Pathophysiologic mechanisms of central aortal pressure (CAP) are more complex than those of peripheral pressure, measured at brachial artery level. CAP indirectly reflects the state of circulatory system as a whole, since it is modulated by aorta elasticity, as well as structure and function of middle arteries and microcirculatory vessels. The difference between central and peripheral systolic blood pressure is maximal in young people and decreases in the elderly. For non-invasive CAP measurement, radial artery applanation tonometry is used, with subsequent computer transformation of peripheral pulse wave into central one, or applanation tonometry of carotid artery. The growing body of evidence supports the use of CAP measurement in assessing cardiovascular risk assessment and comparing various therapeutic regimens.

Aim. To compare the wall rigidity of common carotid artery (CCA), assessed by ultrasound (US), in young men with arterial hypertension (AH).

Material and methods. The study included young men aged 18-25 years (mean age 22 years): 25 with normal blood pressure (BP) during office visits and 24-hour BP monitoring (BPM), 11 with white coat AH (WCAH), and 23 with AH. Intima-media thickness (IMT) was examined by B-mode US, maximal systolic and minimal diastolic diameters — by M-mode US. Elasticity and dispensability coefficients, Peterson’s elasticity module, Young module, and flow deformation index were calculated.

Results. In AH patients, IMT levels and CCA wall rigidity were higher than in young men with normal BP or WCAH.

Conclusion. In young men aged 18-25 years, AH, confirmed by office measurement and 24-hour BPM, was asso­ciated with carotid artery remodelling and reduced elasticity.

Aim. To study the clinical and diagnostic role of pulse wave time (PWT) in 24-hour blood pressure monitoring (BPM) and its link to elasticity of larger arteries and aorta (carotid-femoral pulse wave velocity, PWVcf; cardioankle vascular index, CAVI) in patients aged over 75 years.

Material and methods. The study included 52 patients (20 men) aged over 75 years (mean age 79,1±3,5 years) with arterial hypertension (AH). Fifteen participants had cardiovascular events (CVE) in anamnesis: myocardial infarction, MI (n=11) or stroke (n=4). Sixteen patients had Functional Class II-III angina (n=16), and 32 received antihypertensive therapy. 24-hour BMP and PWT parameters were measured. Corrected PWT100-60 was calculated for systolic BP (SBP) 100 mm Hg and heart rate (HR) 60 bpm. PWVcf and CAVI were assessed with a screening device VS 1000 VaSera, Fukuda Denshi, Japan.

Results. In all participants, clinical BP level was 147,5+6,9/76,5+5,1 mm Hg; 24-hour BPM BP level - 139,6+6,7/70,7+4,6 mm Hg; PWT100-60 - 161,7+6,2 ms; PWVcf - 17,3+4,6 m/s, and CAVI - 10,6+3,1. A sig­nificant negative correlation between PWT100-60 and 24-hour BPM SBP (r=-0,36, p<0,05), 24-hour BPM PBP (r=-0,43, p<0,01), PWVcf (r=-0,54, p<0,01) and CAVI (r=-0,34, p<0,05) was observed. Patients with and without CVE were comparable by age. CVE-free participants were characterised by lower frequency of antihypertensive therapy, higher levels of clinical BP (153,5+6,9/82,5+6,3 vs. 136,5+3,4/71,1+3,9 mm Hg), higher 24-hour BPM BP (144,0+6,9/73,2+5,3 vs. 132,6+4,2/69,3+3,8 mm Hg), lower PVWcf (15,8+4 vs. 18,7+4,4 m/s), lower CAVI (9,7+2,4 vs. 11,5+3,8), and higher PWT100-60 (167+5,4 vs. 156,2+6,9 ms; p<0,05).

Conclusion. In AH patients aged over 75 years, PWT100-60 correlated with traditional indices of arterial rigidity. Lower PWT100-60 and higher PWV were observed among individuals with CVE in anamnesis.

Aim. To investigate the potential of sibutramine (Meridia®) therapy in patients with obesity and arterial hypertension (AH); to assess sibutramine effects on blood pressure (BP), organ protection and quality of life (QoL) in individuals with obesity and AH, in comparison to traditional antihypertensive therapy (AHT).

