Aim. To assess the effectiveness and safety of the full-dose combination therapy with perindopril (10 mg) and indapamide (2,5 mg) in patients with arterial hypertension (AH).
Material and methods. The simple, non-randomised, prospective study included 36 patients with Stage 1-2 AH. Treatment effectiveness was assessed by the reduction in office blood pressure (BP) levels, results of the 24-hour BP monitoring (BPM), morning BP surge (MS), BP load area and time, BP variability, and diurnal index. Safety parameters included the levels of sodium, potassium, glucose, hepatic aminotransferases, urea, creatinine, and the presence of hypotension episodes. Statistical analysis was performed in SPSS 12.
Results. The three-month therapy resulted in the achievement of target levels of systolic and diastolic BP (SBP, DBP) in 83% and 100% of the patients, respectively. According to the 24-hour BPM results, there was a significant reduction in the levels of SBP24 (from 148,3±18,2 to 134±11,1 mm Hg; p=0,001), DBP (from 84,8±12,3 to 76,9±9,1 mm Hg; p=0,001), and pulse BP (from 64,0±14,6 to 58,4±9,6 mm Hg; p=0,012). There was also a significant reduction in the load time indices of SBPday (from 72,5% (95% confidence interval, CI, 43,3-95,3) to 46,5% (95% CI 16,3-64,0); p=0,001) and DBPday (from 84,5% (54,0-100,0) to 57,0% (35,0-82,3); p=0,002). MS velocity decreased for both SBP (from 16,4 (12,5-25,1) to 12,7 (10,8-15,8) mm Hg (p=0,017) and DBP (from 15,8 (10,2-22,0) to 12,2 (9,3-17,8) mm Hg (p=0,019). During the therapy course, no hypotension episodes or marked changes in blood biochemistry and electrolyte parameters were registered.
Conclusion. Initiating antihypertensive therapy with a full-dose combination of perindopril and indapamide was both effective and safe.

Aim. To study the role of obstructive sleep apnoea syndrome (OSAS) in the development of treatment resistance in patients with arterial hypertension (AH). To assess the effects of autonomic nervous system (ANS) dysfunction, as one of the potential pathophysiological mechanisms of inadequate blood pressure (BP) reduction in patients with AH and OSAS.
Material and methods. The study included 365 ambulatory AH patients: 194 with OSAS and 161 with resistance to antihypertensive therapy after 6-15 months. The 24-hour BP monitoring (BPM) and 24-hour cardio-respiratory monitoring of electrocardiogram (ECG), with heart rate variability (HRV) analysis, were performed.
Results. Among patients with AH and OSAS, most individuals had low antihypertensive therapy compliance. All parameters of 24-hour BPM in this group were lower than in OSAS-free hypertensives, and this difference was more pronounced in patients with lower treatment compliance, particularly for pulse BP and HR. HRV parameters correlated with apnoea-hypopnoea index (AHI) and BP levels during 24-hour BPM. However, in multivariate analyses, these correlations were observed only for HRV parameters and AHI.
Conclusion. In AH patients, OSAS aggravates the clinical course of the disease. ANS dysfunction could be one of the mechanisms underlying the development of antihypertensive treatment resistance.

Aim. Using the Doppler ultrasound method, to describe functional status of arterioles in patients with essential arterial hypertension (AH) and individuals with Type 2 diabetes mellitus (DM-2) and concomitant AH.
Material and methods. The study included 90 AH patients and 83 patients with DM-2 and AH. Systolic (Vs, cm/s), diastolic (Vd, cm/s), and mean (Vm, cm/s) arteriolar blood flow velocity was measured using the Miniplex Doppler device. The subsequent spontaneous changes in blood flow velocity were registered for one minute and presented as percentages.
Results. The maximal blood flow velocity was observed in AH patients, followed by healthy controls and patients with DM-2 and AH. The Vs variation was the largest in healthy people, smaller in AH patients, and the smallest in participants with AH and DM-2. The maximal Vd variation was observed in AH patients, followed by patients with AH and DM-2 and healthy controls.
Conclusion. The assessment of arteriolar blood flow velocity provides information about arteriolar tonus and its dynamics over time.

