Aim. (1) To investigate clinical characteristics of primary care patients with arterial hypertension (AH), according to the achievement of target blood pressure (BP) levels; (2) to assess the effectiveness of therapeutic measures aimed at achieving target BP and maintaining its long-term control.
Material and methods. This retrospective analysis included the data from ambulatory medical records of 5558 AH patients, who attended primary care centres in 2007. Clinical characteristics were compared in patients with achieved vs. non-achieved target BP levels. According to the national AH guidelines (2004), the completeness of examination, pharmaceutical therapy tactics, and frequency of the follow-up were assessed in both groups.
Results. Based on the 2007 data, target BP levels were maintained in 28% of AH patients. Mean BP level was 144/87 mm Hg. Patients with optimal BP levels, compared to their peers with inadequate BP control, had significantly (p<0,001) higher prevalence of angina pectoris (40,4% vs. 30,1%, respectively) or previous myocardial infarction (19,4% vs. 8,4%), as well as higher frequency of lipid profile assessment, creatinine measurement, and echocardiography. Mean number of prescribed antihypertensive medications was 2,08 vs. 1,60, respectively. Mean number of clinical visits per year was 4,07 vs. 2,99, while mean interval between the visits reached 72,3 vs. 62,7 days, respectively. Regardless of the target BP achievement, the quality of diagnostic and therapeutic management did not comply with the recommended standards.
Conclusion. Patients with optimal BP control were characterised by a more severe clinical course, as well as by a wider scope and higher frequency of diagnostic and therapeutic procedures. At the primary care level, the quality of AH diagnostics and treatment did not comply with the recommended standards; therefore, mean BP levels in the AH Register sample were higher than the target ones.

Aim. To study the gender specifics of acute myocardial infarction (AMI) among the adult population (age >20 years) of Tomsk City.
Material and methods. In total, 1628 AMI cases from the AMI Register (2007-2008) were analysed. The study included 992 (60,82%) men and 636 (39,18%) women.
Results. Compared to male patients, AMI in women typically developed in older age (over 60 years), was preceded by various forms of progressing angina pectoris, and associated with severe co-morbidities and pre-existing disease. Its clinical course was characterised by a high risk of recurrent MI, various complications, and in-hospital death. The leading causes of in-hospital death in women with AMI included cardiogenic shock, congestive heart failure, and myocardial rupture, in contrast to cardiac arrhythmias and cardiac blocks in their male peers.
Conclusion. The observed specifics of AMI development and clinical course in women could be both a barrier for a wider use of modern invasive treatment methods and an explanation of adverse prognosis. The AMI management guidelines should take into account gender-specific characteristics of the disease.

Aim. To identify early signs of renal dysfunction; to investigate the associations between renal function and vascular remodelling; to evaluate the role of metabolic and hydrodynamic disturbances in the development of cardiorenal syndrome among perimenopausal women; and to assess the potential of hormone replacement therapy (17β-estradiol 1 mg and drospirenone 2 mg) for the correction of the above-mentioned disturbances.
Material and methods. In total, 69 perimenopausal women were divided into two groups. Group I included 69 premenopausal women, while Group II consisted of 43 women in early postmenopause. Mean age in Group I was 49,0 years (95% CI 48,0-51,0 years); in Group II, it was 54,0 (50,0-56,0) years (p<0,01). Age at menopause reached 50,3 (48,0-52,0) years, with median duration of menopause of 3,5 (2,0-5,0) years. All participants underwent biochemical blood tests (creatinine (Cr), uric acid (UA), lipid profile, and glucose tolerance test (GTT)). Large elastic artery remodelling was assessed by intima-media thickness (IMT) of common carotid artery (CCA). Non-invasive assessment of endothelial vasoregulatory function involved the measurement of brachial artery (BA) endothelium-dependent vasodilatation (EDVD) in the reactive hyperemia test (RHT). Renal function was assessed by glomerular filtration rate (GFR) and Cr clearance (CrC). Monoalbuminuria (MAU) was qualitatively assessed with a urine strip test. Postmenopausal women were additionally divided into two groups: 23 patients were administered HRT (17β-estradiol 1 mg and drospirenone 2 mg; Angelique medication), while 20 women not receiving HRT comprised a control group. At the end of the study, after 12 months, the assessment of metabolic status, body mass dynamics, endothelial vasoregulatory function, and CCA IMT was repeated.
Results. In most postmenopausal women, lipid and carbohydrate metabolism disturbances were observed, which were typical for metabolic syndrome (MS). Lipid metabolism disturbances were observed as early as in premenopause, but reached their maximum during early postmenopause. Postmenopausal women, compared to their peers in premenopause, had significantly higher fasting and postprandial levels of blood glucose. Structural and functional changes in vascular wall were more severe in postmenopausal vs. premenopausal women (p<0,001). While blood flow velocity in the RHT was comparable in both groups, postmenopausal women did not demonstrate a comparable increase in BA EDVD, in contrast to premenopausal females. This could point to the decrease in BA sensitivity to endothelial shear stress among women in postmenopause. Reduced GFR was observed only in postmenopausal women. MAU was registered in premenopausal women with normal GFR, as well as in postmenopausal females. These data on independent role of MAU and reduced GFR suggest an increase in the proportion of women with subclinical renal injury, as a manifestation of target organ damage.
Conclusion. The associations between vascular structure and function, renal function, and main MS components were demonstrated. HRT (17β-estradiol 1 mg and drospirenone 2 mg) had beneficial effects on BP dynamics, visceral obesity, metabolic status, and arterial structure and function.

