Aim. To study the dynamics of arterial hypertension (AH) epidemiology in urban and rural population of Bryansk Region, aged 19-64 years. To evaluate AH awareness, treatment, and control in the local healthcare settings. Material and methods. Random representative samples of the urban and rural Bryansk Region population - men and women aged 19-64 years - were selected. The study sample was constructed in three stages: selection of policlinics and central regional hospitals; selection of healthcare catchment areas; and selection of households (flats). At the first stage, a random urban and rural sample of 2345 people (response rate 78%) was examined; at the third stage, a sample of 1909 individuals (response rate >70%) was examined. The data were collected using a unified registration form (140-1/u). The study was performed as a part of the Target Federal Program, Ministry of Health. Results. In rural men and women, AH prevalence was 25,9% and 35,4%, while in their urban peers, it was 30% and 38,6%, respectively. The respective levels of AH awareness in urban and rural participants varied from 87,5% to 90,4%, and from 86,6% to 94,6%. In rural and urban samples, AH treatment percentages were 60,3%-76,8% and 77,5%-82,9%, respectively. Effective blood pressure control was achieved in 14,3%-13,8% and 10,1%-29,8% of rural and urban AH patients, respectively. The most popular antihypertensive medications were ACE inhibitors (59,0%–64,1%), diuretics (34,8%–37,0%), beta-adrenoblockers (12,8%–31,6%), and calcium antagonists (10,5%–12,4%). Conclusion. The urban population of Bryansk Region demonstrated higher levels of AH prevalence, awareness, treatment, and especially control throughout the four-year follow-up period.

Aim. To study the prevalence and specific clinical features of metabolic syndrome (MS) in a random sample of urban adult population. Material and methods. In total, 1800 participants were randomly selected: 749 men and 1051 women, aged 30-69 years. The study protocol was completed by 1570 subjects: 620 men and 950 women (response rate 87,2%). All participants underwent standard questionnaire survey, anthropometry, and the measurement of blood pressure (BP), blood lipids, and blood glucose (fasting glycemia and glycemia at 2 hours after oral glucose tolerance test). Results. According to the NCEP ATP III criteria, MS was registered in 314 participants (20,6%), and according to the IDF criteria – in 447 (28,5%; p<0,0001). On average, MS was twice as prevalent in women as in men. In both genders, advanced age was associated with increasing MS prevalence. The majority of the participants had three MS components (61,5%). Four MS components were registered in 28,7%, and all the components were observed in 9,8%. The most prevalent MS component was low level of high-density lipoprotein cholesterol (68,8%), followed by hypertriglyceridemia (65,3%), abdominal obesity by ATP III criteria (65%), arterial hypertension, AH (65%), and hyperglycemia (45,2%). Each third respondent with MS demonstrated clinical manifestations of atherosclerosis, such as coronary heart disease, myocardial infarction in anamnesis, peripheral or cerebrovascular atherosclerosis. Conclusion. Among this working-age population, MS prevalence was 20%. The most common MS components included dyslipidemia, AH, and abdominal obesity. Each third MS patient had various manifestations of cardiovascular pathology.

Aim. To study hemorheological disturbances in patients with essential arterial hypertension (AH) and dyslipidemia (DLP). Material and methods. In total, 83 AH patients without target organ disease were examined, including 30 without lipid metabolism disorders and 53 with DLP (total cholesterol, TCH >5 mmol/l and/or triglycerides, TG >1,7 mmol/l). All participants underwent general clinical examination and hemorheology assessment (hematocrit, plasma viscosity, blood viscosity by rotation viscosimetry at various shift speeds, erythrocyte aggregation (EA) by optic and automatic methods, erythrocyte deformability (ED) by filtration method, and erythrocyte cytoarchitectonics). Results. In patients with AH and DLP, comparing to healthy participants, impaired blood rheology was observed, manifesting in increased blood viscosity in high and average shift speeds, increased EA and impaired ED, which correlated with lipid metabolism disturbances. Conclusion. In patients with AH and DLP, blood rheology parameters were significantly affected due to disturbed lipid metabolism.