Material and methods. This open clinical study included 50 patients, randomised by envelope method into two groups. Group I received Meridia® (10 mg/d), and Group II received traditional AHT for 12 weeks. All participants were aged 18-60 years, with body mass index >27 kg/m². AHT was not modified during the study period. Inclusion criteria were Stage I-III AH, systolic BP (SBP) level 140-180 mm Hg, and no previous AHT At baseline and in the end of the study, all participants underwent 24-hour BP monitoring (BPM), echocardiography (EchoCG), blood biochemistry, and pulse wave velocity (PWV) measurement, as well as 6-minute walk test, QoL assessment, and Hospital Anxiety and Depression Scale administration. In men, erectile function was also assessed.

Results. Compared to traditional AHT, Meridia® more effectively reduced SBP, diastolic BP, left ventricular myocardial mass and increased ejection fraction. No significant increase in HR was observed during Meridia® therapy. Meridia® was also associated with significant PVW reduction and improvement in flow-dependent vasodilatation, QoL, psycho-emotional status and erectile function in males.

Conclusion. Sibutramine therapy in patients with obesity and AH improved hemodynamics, carbohydrate and lipid metabolism, QoL, anthropometry and organ protection parameters more effectively than traditional AHT In patients with obesity and AH, short-term Meridia® therapy was associated with a reduction in systolic and diastolic BP, without any significant increase in HR.

Aim. To study the effects of an angiotensin II receptor antagonist (ARA II) valsartan, a statin (fluvastatin XL), and their combination on endothelial function (EF) in patients with arterial hypertension (AH) and dyslipidemia (DLP).

Material and methods. In total, 30 patients with untreated, non-complicated Stage I-II AH and DLP IIA or IIB were randomised for 8-week monotherapy with valsartan or fluvastatin XL, with the subsequent addition of the second component, fluvastatin XL or valsartan, respectively.

Results. Valsartan monotherapy was associated with a reduced increase in linear blood flow velocity (LFV) during the reactive hyperemia test (RHT) - 177,7+5,8 vs. 170,0+4,9% (p<0,01). At the same time, brachial artery endothelium-dependent vasodilatation (BA EDVD) increased by 14% (p>0,05). Eight-week monotherapy with fluvastatin XL (80 mg/d) was linked to moderate but statistically significant reduction (-2%) in systolic blood pres­sure (SBP), with no effect on diastolic BP level. In RHT, LFV increase did not change, but EF improved, as manifested in BA EDVD increase. Prolonged combined therapy resulted in further EF improvement.

Conclusion. Combined fluvastatin XL and valsartan therapy in patients with untreated Stage I-II AH and DLP IIA or IIB improved EF more effectively than valsartan or fluvastatin XL monotherapy.

Aim. To assess atherosclerosis severity by duplex ultrasound of common carotid arteries (CCA), as well as C-reactive protein (CRP) levels, in 30-55-year-old patients with abdominal obesity (AO).

Material and methods. The study included 203 patients (mean age 45,9+0,5 years) — 152 women (mean age 45,9+0,8 years) and 51 men (mean age 44,4+1,5 years) with AO (waist circumference, WC, >80 cm in women, >94 cm in men). In total, 36,5% were overweight (body mass index, BMI, 28,0+0,2 kg/m²), and 63,5% were obese (BMI 35,1+0,5 kg/ m²). All participants underwent duplex CA ultrasound (ALOKA SSD-3500, Japan); CRP level was measured by quantitative turbidimetry.

Results. In AO patients, early CA atherosclerosis and increased CRP level were observed. Atherosclerotic plaques in CCA and/or internal CA were found in 39,8%. CCA intima-media thickness (IMT) correlated with WC and insulin level. CRP concentration positively correlated with IMT insulin level, WC, BMI, and negatively correlated with highdensity lipoprotein cholesterol.

Conclusion. In AO patients aged over 30 years, duplex CCA ultrasound should be recommended for early atherosclerosis diagnostics.

Aim. To investigate the effects of Co-renitek (enalapril 20 mg + hydrochlorothiazide 12,5 mg) on carotid artery (CA) intima-media thickness (IMT) in patients with Stage II-III essential arterial hypertension (EAH).

Material and methods. In total, 44 patients with Stage II-II AH were examined (mean age 59,2±7,7 years; Stage II and II AH in 43,2% and 56,8%, respectively). At baseline and during the treatment phase, blood pressure (BP) measurement and duplex CA ultrasound were performed. All participants received Co-renitek (1 tablet daily, taken in the morning). If target BP levels (<140/90 mm Hg) were not achieved in 4 weeks, the daily dose was increased up to 2 tablets. The follow-up lasted for 48 weeks.