Aim. To assess the effectiveness of long-term treatment with magnesium orotate (Magnerot®), as a pathogenetic therapy, in patients with mitral valve prolapse (MVP).
Material and methods. In total, 31 MVP patients, administered Magnerot® (1500 mg/d) in three-month courses, twice a year, were followed up for 15 years. All patients underwent a complex clinical and instrumental examination which included clinical assessment, M-mode and B-mode echocardiography with simultaneous electrocardiography (ECG), standard 12-lead ECG at rest, 24-hour ECG monitoring, 24-hour blood pressure monitoring (BPM), and heart rate variability (HRV) assessment.
Results. The study identified the specifics of clinical features, their association with the degree of phenotypical manifestation of connective tissue dysplasia, ECG changes, heart valve structure, autonomic homeostasis, BP levels and circadian profile, and sympathetic and parasympathetic tone. There was a significant reduction in mean and maximal heart rate, the number of tachycardia episodes, QTc interval duration, as well as the incidence of paroxysmal supraventricular tachycardia, supraventricular and ventricular extrasystolia. Maximal systolic and diastolic BP (SBP, DBP) levels, BP load, and initially increased SBP and DBP variability were significantly reduced. The retrospective analysis results showed a normalisation of the above-mentioned parameters in all participants. The sympathetic tone decreased, as demonstrated by a twofold reduction in the number of patients with sympathicotonia, a threefold increase in the number of participants with vagotonia, and a five-fold increase in the number of individuals with balanced sympathetic and parasympathetic tone.
Conclusion. One-half of the examined MVP patients, who were administered a long-term Magnerot® therapy, have demonstrated a significant improvement in the treatment effectiveness index.

Aim. To assess the effects of moxonidine-based combination therapy on clinical status, laboratory parameters, and target organs in patients with metabolic syndrome (MS).
Material and methods. In total, 60 MS patients with Stage 1-2 arterial hypertension (AH) were randomised into 3 groups. Group I was administered moxonidine (0,2-0,4 mg/d) and amlodipine (5-10 mg/d); Group II received moxonidine (0,2-0,4 mg/d) and hydrochlorothiazide (12,5 mg/d); Group III was treated with moxonidine (0,2-0,4 mg/d) and enalapril (10-20 mg/d). At baseline and after 24 weeks of treatment, the following characteristics were assessed: waist circumference (WC), body mass index (BMI), 24-hour blood pressure monitoring (BMP) parameters, left ventricular myocardial mass index (LVMMI), E/A ratio, isovolumetric relaxation time (IVRT), deceleration time (DT) of early diastolic velocity, peak Em velocity at interventricular septum and lateral wall levels, E/Em ratio (myocardial tissue Doppler echocardiography), pulse wave velocity (PWV) between descending aorta and aortic bifurcation levels (ultrasound method), and stiffness index β of ascending aorta. In addition, lipid, carbohydrate, and purine metabolism parameters were assessed; glomerular filtration rate (GFR) was calculated (MDRD method); and urine albumin levels were measured.
Results. In Group I (moxonidine + amlodipine), target blood pressure (BP) levels were achieved in 70% of the patients. Systolic BP (SBP) levels, LVMMI, and DT decreased by 19,3±11,4 mm Hg, 4,4 g/m2 (p=0,09), and 10,6 ms (p<0,05), respectively. The increase in E/A ratio and Em annular velocity (Em av) reached 0,4 (p<0,05) and 1,4 cm/s (p<0,05), respectively, while E/Em av ratio decreased by 0,8 (p<0,05), and PWV decreased by 1,6 ms (p<0,05). The BMI decrease reached 0,7 kg/m2 (p<0,05). In Group II (moxonidine + hydrochlorothiazide), target BP levels were achieved in 40% of the participants, with a decrease in SBP levels by 14,7 mm Hg (p<0,05). DT was reduced by 9,4 ms (p<0,05), E/A ratio increased by 0,1 (p<0,05), while PWV, BMI, and GFR decreased by 1,3 m/s (p<0,05), 0,8 kg/m2 (p<0,05), and 5,6 ml/min/1,73 m2 (p<0,05), respectively. In Group III (moxonidine + enalapril), 60% of the patients achieved target BP levels, and SBP levels were reduced by 21,1 mm Hg (p<0,05). LVMMI decreased by 5,1 g/m2 (p<0,05), Em av increased by 0,3 cm/s (p<0,05), while the respective reduction in PWV, WC, and BMI reached 1,1 m/s (p<0,05), 1,8 cm (p<0,05), and 0,5 kg/m2 (p<0,05). All three groups demonstrated a significant reduction in urine albumin levels.
Conclusion. The moxonidine-based combination therapy effectively
reduced the levels of BP and urine albumin. The combination of moxonidine with amlodipine or enalapril improved cardiac structure and function, as well as renal excretory function. The combination of moxonidine and hydrochlorothiazide, however, negatively affected renal excretion. All three variants of combination therapy were metabolically neutral and demonstrated beneficial effects on visceral obesity.