Aim. To assess memory and attention parameters, as well as their association with circadian blood pressure (BP) profile, in young male military officers with arterial hypertension (AH). Material and methods. In total, 47 men with Stage I-II essential AH (EAH) (mean age 39,3±0,8 years), not treated previously or treated irregularly, were examined (main group, MG). The 24-hour BP monitoring (BPM) and cognitive function (memory and attention) assessment were performed. The cognitive function association with AH stage, BP elevation degree, and AH duration was also investigated. The control group (CG) included 12 normotensive men. Results. In the MG, comparing to the CG, the memory and attention parameters were decreased as early as at Stage I AH and with AH duration <5 years. Reduced scopes of semantic memory and attention were observed in men with AH irrespective of its duration. There was a negative correlation between 24-hour BPM parameters and memory and attention indices. Conclusion. In young male officers with AH, mild cognitive disturbances were observed even at Stage I of the disease, and were more prevalent at Stage II.

Aim. To investigate the parameters of central, intracardiac, and organ hemodynamics in various age groups, among the patients with previously diagnosed arterial hypertension (AH). Material and methods. The study included 1846 patients with primary AH of labile (borderline and Stage I AH) or stable (Stage II-III AH) clinical course, aged 16-72 years. Central and intracardiac hemodynamics parameters were assessed by echocardiography; carotid, suprapubic, and supraclavicular arteries were examined by Doppler ultrasound; retinal vessels – by ophthalmoscopy; renal arteries – by Doppler ultrasound and X-ray angiography; and abdominal aorta - by dynamic renal scintigraphy and Doppler ultrasound. Results. In patients with primary AH, older age correlated with higher systolic blood pressure (BP), decelerated heart rate, and lower diastolic BP. Hyperkinetic hemocirculation type was more common in patients with labile AH, combining with psychotic disturbances and syndromes; however, this type was not common in participants with stable AH. Conclusion. Antihypertensive therapy effectiveness and response were substantially lower in older patients with primary AH. In stable AH, this inverse association was less strong, possibly due to dominating renal and renovascular mechanisms of antihypertensive treatment resistance.

Aim. To study the effects of cardiologic shock wave therapy (SWT) on the clinical manifestations of effort angina (EF) and left ventricular (LV) myocardial contractility, as well as to investigate the safety of SWT, as a part of combined therapy, in patients with coronary heart disease (CHD). Material and methods. The study included 40 patients, aged 44-75 years, with the diagnosis of CHD, Functional Class (FC) II-III stable EF (Canadian Cardiovascular Society classification). The participants were randomised into two groups. The main group (MG; n=20) received standard pharmaceutical therapy (PT) and SWT, while the control group (CG; n=20) received PT only. Before and after the SWT course, questionnaire survey, clinical examination, electrocardiography (ECG) at rest, treadmill stress test, echocardiography (EchoCG), stressEchoCG, and measurement of creatine phosphokinase (CPK) and MB-CPK levels were performed. Quality of life (QoL) was assessed by the SF-36 scale. All patients were given self-control diaries, to record blood pressure (BP) levels, angina attack incidence, and any adverse effects. The SWT course included 9 procedures (3 procedures with one-day intervals in Weeks 1, 5, and 9), using the “Cardiospec” system. Results. The SWT therapy was associated with an 8-fold reduction in nitrate doses (a significant difference with the CG). The angina attack incidence significantly reduced, from 7 to 1 per week. In the stress test, the exercise capacity and test time increased by 28% and 20%, respectively, in MG patients with CHD, FC II-III EA. The mean FC changed from II to I. There was a two-fold reduction in the size of hypokinetic myocardial zones, and a significant decrease in local dyskinesia index (-7%). In the MG, QoL substantially improved. The SWT course did not affect impulse generation and conduction in myocardium, as well as CPK and CPK-MB levels. Conclusion. SWT is a safe therapeutic method, improving myocardial perfusion, physical stress tolerability, QoL, and reducing angina attack incidence.

Aim. To study the dynamics of structural and functional parameters of left atrium (LA) in various localizations of myocardial infarction (MI), as a response to structural and functional remodelling of left ventriculum (LV). Material and methods. In total, 180 patients with primary acute LV MI and ST segment elevation were randomised into three groups: Group I – anterior MI (AIM); Group II – inferior MI (IMI); and Group III – posterior/lateral MI (PLMI). At Days 7, 90, and one year later, transoesophageal, transthoracic two-dimensional, flow and tissue Doppler ultrasound was performed, with the assessment of LV, LA body, and LA appendage (LAA) structure and function. Results. At baseline, LF structure and function were significantly lower, and end-systolic volume index was significantly higher in AIM than in IMI and PLMI, due to reduced LV contractility and increased LV rigidity. The maximal changes in baseline volume and functional LA characteristics were registered in PLMI, due to direct myocardial damage, the minimal changes – in IMI, with no negative dynamics in one year. The follow-up demonstrated progressing structural and functional LV and LA changes in AMI, with relatively stable LAA function. In PLMI, LAA function was reduced during the entire follow-up period. Conclusion. Structural and functional post-MI changes were observed for LV and LA, with the magnitude of these changes depending on MI localization. The most severe LV and LA dysfunction were registered in AMI. In PLMI, LA dysfunction was explained by the direct myocardial damage.