Results. A significant (p<0,05) reduction in office BP levels was observed — by 23,2 mm Hg for systolic BP (SBP), and by 11,5 mm Hg for diastolic BP (DBP). At baseline, increased CA IMT was registered in 32 individuals. After 48 weeks of the treatment, IMT significantly decreased for both CA — by 11% for right CA, and by 6% for left CA. For left CA, IMT decreased or normalised in 50% of the participants, remained the same in 31%, and increased in 19%. For right CA, IMT normalised in 25%, decreased in 57%, and increased in 9%.

Conclusion. In Stage II-III AH patients treated for 48 weeks, a fixed-dose combined antihypertensive therapy with Co-renitek resulted in a significant reduction of SBP and DBP, as well as in bilateral CA IMT reduction.

Aim. To study co-morbidity prevalence, as well as metabolic effects on atherosclerosis progression and cardiovascular risk, in patients with osteoarthrosis (OA).

Material and methods. In total, 83 patients with confirmed OA diagnosis (American College of Rheumatology criteria). The age of participants was 45-70 years (mean age 58,35+12,5 years), and OA duration was 1-24 years (mean duration 9,8±4,7 years). The examination included pain syndrome assessment with visual analog scale (VAS), calculation of WOMAC (Western Ontario and McMaster Universities) index and body mass index (BMI), measurement of waist and hip circumference (WC, HC) and WC/HC ratio. Joint ultrasound examination (Phillips HD-11) was used to assess periarticular tissue status and visualise articular cartilage and bone surfaces. Serum levels of C-reactive protein (CRP) and interleukin-6 (IL-6) were measured by immune-enzyme method.

Results. Obesity was diagnosed in 51 OA patients (67,64%). These participants demonstrated higher synovitis prevalence, higher values of algo-functional indices, and elevated IL-6 and CRP levels, as well as higher frequency of cardiovascular disease and cardiovascular events in anamnesis.

Conclusion. In OA patients, obesity was more prevalent. Compared to those with BMI<30 kg/m², obese individuals with OA showed higher levels of triglycerides and CRP, lower concentration of high-density lipoproteins, and higher prevalence of Caro index <0,33 (insulin resistance marker). Therefore, the combination of OA and obesity was characterised by clustering of cardiovascular risk factors.

Aim. To investigate rosuvastatin effects on oxidative stress (OS), endogenous inflammation and neoangiogenesis process in patients with systemic atherosclerosis (SA).

Material and methods. In total, 46 SA patients (mean age 56,5±2,2 years) were divided into two groups, comparable by clinical and functional parameters. Group I (n=24) received standard therapy, while Group II (n=22) was administered standard therapy plus rosuvastatin (10 mg/d). In all participants, serum lipid profile, in vitro Cu-ion oxidation of serum and high-density lipoproteins (HDL), concentrations of 3-nitrotyrosine (3-NT), high-sensitive C-reactive protein (hs-CRP), and interleukin-6 (IL-6), activity of secretory phospholipase A₂ Type IIA (secPHLA₂-IIA), and VEGF and PIGF factor levels were measured.

Results. Moderate doses of rosuvastatin significantly decreased serum and HDL oxidation — by 34% (р<0,01) and 37% (р<0,05), respectively. They also reduced the levels of 3-NT by 26% (р<0,05), hs-CRP — by 35% (р<0,05), and IL-6 — 26% (р<0,05). SecPHLA₂-IIA activity decreased by 27% (р<0,05), VEGF level — by 28% (р<0,05), and PIGF level - by 43,5% (р<0,05).

Conclusion. 3-NT and hs-CRP levels, together with secPHLA₂-IIA activity, could be effective markers of systemic OS and endogenous inflammation in SA patients.

Aim. To investigate a new technique of transcutaneous electroneurostimulation of reflexogenic zones by shortimpulse current (DiaDENS-Cardio) as a potential method to improve blood pressure (BP) control in patients with arterial hypertension (AH) uncontrolled by three-component therapy.

Material and methods. A placebo-controlled study of DiaDENS-Cardio device included 60 AH patients, receiving regular three-component antihypertensive therapy but failing to achieve the target BP level <140/90 mm Hg. BP was self-measured (SMBP) and monitored for 24 hours (24-hour BPM).