Aim. To assess the potential of Health Centres in identification of individuals at higher cardiovascular risk.
Material and methods. In total, 1583 individuals (mean age 51,79±14,75 years) participated in a complex screening programme, including laboratory and instrumental examination.
Results. The screening resulted in identification of individuals with high normal blood pressure (HNBP) and newly diagnosed arterial hypertension (AH) (prevalence 21%). In participants with HNBP, a combination of 2 risk factors (RFs) was the most prevalent (37,79%), while in people with newly diagnosed AH, a combination of 3 RFs was the most common (39,88%). The prevalence of autonomic dysfunction or “Myocardium” parameter increase, as an isolated RF, reached 8,84% and 9,45%, respectively. Abnormal ankle-brachial index (ABI) values were registered in 29,66% of the participants. In 18,97%, ABI values exceeded 1,3, while in 10,69%, they were under 0,9. ABI screening identified 11% of asymptomatic individuals with increased cardiovascular risk.
Conclusion. A screening programme could identify individuals with preAH, primary autonomic dysfunction, functional myocardial instability, or subclinical atherosclerosis of peripheral arteries. Therefore, all subjects with increased cardiovascular risk require lifestyle modification and additional laboratory and instrumental examination, in order to assess the target organ damage and the need for pathogenetic therapy.

Aim. To investigate the components of metabolic syndrome (MS) and to evaluate the role of cardiometabolic risk factors (RFs) in high-stress vs. low-stress occupations, in order to enable early diagnostics of the most important factors.
Material and methods. In total, 299 men were examined (mean age 43,25±7,75 years). Group I worked as train drivers (n=185), while Group II included railway track workers (n=114). All participants underwent clinical examination, measurement of body mass index, waist circumference (WC), office blood pressure (BP), blood glucose, and lipid profile. MS was diagnosed according to the criteria by IDF (2005), ATP III (2005), and the Society of Cardiology of the Russian Federation (2009).
Results. Group I, compared to Group II, demonstrated higher prevalence (p<0,05) of smoking (+22%); abdominal obesity (AO), as denoted by WC ≥94 cm (+28%) or WC 94-102 cm (+16%); elevated systolic BP, SBP (+36%); total cholesterol, TCH (+12%) and very low density lipoprotein cholesterol, VLDL-CH (+16%). The most prevalent combination of MS components among individuals in a high-stress occupation was AH and AO. In Group I, MS prevalence ranged from 30% to 49% (p<0,05) and was 2,5-2,7 times higher than in Group II (p<0,001).
Conclusion. Individuals in high-stress occupations demonstrated high prevalence of cardiometabolic RFs and MS. Based on strict MS criteria, early preventive measures among people in high-stress occupations should target individuals with WC 94-102 cm combined with other cardiovascular RFs.

Aim. To assess the levels of body mass index (BMI) in an urban Siberian population of 25-64-year-old men; to investigate the prevalence of overweight (OW) and its dynamics over the 12-year period of the population monitoring.
Material and methods. The study included two randomised, electoral list-based samples of 25-64-year-old male residents of one Tumen City district. Each sample included 1000 individuals (250 in each 10-year age group – 25-34, 35-44, 45-54, and 55-64 years). The response rates for the first and second cardiologic screenings (1996 and 2008) were 79,5% and 85,2%, respectively.
Results. In the male Tumen population, OW was more prevalent in middle-aged people. Obesity (O) was more prevalent in men with primary education or non-strenuous manual occupation. No considerable social gradient in OW was observed.
Conclusion. Over 12 years, the male Tumen population, aged 25-64 years, has demonstrated an increase in O and OW prevalence, mostly due to increasing BMI levels in younger age groups. The 12-year trends have shown that the increase in O prevalence takes place one decade earlier.