Aim. To perform pharmacoeconomic analysis of the standard therapy vs. standard therapy plus enteric-coated aspirin, Aspirin Cardio®, in preventing acute myocardial infarction (AMI) among patients with stable angina (SA). Material and methods. To assess the effectiveness of Aspirin Cardio®, the results of the randomised SAPAT Study were used. The costs of treating 100 SA patients for 50 months were modelled for standard therapy only and compared with the study results for standard therapy plus Aspirin Cardio®. Two types of analysis were performed: “budget impact analysis of in- and outpatient treatment of SA” and “cost-effectiveness” analysis. Results. Overall costs of treating 100 SA patients for 50 months were 7 826190 roubles for standard therapy with betaadrenoblockers, and 7 751072 roubles – for standard therapy plus Aspirin Cardio®. Therefore, costs were lower by 75118 roubles per 100 patients treated with standard therapy and Aspirin Cardio® for 50 months. Costs of preventing one AMI case were lower for combined therapy than for standard therapy alone: 81248 vs. 84699 roubles, respectively. Total costs of preventing one AMI case are lower by 34144 roubles for combined therapy, comparing to standard therapy only. The combination of standard therapy and Aspirin Cardio® reduces mortality in many SA patients, due to decreased sudden death rates, and also cuts costs on preventing one death by 62598 roubles. Conclusion. Pharmacoeconomic analysis demonstrated that a combination of standard therapy plus Aspirin Cardio® improves “cost-effectivenes” ratio in SA patients.

Aim. To compare the effectiveness of ramipril + amlodipine and enalapril + amlodipine combinations in the treatment of Stage I-II arterial hypertension (AH) in women with postmenopausal metabolic syndrome (MS). Material and methods. The study included 80 postmenopausal women with AH and MS. The control group consisted of 25 healthy women. The treatment phase lasted for 24 weeks. In all participants, the effects of the combinations on blood pressure (BP) and endothelial vasodilatation were assessed. Endothelial function was measured in a reactive hyperemia test; NO metabolites in serum were measured using the method by N.L. Emchenko et al. (1994). Metabolic effects of the medications were assessed by the dynamics of lipid and carbohydrate metabolism parameters. Results. The combination of ramipril and amlodipine more effectively controlled BP and improved carbohydrate and lipid metabolism parameters in postmenopausal women with Stage I-II AH and MS. This combination was also more effective in terms of endothelium protection, which manifested in normalized endothelium-dependent vasodilatation and increased production of NO metabolites. Conclusion. The combination of ramipril and amlodipine could be recommended for the treatment of postmenopausal women with AH and MS.

Aim. To assess quality of life (QoL) and severity of vegetative dysfunction syndrome (VDS) in patients with idiopathic mitral valve prolapse (MVP); to evaluate the effects of alprazolam therapy on QoL and VDS. Material and methods. This single-blind, placebo-controlled study included 60 patients with idiopathic MVP (33,3% men, 66,7% women). All patients were randomised into two groups: the main group (MG), receiving alprazolam, and the control group (CG), receiving placebo. Both groups were comparable by age (mean age 30,8±0,4 and 31,1±0,2 years, respectively) and gender structure. In all patients with idiopathic MVP, organic internal pathology was ruled out. Both groups underwent complex examination at baseline and 10 weeks after the therapy started. Results. Clinically significant effectiveness of the treatment (VDS severity reduction (in points) by at least 50%, comparing to the baseline level) was observed among 80,0% of the patients receiving alprazolam (71,4% men, 82,6% women) and only in 33,3% (58,3% men, 16,7% women) of the controls. Alprazolam was clinically effective by the “DISS-work” scale in 30% (28,6% men, 30,4% women), by the “social life” scale – in 43,3% (57,1% men, 39,1% women), and by the “personal relationships” scale – in 56,7% (42,8% men, 60,9% women). In the placebo group, the respective percentages were 43,3% (50% men, 38,9% women), 30,0% (41,7% men, 22,2% women), and 46,7% (58,3% men, 38,9% women). Conclusion. Alprazolam therapy demonstrated significant QoL improvement and VDS severity reduction in patients with MVP.