Aim. To assess the effects of amlodipine therapy on quality of life (QoL) parameters among patients with different stages of essential arterial hypertension (EAH).
Material and methods. In 97 EAH patients, aged 30-60 years, QoL parameters were assessed before and after amlodipine therapy.
Results. In EAH patients, baseline QoL levels were relatively low, especially for the domains of general health, vitality, and mental health. Amlodipine monotherapy improved the physical QoL component, without any clear beneficial impact on mental wellbeing. The largest effect of amlodipine monotherapy on QoL parameters was observed among Stage I EAH patients. It might be the case that this therapy decreases QoL in Stage II and especially Stage III EAH patients, negatively affecting the mental health domain.
Conclusion. QoL monitoring during antihypertensive therapy could not only improve therapy compliance, but also increase the motivation towards long-term treatment.

Aim. To study the specifics of coronary artery pathology in patients with coronary heart disease (CHD) and chronic obstructive pulmonary disease (COPD), using the data of selective coronary angiography (CAG).
Material and methods. In total, 907 CHD patients were examined. Group I included 251 participants with CHD and COPD; Group II included 656 individuals with CHD only. CAG was performed in 582 patients (64,2%): 184 from Group I (73,3%) and 398 from Group II (60,7%).
Results. In patients with the combination of cardiac and pulmonary disease, the prevalence of two- and three-vessel pathology was higher, compared to CHD-only patients: 70,6% in Group I vs. 53,8% in Group II (p=0,002). In Group I, the Syntax Scale score was significantly higher than in Group II (24,7±4,1 vs. 18,7±3,1, respectively).
Conclusion. Patients with combined cardiac and pulmonary pathology demonstrated a more severe coronary artery atherosclerosis, based on such CAG parameters as stenosis degree, number of involved vessels, size and location of lesions, and proximal stenosis.

Aim. To assess the effects of the “interval” (3 months of treatment, followed by treatment-free 3 months) and “persistent” (52 weeks) therapy with Mildronate (500 mg/d) in elderly patients with arterial hypertension (AH) and cognitive dysfunction.
Material and methods. In total, 1800 elderly patients with AH and mild to moderate cognitive dysfunction were randomised into 3 groups. Group I (“interval” treatment) included 60 patients (28 men and 32 women; mean age 69,13±1,09 years), who received Mildronate 500 mg once a day in the morning for 3 months, then had a treatment-free period of 3 months, followed by 3 months of therapy and 3 months of no therapy. Group II (“persistent” treatment) included 60 patients (20 men and 40 women; mean age 73,25±2,19 years), who received Mildronate 500 mg once a day in the morning for 12 months. Group III (controls) included 60 patients (16 men and 44 women; mean age 67,75±2,05 years), who were administered only standard antihypertensive treatment. The groups were comparable by age, gender, concomitant pathology, and blood pressure levels. To assess the cognitive status at Weeks 4, 12, 26, and 52, all participants underwent neuro-psychological testing (Mini-Mental State Examination (MMSE), Schulte test, Reiten test, Wechsler test, speech, memory (memorising 10 words), and counting test).
Results. In elderly patients with AH, both regimens of Mildronate treatment were significantly associated with preserved cognitive and mnestic functions, which was manifested in increased mean scores of MMSE and its time domain. However, the “interval” Mildronate treatment was more beneficial than the “persistent” therapy, as the former was also linked to a significant improvement in attention and speech MMSE domain, reduction in the time of memorising 10 words and performing Reiten test, improvement in delayed memorisation, and increased mean score in Wechsler test.
Conclusion. Additional treatment with Mildronate (500 mg/d), as both “interval” and “persistent” therapy, was associated with preserved cognitive and mnestic functions in elderly AH patients.