Aim. To analyse the results of clinical cardiovascular disease (CVD) monitoring and the specifics of CVD manifestations in Chernobyl liquidators, who were exposed to “low” radiation doses 25 years ago.
Material and methods. In total, 402 Chernobyl liquidators were examined. One hundred eighty five individuals have been followed up for 15 years (1994-2009) and underwent primary and repeat cardiologic examination, such as coronary artery (CA) angiography, endomyocardial biopsy, computed spiral tomography of CA, peripheral artery ultrasound, and the assessment of hormone levels, carbohydrate metabolism, and cardiovascular function.
Results. At the first stage of cardiovascular monitoring (1995-1999), the most prevalent forms of CVD among Chernobyl liquidators were arterial hypertension, AH (70,3%) and/or coronary microvascular coronary heart disease, MVCHD (58,9%). Ten-fifteen years later, the prevalence of AH had not changed substantially. The prevalence of atherosclerotic coronary heart disease (ACHD) had increased, partly due to CA atherosclerosis development in patients with earlier diagnosed MVCHD. Severity, manifestations, and outcomes of CVD in Chernobyl liquidators were dependent on a range of factors, such as age, duration and doses of radiation exposure, and subsequent lifestyle and work characteristics.
Conclusion. Stabilisation of AH pathomorphosis and prevention of atherosclerotic progression of MVCHD were associated with early diagnostics of vascular pathology and effective CVD prevention.

Aim. To investigate the association between the stress-related hemodynamic response during the mental calculation test (MCT) and the presence of Type D personality in healthy young individuals.
Material and methods. The study included 80 healthy individuals (19 men and 61 women; mean age 18,8±0,2 years). Psychological status examination included the DS-14 scale, depression scale, and Spielberger-Khanin scale. MCT was performed with simultaneous assessment of hemodynamic response.
Results. Type D personality (distressed type) was observed in 32,5% of the participants. Among young students, Type D personality was associated with higher levels of trait and state anxiety (TA and SA), as well as higher depression scale scores, compared to students without Type D personality. Type D personality was also linked to a more pronounced response of systolic blood pressure (SBP) during MCT (p=0,05). There was a strong correlation between social inhibition levels and maximal heart rate (HR) during MCT (r=-0,238; p=0,034). Young men demonstrated a moderate correlation between Type D personality and HR response (r=-0,508; p=0,026), as well as between negative affectivity levels and HR response during MCT (r=0,469; p=0,043).
Conclusion. Distressed personality type was observed in one-third of healthy young participants of the study. Type D personality and its subscales correlated with the hemodynamic response during MCT, with some gender-specific features observed. These findings clarify potential mechanisms of Type D personality effects on the development and prognosis of cardiovascular disease.

Recently obtained data have identified potential mechanisms linking D-endocrine system and blood pressure regulation. Vitamin D deficiency is associated with calcium metabolism disregulation, increased tonus of renin-angiotensin-aldosterone system, endothelial dysfunction, and metabolic syndrome development. The evidence presented suggests a possibility for developing a new, vitamin D-derived class of antihypertensive medications. This review discusses the mechanisms of arterial hypertension development which are related to vitamin D metabolism in humans.

Subclinical atherosclerosis is an initial, latent stage of chronic progressing arterial inflammation. Destabilisation of asymptomatic, hemodynamically non-significant atherosclerotic plaques (AP) could lead to myocardial infarction, stroke, or sudden death. Since the assessment of AP stability is problematic in real-world clinical settings, the risk stratification should, at least, account for the presence of subclinical atherosclerosis. In 600 ambulatory patients from the Moscow City Western Administrative Okrug who had low and moderate SCORE-assessed cardiovascular risk levels, the prevalence of AP, based on the duplex carotid ultrasound results, was 59% (n=358). Presently, no standard guidelines exist on cardiovascular risk stratification which would include the assessment of subclinical atherosclerosis, despite the importance of the latter as a prognostic factor. Large clinical studies on prognosis in patients with subclinical atherosclerosis will clarify the role of this parameter as an independent cardiovascular risk factor and facilitate the development of respective clinical recommendations.

