Aim. To investigate the features of antihypertensive therapy (AHT), as a method of left ventricular hypertrophy (LVH) prevention, in patients with essential arterial hypertension (EAH), absence of target organ damage (TOD), and high treatment compliance.
Material and methods. This prospective cohort study included 428 patients with EAH and no TOD (mean followup 8,8±2,6 years).
Results. In patients with EAH, and high treatment compliance, LVH incidence was 36,9 %. AHT was more aggressive in patients with LV remodelling, and was characterised by higher rates of combined treatment or b-adrenoblocker treatment.
Conclusion. In EAH patients with high treatment compliance, LVH incidence was lower than in general population. More aggressive AHT among patients with LVH could be explained by potential therapy resistance in this clinical group.

Aim. To assess the antihypertensive effectiveness of perindopril and enalapril, as well as their effects on metabolic parameters, in patients with arterial hypertension (AH) and obesity (O).
Material and methods. This blind, randomized, controlled, parallel comparative study included 60 patients with AH and O, who were administered perindopril or enalapril for 24 weeks.
Results. Perindopril demonstrated significantly better antihypertensive effectiveness, cardio-, angio-, and nephroprotection, as well as an improvement in lipid, carbohydrate, and purine metabolism parameters. In patients with AH and O, only perindopril had beneficial effects on insulin resistance, hyperleptinemia, and inflammation. In contrast to enalapril treatment, perindopril therapy was associated with a marked improvement in anthropometry parameters and a reduction in fat tissue deposits.
Conclusion. In patients with a combination of AH and O, perindopril was superior to enalapril in terms of antihypertensive effectiveness, organ protection, and the effects on key humoral factors determining body mass increase and blood pressure elevation.

Aim. To study the incidence, time of development, and the main causes of recurrent myocardial ischemia after effective revascularization and percutaneous coronary intervention (PCI).
Material and methods. The study included 108 patients PCI with coronary artery (CA) stenting (85 men (78,7 %), 23 women (21,3 %)), who were followed for two years. All participants underwent clinical examination, blood biochemistry, electrocardiography (ECG), 24-hour ECG monitoring, stress echocardiography (EchoCG), and coronary angiography (CAG).
Results. After PCI, favorable clinical course of coronary heart disease (CHD) was observed in 72 patients (66,7 %), while recurrent ischemia or a reduction in FC of effort angina was registered in 36 (33,3 %). Among women, recurrent or persistent ischemia was more prevalent than among men: 13 (56,5 %) vs. 23 (27 %) cases (p=0,015). Positive test stress EchoCG was observed in 30 patients. Based on the repeat CAG results, recurrent ischemia was due to incomplete myocardial revascularization (n=15), in-stent restenosis (n=12), or atherosclerosis progression (n=10).
Conclusion. Active clinical examination is recommended to all patients after PCI, especially women. Stress EchoCG is recommended within first 9 months after PCI for angina-free patients and at any time for patients with recurrent angina.

Aim. To study the prevalence of choleretic system pathology in patients with coronary heart disease (CHD) and recent acute coronary events; to assess the effects of the long-term, moderate-intensity physical training (PT) programme on the gallbladder (GB) function, lipid metabolism, and exercise capacity (EC).
Material and methods. First, the prevalence of gastrointestinal symptoms was assessed in CHD patients with recent acute coronary events. Second, 85 patients with concomitant GB dysfunction were randomised into the main group (MG; n=43) receiving moderate-intensity PT, or the comparison group (CG; n=42). The intervention effectiveness was assessed by the clinical, functional, and biochemical parameters at baseline and 12 months later. All patients received standard pharmaceutical treatment, as required.
Results. Gastrointestinal symptoms were reported by 81 % of the patients, including 75,9 % with hypotonic-hypokinetic GB dysfunction. The six-minute walk test distance increased. After the PT course, the GB volume decreased from 37,5±2,7 to 27,3±2,1 ml in the MG, and did not change in the CG. GB dysfunction prevalence decreased by 62,7 % in the MG and increased by 3,1 % in the CG.
Conclusion. In CHD patients after acute coronary events, the prevalence of GB dysfunction was 78,9 %. The longterm, moderate-intensity PH programme, combined with standard pharmaceutical therapy, improved EC, reduced angina attack incidence, and normalised GB motoric function and serum lipid profile in CHD patients with concomitant GB dysfunction.