Results. Systolic BP decreased after two days of DiaDENS-Cardio therapy, as demonstrated by SMBP (123,4+5,4 vs. 144,9+7,4 mm Hg; p<0,05) and 24-hour BPM (125,8+4,9 vs. 147,1+11,7 mm Hg; p<0,05).

Conclusion. DiaDENS-Cardio therapy significantly improved BP control in patients with resistant AH.

Aim. The CORD Study compared effectiveness and tolerability of losartan and ramipril in patients with arterial hypertension (AH).

Material and methods. The study included two groups, A and B. In Group A (n=4016; mean age 62,6+11,6 years; 53,1% women), the patients with blood pressure (BP) <160/100 mm Hg and ACE inhibitor therapy lasting for >3 months were switched from ACE inhibitors to losartan. At baseline and 1, 3, 6, and 12 months later, BP, heart rate, and biochemical parameters were measured; general blood assay and electrocardiography (ECG) were also performed. In group B (n=3813; mean age 60,5+12,2 years; 50,5% women), the patients with BP >140/90 mm Hg and no previous ACE inhibitor or angiotensin receptor blocker (ARB) therapy were randomly administered either losartan (50 mg/d; n=1887) or ramipril (5 mg/d; n=1926).

Results. Group A demonstrated a decrease in BP — from 147,4+14,8/87,7+9,3 to 139,7+11,8/83,0+9,3 mm Hg (p<0,001) after one month of the treatment, and to 133,7+11,3/79,1+7,06 mm Hg (p<0,001) after one year. Adverse effect prevalence did not increase. After one year, Group B demonstrated a reduction in BP levels — in losartan subgroup, from 156,5+13,1/93,4+8,8 to 134,55+11,3/80,16+6,6 mm Hg (p<0,001), and in ramipril subgroup — from 155,9+13,1/93,0+8,9 to 134,1+11,2/81,5+6,8 mm Hg (p<0,001). No severe adverse effects were registered, but in ramipril subgroup, cough was 8 times more prevalent.

Conclusion. ACE inhibitor substitution with losartan was safe and effective. Losartan and ramipril demonstrated equal antihypertensive effectiveness and a tendency to improve metabolic parameters. Losartan therapy was better tolerated than ramipril.

Aim. To assess the real clinical practice implementation of the recommendations on secondary cardiovascular disease (CVD) prevention in patients after myocardial infarction (MI).

Material and methods. In total, 6,000 ambulatory medical cards were randomly selected from all cards of the patients visited the city cardiology dispanser in 2006. Among the selected cards, 752 belonged to patients with an MI in anamnesis. The information on main CVD risk factors (RFs), achievement of target levels of body mass index (BMI), blood pressure (BP), total cholesterol (TCH), and low-density lipoprotein CH (LDL-CH), as well as the data on pharmaceutical treatment, invasive diagnostics and therapy of coronary heart disease (CHD), were analysed.

Results. Inadequate attention of ambulatory specialists to the main modifiable and non-modifiable CVD RFs was observed. The prevalence of achieved target levels of BMI, BP, TCH, and LDL-CH was very low. In post-MI patients, anti-aggregants, statins and anticoagulants as a part of the pharmaceutical secondary CVD prevention, were not administered often enough by the specialists working at polyclinics and the cardiology dispanser. The usage of invasive diagnostics and treatment of CHD remained low.

Conclusion. The recommendations on secondary CVD prevention in post-MI patients were implemented inadequately.

Aim. To study pharmacodynamics and clinical effectiveness of clopidogrel and atorvastatin in patients with acute coronary syndrome (ACS) and hyperlipidaemia (HLP).

Material and methods. The study included 90 patients with ACS and Type IIA or IIB HLP. Group I received clopidogrel monotherapy, Group II — a combination of clopidogrel and atorvastatin, and Group III — atorvastatin monotherapy. Blood lipid profile (LP), induced platelet aggregation (IPLA), and cytochrome P-450 3A4 isoen­zyme were measured.

Results. Clopidogrel did not affect blood LP, but significantly reduced IPLA. Its effectiveness was also demonstrated in combination with atorvastatin, despite reduced activity of cytochrome P-450 3A4 isoenzyme. Lipidlowering effect of atorvastatin was observed both for monotherapy and its combination with clopidogrel. Atorvastatin monotherapy has a mild anti-aggregant effect: IPLA was reduced as early as during the third month of the treatment.