Aim. To assess the levels of selected biomarkers and the type of left ventricular (LV) dysfunction in geriatric patients, in regard to their age, gender, and the severity of coronary artery pathology.
Material and methods. In total, 135 geriatric patients with coronary heart disease (CHD) were examined. The diagnostic algorithm was based on the results of coagulogram, blood biochemistry, measurement of C-reactive protein (CRP) levels, treadmill test, echocardiography (EchoCG), coronary angiography (CA), and LV ventriculography (LVG).
Results. Decreased hematocrit levels (p<0,05), increased levels of urea (p<0,05) and creatinine (p<0,05), reduced LV ejection fraction (p<0,05), increased end-diastolic volume (p<0,05), as well as restrictive type of LV dysfunction, were among age-dependent determinants of angina progression in elderly patients. The major determinant of ischemia severity was multi-vessel coronary pathology, manifested in higher angina classes, reduced exercise capacity (p<0,05), and impaired local LV contractility (p<0,05).
Conclusion. To objectively assess the severity of clinical course of CHD in elderly patients, the following data should be taken into account: hematocrit and CRP levels, increased levels of creatinine and urea, and the results of EchoCG, CA, and LVG.

Aim. Based on the autopsy data, to investigate the role of various risk factors (RFs) in the development of the incident cases of pulmonary thromboembolism (PTE) and their outcomes among the patients who died in Tomsk City hospitals (2003-2010).
Material and methods. The analysed data came from autopsy protocols and medical histories of all patients (n=651) who had PTE diagnosed prior to or after death and who died in Tomsk hospitals between March 1st 2003 and December 31st 2010. The pathologoanatomical examination used the total evisceration technique by Shor. Data analysis was performed with the Pentium-V software package “Statistica for Windows”. The impact of RFs and treatment on the PTE outcome was assessed in a statistical model.
Results. The presence of two or three RFs was associated with a higher risk of fatal in-hospital PTE. Overall, the risk of fatal PTE was explained by RF patterns (56,0%), inadequate treatment (43,9%), and other factors (0,1%).
Conclusion. The identified features of the impact of RFs and medical treatment on the PTE outcome in Tomsk hospitals (2003-2010) should be taken into consideration when planning the strategy of improving the effectiveness of diagnostics, prevention, and treatment programmes.

Aim. To assess the predictive value of syncope in the clinical course of pulmonary thromboembolism (PTE).
Material and methods. The study included 117 PTE patients (62 men and 55 women; mean age 51,86±13,4 years). High and intermediate risk of fatal outcome was observed in 37 and 80 patients, respectively. In all participants, PTE diagnosis was verified by pulmonary artery (PA) computed tomography. All patients were divided into two groups: Group I (n=35) with syncope registered 1-30 days ago (median time 1 day) and Group II (n=82) without syncope. The groups were comparable by age, gender, time of the clinical onset, clinical risk of PTE, and PA pressure levels. However, in Group I patients, the prevalence of high risk of fatal outcome was twice as high as in Group II participants (45,7% vs. 25,6%; p=0,032). To compare the thrombolysis therapy (TLT) independent levels of in-hospital mortality, the two TLT-free subgroups – 1 (14 patients with syncope) and 2 (58 patients without syncope) – were identified.
Results. Syncope was associated with massive PA embolism (60% in Group I vs. 39% in Group II; p=0,036), often accompanied by shock/ hypotension (49% vs. 28%, respectively; p=0,032). Group I patients required TLT twice as often as Group II subjects (p=0,001), which resulted in reduced in-hospital mortality levels among individuals with syncope (p=0,048). Overall, both groups did not differ significantly by the levels of in-hospital mortality, while syncope patients demonstrated a tendency towards increased mortality (14,2% and 8,5%; p=0,35). However, in the absence of TLT, mortality levels reached 28,5% (4/14) in Subgroup 1 and 8,6% (8/58) in Subgroup 2 (p=0,042).
Conclusion. Syncope in patients with possible PTE should be regarded as a marker of high risk of in-hospital death, due to a high prevalence of embolism in the PA trunk and main branches. TLT could improve the inhospital prognosis. To clarify the issue of prognostic value of syncope in PTE, further studies are necessary.