Aim. To study clinical and psycho-pathological features of anxiety disorders (AD), as well as quality of life (QoL) in the patients with implanted pacemakers (PM). Material and methods. In total, 75 patients underwent psychological testing with the Hospital Anxiety and Depression Scale (HADS) before and after the PM implantation. QoL was assessed with a short-form health survey instrument MOS-SF-36. Results. In 70,7% of PM patients, various AD forms were observed. Their prevalence and severity correlated with the duration and regimen of electrocardiostimulation (ECS), age, somatic pathology, and ECS complications. The highest summary QoL scores were registered in the patients with heart rate-adapting ECS, no manifested chronic heart failure, and those aged under 50 years. Conclusion. PM patients require additional psychological rehabilitation measures.

Aim. To study inflammatory reaction specifics in Vistar rats with non-coronary metabolic myocardial infarction (MMI). Material and methods. Electrocardiographical and histological verification of MMI. Measurement of neutrophil biocide activity, antioxidant system activity, the levels of lipid peroxidation (LP) products and pro-inflammatory cytokines, and plasma lipoprotein (LP) profile assessment. Results. In MMI rats, neutrophil biocide activity was increased, the balance between pro- and antioxidant systems was disturbed, plasma LP profile was affected, with increased pro-inflammatory LP levels, and pro-inflammatory cytokine concentrations were elevated. Conclusion. The observed inflammatory reaction specifics determined the clinical course of MMI.

The paper presents the design of the ORIGINAL Programme (substituting indapamide generics with arifon retard in patients with arterial hypertension), evaluating blood pressure (BP) reduction in arterial hypertension (AH) patients starting the treatment with original indapamide retard and previously receiving mono- or combined therapy with indapamide generics, without adequate BP control. This prospective, multi-centre, open, noncomparative programme will involve 328 out-patient internists and cardiologists from 56 Russian cities. In total, 1372 patients will be treated and followed up for 3 months. The aim of the programme is to demonstrate the benefits of original indapamide, comparing to indapamide retard generics, in terms of BP control and safety.

Aim. To study the effectiveness of combined therapy (Noliprel, Noliprel forte) and patients’ education, as a complex approach to maximal reduction of total cardiovascular risk. Material and methods. This multi-centre, randomized study, involving 350 therapeutists from 47 Russian cities, included 1050 patients with arterial hypertension (AH), uncontrolled by the previous pharmaceutical therapy. The antihypertensive therapy, AHT (Noliprel, Noliprel forte) was combined with patients’ education in the Health School, aimed at correction of such risk factors (RFs) as dyslipidemia, smoking, and overweight. The control group did not receive any educational intervention. Results. The long-term therapy with Noliprel/Noliprel forte demonstrated high effectiveness and safety of the medication. The prevalence of adequate blood pressure control and treatment response was so high (92,6%) that patients’ education did not increase this parameter. However, in the main group, total risk reduction was larger than in controls, mostly due to decreased smoking prevalence. Conclusion. The study demonstrated high effectiveness and safety of Noliprel/Noliprel forte therapy. Combination of modern AHT and patients’ education resulted in larger reduction of total cardiovascular risk, comparing to pharmaceutical AHT only.

Beta-adrenoblockers (BAB) in secondary prevention of coronary heart disease (CHD) are not always effective, due to non-achieved target heart rate (HR). The reasons for that could include medication intolerance, baseline bradycardia (HR<55 bpm), II-III Stage atrio-ventricular blocks, and acute episodes of generalized weakness when HR is reduced. In these situations, BAB could be effectively combined with ivabradine (10-15 mg/d). This combination provides an opportunity to achieve target HR levels (60-55 bpm).

A new, produced in Russia, form of acetylsalicylic acid (ASA), Askolong, could substantially improve patients’ compliance to long-term anti-aggregant therapy. Oral Askolong (12,5 mg) is absorbed via oral mucosa and does not cause gastrointestinal adverse effects, which are the main reason for treatment discontinuation in patients prescribed most oral ASA forms. Askolong demonstrates anti-aggregant effects similar to those for intestinally absorbed ASC medication ThromboASS. The latter dose of ASA is eight times higher, and gastrointestinal adverse effects are registered in 40% of the patients.

Currently, combined antihypertensive therapy is considered as the leading strategy in the management of patients with arterial hypertension. One of the effective combined antihypertensive medications is a hybrid agent urapidil, which chemical structure provides a combination of central antihypertensive action and peripheral vasodilatation. This review discusses the results of the clinical and experimental studies on urapidil antihypertensive effectiveness. The clinical use of the medication, as well as its good tolerability and safety, is also discussed.