients (Group II, similar by age and sex structure; n=72).

Results. Preventive education was performed in the group with high prevalence of myocardial infarction, stroke, and Type 2 diabetes mellitus. After the education program, mean BP level was close to target figures in Group I. In Group II, hemodynamics control was substantially worse (p<0,01). Treatment effectiveness was 61,8% in Group I vs. 13,9% in Group II (p<0,01), due to inadequate therapy compliance in the latter group. Overweight prevalence was similar in both groups (80-90%). TCH level was optimal only in Group I males (p<0,05), being significantly lower than that in females and Group II participants.

Conclusion. Preventive education of elderly patients improved therapy compliance, AH control, and lipid metabolism. It could be recommended for increasing elderly patients' participation in preventive programs.

Aim. To compare clopidogrel and acetylsalicylic acid (ASA) on vasculo-platelet and coagulation hemostasis; to assess the prevalence of laboratory resistance to these agents; and to study 3-month prognosis in coronary heart disease (CHD) patients after coronary artery bypass graft (CABG) surgery.

Material and methods. In total, 94 CHD patients, 45-72-year-old males with initially elevated platelet aggregation with ADPH 5mM (PAADPH) and adrenalin 10 mcg/ml (PAAdr), were randomized into two treatment groups, receiving clopidogrel (75 mg/d; n=44) or ASA (75-100 mg/d; n=50). In all participants, parameters of vasculo-platelet and coagulation hemostasis were measured before CABG, 12-14 days and 3 months after CABG. The patients not responding to two-week monotherapy were regarded as resistant. During three-month follow-up period, the incidence of adverse coronary events and pharmacotherapy complications were assessed.

Results. Positive dynamics of vasculo-platelet and coagulation hemostasis was observed during clopidogrel or ASA treatment: fibrinogen level was significantly lower in clopidogrel group that in ASA group; 12-14 days and 3 months after CABG, induced PAADPH intensity was significantly reduced in 100% of the patients receiving clopidogrel; no laboratory resistance was observed. No cases of unstable angina, acute myocardial infarction, or death were registered. In those receiving ASA, induced PAADPH was elevated in 24% (n=12) 12-14 days and 3 months after CABG (ASA-resistant subjects), and in 76% (n=38) in reduced by three times (ASA-sensitive subjects). Major or minor hemorrhages, allergic reactions to clopidogrel or ASA were not registered.

Conclusion. In patients after CABG, no cases of laboratory resistance to Clopidogrel ("Zyllt", KRKA) were registered; moreover, cardiovascular prognosis was better in clopidogrel group.

The benefits of arterial hypertension (AH) combined treatment are discussed. A combined medication, Tarka (calcium antagonist verapamil SR plus ACE inhibitor trandolapril), is used as an example to demonstrate high antihypertensive activity, metabolic neutrality, cardio- and nephroprotection. Not only Tarka components per se, but also their combination was effective in large clinical trials. Indications for this combined medication are presented.

Based on the results of international clinical trials, the clinical benefits of a dihydropyridine calcium antagonist, nifedipine GITS (slow-release gastrointestinal therapeutic-system) are discussed. Nifedipine GITS has been demonstrated to reduce cardiovascular morbidity and mortality effectively. The medication is safe and metabolically neutral even when administered as a long-term treatment.

At the moment, obesity is a global problem, with an increasing prevalence worldwide, which could be characterized as an obesity "epidemic". The article presents the distribution of body mass index (BMI) and abdominal obesity by age and gender in a representative national sample of the Russian population. In total, 13528 people (5760 men, 7768 women) were examined (response rate 87,8%). Overweight (IMT>25 kg/m²) increased with advanced age, from 11,0% and 15,5% among 20-year-old men and women to 53,6% and 77,0%, respectively, in those aged 60 years (p<0,0001). Obesity (BMI>25 kg/m²) prevalence in women of all ages was at least 2,5 times more prevalent than that in men (among the latter, it was no higher than 15%). Similarly, among males, abdominal obesity prevalence increased with age: from 1,5% in 20-year-olds to 20,9% in those aged 80 years and older. Regardless of age, abdominal obesity prevalence among women was substantially higher than that in men, being maximal (65,2%) among 60-year-old females.

Perindopril is one of the most effective ACE inhibitors used for cardiovascular disease treatment. At the moment, perindopril is used as perindopril tert butylamine with limited "shelf life"; the medication should be specially packed for the countries with hot and humid climate. To increase medication stability and "shelf life", a new perindopril salt was introduced for wide clinical use - perindopril arginine. Experimental and clinical studies demonstrated complete bioequivalence of this new salt, comparing to the old one, provided the dose is increased from 4-8 mg (perindopril tert butylamine) to 5-10 mg (perindopril arginine), due to molecular weight difference.

In the last two decades, the interest in hereditary pathology of connective tissue structure and function has substantially increased in Russia. It is mostly explained by a new concept of "non-differentiated connective tissue dysplasia" (NDCTD). It has been proposed to diagnose NDCTD based on the simplified analysis of quantity and/or quality of external and visceral dysplasia symptoms. Such an approach resulted in manifold publications demonstrating NDCTD role in internal disease clinical status and clinical course. At the same time, due to the absence of clear definitions and diagnostic algorithms, this group includes some separate syndromes and phenotypes (MASS-like phenotype, mitral valve prolapse, joint hypermobility syndrome, etc.). The latter complicates literature data analysis and further development of CTD concept. Limitations of this concept are discussed in detail, and NDCTD is proposed to be diagnosed only in the absence of external and visceral symptoms of already known and described dysplastic syndromes and phenotypes.

The review presents literature data on the key role of platelet aggregation (PA) for intracoronary thrombogenesis in various acute coronary syndromes (ACS) and percutaneous coronary interventions (PCI). Clinical pharmacology of main antiplatelet medication (APM) classes is discussed, with emphasis on a new APM class - blockers (inhibitors) of IIb/IIIa glycoprotein receptors (GP IIb/IIIa). The authors analyse the results of randomized clinical trials on effectiveness and safety of abciximab, tirofiban, and eptifibatide in non-ST ACS and planned or urgent PCI. Clinical situations and other factors determining the choice of specific GP IIb/IIIa blocker are discussed.

Stable angina treatment with a prolonged-action beta-adrenoblocker, metoprolol succinate, is discussed. Themedication is effective, metabolically neutral, well tolerated and could also be used in patients with comorbidities.

The review is devoted to the recent European recommendations' view on antihypertensive medications (AHM). The role of beta-adrenoblockers (BAB) in treating arterial hypertension (AH) patients is emphasized. Existing differences in pharmacological parameters and clinical effects are discussed for BAB of various generations. Importance of AH patients' classification by total cardiovascular risk level is explained. The important role of additional (pleiotropic) AHM effects in atherothrombogenesis control is presented, with nebivolol as an example.

The review presents the results of the studies on psycho-emotional, behavioural, and personal factors' role in coronary heart disease (CHD) pathogenesis, from clinical cardiologist's point of view. Possible mechanisms and their impact on CHD pathogenesis are discussed, in comparison to anxiety and depression disorders in psychogenic pathology.