Aim. To assess the role of hypobarotherapy in the correction of cardiovascular disease (CVD) risk factors (RF) among women in early postmenopause.
Material and methods. The hypobaric hypoxia adaptation method (Ural-1 barochamber, 22 daily three-hour sessions; simulated altitude 3500 m, or 460 mm Hg) was used for the metabolic syndrome treatment in 56 women (mean age 53,6±3,1 years) in early postmenopause.
Results. The treatment-induced decrease reached 53,5% for modified menopausal index; 6,1% for body mass; 13,4% and 7,3% for systolic and diastolic blood pressure; 19,5% for cholesterol; 21,3% for glucose; and 20,2% for insulin. Systolic and diastolic left ventricular function parameters also improved.
Conclusion. Hypobarotherapy was an effective method for the CVD RF correction among women in early postmenopause.

Aim. To assess the knowledge of primary care physicians on the choice of medications for the long-term treatment of cardiovascular disease (CVD); on the control of pharmacological therapy effectiveness and safety; and on the selection of optimal medications for specific clinical situations.
Material and methods. In 2010, a voluntary survey of Moscow physicians working at specialised and municipal out-patient clinics was conducted. The number of participants was 281 (response rate 70%).
Results. Thirty percent of the physicians correctly identified a selective β-adrenoblocker (β-AB) from the list of various medications. Typical adverse effects of statins, β-ABs, and calcium antagonists were known to 33%, 66,4%, and 38%, respectively. Every fifth respondent (22,6%) would recommend ACE inhibitors or angiotensin II receptor antagonists (captopril or losartan) to pregnant women. Sixty six percent of the participants identified the patients’ unwillingness to simultaneously take many medications and the fear of adverse effects (AE) as the major barriers to prescribing modern complex pharmacological therapy.
Conclusion. Specialised questionnaires, used for interactive voting, and point-based assessment system provided an opportunity to identify the inadequate physicians’ knowledge of pharmacological therapyrelated AE and of the AE registration system. Poor knowledge of clinical recommendations affects the physicians’ ability to make correct decisions in specific clinical situations.

The paper discusses the role of organoprotection in arterial hypertension treatment. The results of international studies on effectiveness of olmesartan, a modern angiotensin II receptor antagonist, are presented. The available evidence confirms not only a strong antihypertensive effect of olmesartan, but also its vasoprotective characteristics. Olmesartan reduces vascular inflammation, facilitates the regression of vascular wall hypertrophy, and reduces the volume of atherosclerotic plaque. In Russia, the medication Cardosal® has become available relatively recently. Due to the extensive evidence base confirming its antihypertensive and vasoprotective effects, this medication appears promising for various clinical groups of Russian hypertensives. Not only adequate blood pressure control, but also effective reduction in the risk of cardiovascular complications could be expected.

This review is focused on the role of latent inflammation in atrial fibrillation (AF) pathogenesis. The modern views and available evidence on the association between the levels of inflammatory markers and AF development and recurrence are presented. The justification for the use of pleiotropic effects of pharmacological therapy in AF prevention and treatment is discussed.

The review summarises the evidence from international publications on sudden cardiac death (SCD) in psychiatric patients receiving neuroleptics. Modern SCD definitions are presented, together with the relevant epidemiological data. The pathogenesis of fatal cardiac arrhythmias, caused by cardiotoxic effects of antipsychotic medications, is discussed. Electrocardiographic changes, in particular QT interval changes, as well as risk factors of SCD and main principles of its prevention, are described in detail.

This review presents the World Health Organization (WHO) data on diabetes mellitus (DM) epidemiology, medical and social consequences, and economic losses due to DM complications. It is demonstrated that the diagnostics of early carbohydrate metabolism disturbances (ECMD) is an important component of Type 2 DM (DM-2) prevention. At the same time, it is known that ECMD are an independent risk factor of cardiovascular disease (CVD). At early stages of DM-2, metabolic disturbances precede first clinical manifestations of diabetes. The importance of early (preclinical) diagnostics of ECMD is emphasised. The authors present the results of meta-analyses and large studies on DM and prediabetes, which have clearly demonstrated that pathological hyperglycemia cannot be diagnosed based only on fasting glucose levels, as this would underestimate the actual prevalence of prediabetes. Relevant methods of early ECMD diagnostics are described.