Aim. To study the dynamics of left ventricular (LV) remodelling in patients with myocardial infarction (MI) and reversible ischemic dysfunction, before and after myocardial revascularization.
Material and methods. The study included 69 patients after MI. All participants underwent two-dimensional echocardiography (EchoCG), within 24 hours after hospital admission and one month after revascularization. After three-four days of treatment and clinical stabilization, the patients underwent stress EchoCG with dobutamine, to assess myocardial viability.
Results. Complete or partial recovery of all asynergic myocardial segments was observed in 22 (Group I) and 19 (Group II) patients, respectively, while in 28 (Group III), LV aneurysm was detected. In most patients from each group, transluminal balloon angioplasty (TLBAP) with stent implantation was performed. The proportion of conservatively treated patients was maximal in Group III. Despite revascularization, in coronary patients with impaired myocardial viability (Group III), the increase in ejection fraction and reduction in end-systolic volume was significantly lower than in patients with viable myocardium. Sphericity index, relative wall thickness index, and myocardial stress parameters were increased in each group, although this increase was non-significant in Group III. After revascularization, a significant reduction in end-systolic volume, and a tendency towards enddiastolic LV volume reduction were observed in each group, being maximal in Group I.
Conclusion. In MI patients with viable myocardium in dyskineticLV zones, revascularization surgery should be considered.

Aim. To assess the dynamics of structural and geometric left ventricular (LV) remodelling and myocardial electrical instability in patients with post-infarction cardiosclerosis (PICS), at baseline and one year after coronary artery bypass graft (CABG) surgery.
Material and methods. The study included 54 patients with PICS (mean age 57,9±6,2 years) and previous coronary revascularization (up to two years earlier). The examination included 12-lead electrocardiography (ECG), with QT interval analysis (QTd, QTс), Holter ECG monitoring, echocardiography, signal-averaged ECG (SA ECG) with late ventricular potential analysis, heart rate variability (HRV) and heart rate turbulence (HRT) assessment.
Results. The analysis of structural and geometric parameters in patients after myocardial revascularization demonstrated adaptive LV remodelling, independent of the type of myocardial changes. Improved coronary perfusion after revascularization was associated with positive dynamics of SA ECG parameters, normalization of the last part of filtered QRS complex (in 26 % of the patients), and a decrease in QTd (-24 %) and QTс (-12,8 %). After CABG, HRT and HRV parameters also improved.
Conclusion. In patients with coronary heart disease, the parameters of myocardial electrical instability could be used as additional, non-invasive markers of revascularization effectiveness.

Aim. To assess intima-media thickness (IMT) of carotid arteries (CA), large artery elasticity, and their effects on clinical prognosis in patients with ischemic chronic heart failure (CHF).
Material and methods. The study included 207 patients (mean age 55,1±6,4 years) after myocardial infarction (MI), with CHF symptoms, and 40 healthy controls. The assessment of CA IMT was performed with Acuson 128 XP/10 device; large artery elasticity and stiffness was assessed with arteriograph TensioClinic (TensioMed, Hungary).
Results. In CHF patients, increased CA IMT, increased large artery stiffness, and an association between aortic pulse wave velocity (APWV) and CA IMT were observed. APWV values >12 m/s were associated with a significantly higher risk of CHF decompensation (р=0,001), repeat MI (р=0,01), death (р=0,001), and all major cardiovascular events (CVE) (р=0,01), compared to APWV ≤12 m/s. Multivariate analysis results demonstrated that in CHF patients with APWV >12 m/s, one-year risk of CVE was 2,02 times higher than in patients with APWV ≤12 m/s (hazard ratio 2,02; 95 % CI 1,01-4,03).
Conclusion. CA IMT was associated with APWV, while the latter was an independent risk factor of CVE in patients with ischemic CHF.

Aim. To identify the predictors of recurrent atrial fibrillation (AF) in patients with arterial fibrillation (AF), based on the analysis of circadian heart rate variability (HRV).
Material and methods. The study included 62 patients with recurrent AF: 44 with AH (main group, MG) and 18 without AH (control group, CG). All participants underwent clinical examination, anamnestic assessment, Holter electrocardiography (ECG) with circadian HRV analysis, and echocardiography.
Results. Based on the circadian HRV data, the predictors of recurrent AF in AH patients could include reduced range of cardiac intervals (up to 805,1 ms) and reduced standard deviation (<116,2 ms) among individuals with concentric left ventricular hypertrophy (LVH), as well as increased PNN50 >7,5 % and increased RMMSD >24,7 ms among individuals with eccentric LVH and LV dilatation.
Conclusion. In AH patients with concentric LVH, recurrent AF is associated with increased sympathetic stimulation. As myocardial remodelling progresses, recurrent AF is linked to increased parasympathetic activation.

Purpose. To assess effectiveness of fluoxetine treatment of depressive disorders among female patients at menopause in various AF types and impact of this treatment on AF.