Antihypertensive medications of the same class could differ by their pharmacodynamic parameters, which substantially affects the longterm treatment results. Nebivolol is one of the modern, highly selective β-adrenoblockers (β-AB). It is characterised not only by high β1-selectivity, but also by additional vasodilating activity, due to increased nitric oxide synthesis and, hence, beneficial metabolic effects. The results of the original studies and the external evidence demonstrate metabolic neutrality of nebivolol, absence of substantial changes in thyroid hormone levels, and improvement in heart rate variability, electrophysiological myocardial parameters, QT interval duration, and cerebral perfusion. Nebivolol is effective and safe even in higher-risk patients with metabolic syndrome and Type 2 diabetes mellitus.

Aim. Sulfhydryl angiotensin-converting enzyme (ACE) inhibitors exert antiatherosclerotic effects in preclinical models and antioxidant effects in patients. However, whether ACE inhibitors have any clinically significant antiatherogenic effects remains still debated.
Objectives. In mildly hypertensive patients, we evaluated the effect of the sulfhydryl ACE inhibitor zofenopril in comparison with the carboxylic ACE inhibitor enalapril on carotid atherosclerosis (intima-media thickness [IMT] and vascular lumen diameter) and systemic oxidative stress (nitrite/nitrate, asymmetrical dimethyl-L-arginine, and isoprostanes).
Material and methods. In 2001, we started a small prospective randomized clinical trial on 48 newly diagnosed mildly hypertensive patients with no additional risk factors for atherosclerosis (eg, hyperlipidemia, smoke habit, familiar history of atherosclerosisrelated diseases or diabetes). Patients were randomly assigned either to the enalapril (20 mg/d, n = 24) or the zofenopril group (30 mg/d, n = 24); the planned duration of the trial was 5 years. Carotid IMT and vascular lumen diameter were determined by ultrasonography for all patients at baseline and at 1, 3, and 5 years. Furthermore, nitrite/nitrate, asymmetrical dimethyl-L-arginine, and isoprostane levels were measured.
Results. In our conditions, IMT of the right and left common carotid arteries was similar at baseline in both groups (P = NS). Intima-media thickness measurements until 5 years revealed a significant reduction in the zofenopril group but not in the enalapril group (P b .05 vs enalapril-treated group). This effect was coupled with a favorable nitric oxide/oxidative stress profile in the zofenopril group.
Conclusion. Long-term treatment with the sulfhydryl ACE inhibitor zofenopril besides its blood pressure–lowering effects may slow the progression of IMT of the carotid artery in newly diagnosed mildly hypertensive patients. (Am Heart J 2008;156:1154.e1-1154.e8.)

Cardiovascular (CV) disease is a major factor in mortality rates around the world and contributes to more than one-third of deaths in the US. The underlying cause of CV disease is atherosclerosis, a chronic inflammatory process that is clinically manifested as coronary artery disease, carotid artery disease, or peripheral artery disease. It has been predicted that atherosclerosis will be the primary cause of death in the world by 2020. Consequently, developing a treatment regimen that can slow or even reverse the atherosclerotic process is imperative. Atherogenesis is initiated by endothelial injury due to oxidative stress associated with CV risk factors including diabetes mellitus, hypertension, cigarette smoking, dyslipidemia, obesity, and metabolic syndrome. Since the renin– angiotensin–aldosterone system (RAAS) plays a key role in vascular inflammatory responses, hypertension treatment with RAAS-blocking agents (angiotensin-converting enzyme inhibitors [ACEIs] and angiotensin II receptor blockers [ARBs]) may slow inflammatory processes and disease progression. Reduced nitric oxide (NO) bioavailability has an important role in the process of endothelial dysfunction and hypertension. Therefore, agents that increase NO and decrease oxidative stress, such as ARBs and ACEIs, may interfere with atherosclerosis. Studies show that angiotensin II type 1 receptor antagonism with an ARB improves endothelial function and reduces atherogenesis. In patients with hypertension, the ARB olmesartan medoxomil provides effective blood pressure lowering, with inflammatory marker studies demonstrating significant RAAS suppression. Several prospective, randomized studies show vascular benefits with olmesartan medoxomil: reduced progression of coronary atherosclerosis in patients with stable angina pectoris (OLIVUS); decreased vascular inflammatory markers in patients with hypertension and micro- (pre-clinical) inflammation (EUTOPIA); improved common carotid intima-media thickness and plaque volume in patients with diagnosed atherosclerosis (MORE); and resistance vessel remodeling in patients with stage 1 hypertension (VIOS). Although CV outcomes were not assessed in these studies, the observed benefits in surrogate endpoints of disease suggest that RAAS suppression with olmesartan medoxomil may potentially have beneficial effects on CV outcomes in these patient populations.