Conclusion. High effectiveness of an anti-platelet agent clopidogrel and a lipid-lowering medication atorvastatin opens a window for their wide use in cardiologic practice, in particular, for ACS patients.

Aim. To study the prevalence and severity of hemostasis disturbances in young men with mitral valve prolapse (MVP) and reduced compensatory and adaptive organism potential; to assess corrective therapy variants.

Material and methods. In 500 young men with MVP, 16 hemostasis parameters were studied by standard methods. Among patients with reduced compensatory and adaptive potential (n=73), the combination of magnesium and pyridoxine (2 tablets 3 times per day for one month) was administered to correct functional and metabolic disturbances.

Results. At baseline, platelet (PL) functional activity was 16,9 % higher than in control group. The number of spontaneous PL aggregates was 5,8 times higher, disaggregation — 47,6 % lower, and levels of paracoagulation products (fibrinogen B, fibrin-monomer complexes, soluble fibrin) — by 6,7, 4,28 and 5,3 times higher, respectively, than in controls. Reduced concentration of endogenous heparin (-94,5 %; p<0,001) and decreased antithrombin III production (-14,3 %) pointed to suppression of endogenous anticoagulant protection system. Concentrations of fibrinogen-heparin and fibrin degradation products were higher than normal levels by 2,58 and 3,38 times, respectivel. Hematocrit was 15,8 % higher, free red blood cell sedimentation — 16,4 % lower, and red blood cell aggregation — 18,64 times higher than in the control group. Therapy reduced blood coagulation potential and increased endogenous heparin activity, with parallel activation of enzyme fibrinolysis.

Conclusion. Magnesium and pyridoxine therapy improved hemostasis parameters investigated. The absence of clear effect on blood rheology warrants additional administration of agents actively improving microcirculation in young men with MVP.

The article presents an innovative clinico-organisational model of medical care in cardiovascular disease (CVD), functioning in a large industrial city. The model is based on the “closed circle” principle, including a unified ambulatory-outpatient system of cardiologic care and a multi-level hospital system of CVD healthcare: therapeutic cardiologic and high-technology surgical service, post-infarction and post-intervention rehabilitation, including sanatorium level. The base of the model is ambulatory service, uniting all city policlinic cardiologists at specialised municipal healthcare centres — cardiology dispansers, and functionally linked to other healthcare — specialised hospitals and sanatoriums. The “closed circle” system: policlinic — hospital — sanatorium — policlinic, facilitates consistency of patients’ treatment; accessibility and quality of healthcare; wide implementation of promising, cost-effective and high technology-based methods of diagnostics and treatment at ambulatory level; and effective use of expensive inpatient cardiosurgery resources. The new model is focused on CVD prevention, quality of life and demographics improvement, and working capacity maintenance in the population.

Obesity (O) is one of the main risk factors of arterial hypertension (AH). Clinicians face increasing numbers of patients with a combination of AH and O and the problem of correct choice of antihypertensive therapy, which should effectively control blood pressure, provide cardio- and nephroprotection, and be metabolically neutral. At the present, a fixed-dose combined medication is available, which has all the characteristics required — a combination of a non-dihydropyridine calcium antagonist verapamil in its retard form and an ACE inhibitor trandolapril. This combination could be a medication of choice in patients with AH, O, diabetes mellitus and nephropathy.

This literature review discusses various aspects of therapy compliance in cardiovascular patients. The clinician and patient-related causes of low compliance are analysed, and potential effectiveness of complex educational approach is emphasised. The results of major national and international studies (e.g., RELIPH Study) are presented.

Beta-adrenoreceptor blockers are widely used in the treatment of various cardiovascular diseases. The review discusses the benefits of a highly selective beta-adrenoblocker betaxolol in patients with coronary heart disease, arterial hypertension, cardiac arrhythmias, and chronic heart failure. Possible adverse effects are also discussed, including metabolic, bronchial, and lactation-related ones.

The choice of optimal antihypertensive medications in patients with arterial hypertension (AH) and high cardiovascular risk remains one of the important problems in modern cardiology. Calcium antagonists (CA) have demonstrated their effectiveness in various clinical situations, according to numerous randomised clinical trials. However, despite their high effectiveness and safety, CA are still used relatively rarely in the real-world Russian clinical practice.