Materials and methods. The first study group includes 36 female patients with various types of AF and depressive disorders, who took anti-depressant fluoxetine for 6 months period with daily dose of 20 mg. The second reference group includes 34 female patients with various types of AF and major depressive disorder who did not go through treatment of depressive disorders. In both groups the baseline antiarrhythmic therapy has been applied. Evaluation was performed in 6 months after start of treatment. The following has been evaluated: frequency of AF attacks, transition of tachicardic AF type to normocardic AF type and degree of depression as per the questionnaire CESD.
Results. Degree of depression intensity who were treated by fluoxetine overall decreased by 3,9 points. Decrease in the rate of depression disorders was accompanied by stop of AF attacks among 12,0 % of the patients and by lower frequency of AF attacks among 64,0 % of the patients with paroxysmal and persistent AF types; transition of tachicardic type to normocardic among 54,5 % of patients with permanent AF type. The most evident clinical effect was observed in the group with paroxysmal and persistent AF types. The least clinical effect of fluoxetine treatment is observed in the group with permanent AF type, which possibly can be explained by more evident degree of heart failure and heavier disease progression.

Conclusion. Antidepressant fluoxetine reduces severity of depressive disorders among female patients at menopause with AF, and reduces severity of progression of the various AF types.

Aim. To investigate the features of hemodynamic changes and autonomic regulation in adolescents with Stage I-II mitral valve prolapse (MVP).
Material and methods. In total, 112 adolescents with MPV underwent clinical examination, Doppler ultrasound, and cardiointervalography.
Results. Stage I MVP was associated with predominantly autonomic symptoms in 72,7 % of the patients; in 59,5 %, increased sympathetic activation was observed. In Stage II MPV patients, connective tissue dysplasia was registered in 85,4 %, with predominant parasympathetic effects in 47,4 %. Mitral valve visualization (B-mode Doppler ultrasound) demonstrated changes in the valve structure in 49,5 % and 5,4 % of Stage II and I MVP patients, respectively (p<0,001). During clino-orthostatic test, adolescents with MVP had inadequate hemodynamic reaction, especially in Stage II MVP.
Conclusion. Сlinical and functional features were explained by the pathogenetic mechanisms of Stage I and II MVP: the former was characterised by increased sympathetic activation, decreased left ventricular volume, and predominance of chordae and leaflets over mitral annulus; the latter was characterised by inadequacy of valve connective tissue, as a manifestation of connective tissue dysplasia syndrome.

Aim. To study the role of vitamin D in the prevention and treatment of cardio-renal syndrome (CRS), chronic allograft nephropathy (CAN), as well as in the renal and cardiac tissue reparation.
Material and methods. This randomized, blind, placebo-controlled study included 120 vitamin D-deficient Russian and Dutch patients — recipients of asystolic and cadaver donor kidneys. All participants were divided into 4 groups: 28 subjects received paricalcitol (2-4 μg/d); 28 — calcitriol (1-6 μg/d per os); 26 — diet and multivitamins (daily vitamin D consumption of 1200-1800 IU); and 27 — placebo plus controlled diet.
Results. At Day 180, CAN severity reached 1,24 in the paricalcitol group and 1,22 in the calcitriol group, compared to 1,43 and 1,68 in the diet and placebo groups, respectively (p<0,05). Baseline glomerular filtration rate, measured immediately after the transplantation, was changed at Day 180 in all groups (p<0,05). FACS analysis revealed a qualitative induction of SP+ renal epithelial cells and cardiomyocytes at Day 180 (p<0,05). In the paricalcitol, calcitriol, and diet groups, the levels of CD133, CD34, CD73, and CD105 were significantly higher than in the placebo group (p<0,01), which was consistent with renal expression of nuclear vitamin D receptors, NVDR (p<0,05). Circulating stem progenitor cells (SPC) demonstrated a relatively high level of NVDR expression (p<0,05). Hypercalcemia, as one of the most important complications of vitamin D therapy in CAN patients, was observed only in 4 out of 28 participants (14 %) in the calcitriol group (p<0,001). Antihypertensive therapy resulted in the reduction of blood pressure levels, from 180/101 mm Hg at baseline to 143/87, 141/94, 147/102, and 165/101 mm Hg in the respective intervention groups (p<0,01). A decrease in the chronic heart failure functional class (NYHA classification) was also observed. Six months after the transplantation, mean CCS score was 533, 611, 524, and 990 in the respective groups (p<0,05).
Conclusion. Vitamin D is an effective medication for CRS and CAN prevention and treatment, which also stimulates renal and myocardial tissue reparation. In the clinical practice settings, the optimal forms of vitamin D therapy are treatment with an analog of active vitamin D — paricalcitol (204 μg/d), and special diet in combination with multivitamins (up to 1800 IU of cholecalciferol per day).

Aim. To study the prevalence of behavioural risk factors (RFs) in the Perm Region population.
Material and methods. Across 36 areas of Perm Region, 1868 people (810 men, 42,3 %) participated in the questionnaire survey. Mean age of the respondents was 52,3±5,78 years; 36 % of the participants were aged under 30 years, 38,8 % — from 31 to 55 years, and 25,2 % — over 55 years.
Results. The majority of male and female respondents self-assessed their health as “satisfactory”. Prevalence of smoking and sedentary lifestyle was 70,5 % and 44,2 %, respectively. Health diet awareness was low; 70 % of young respondents reported never being advised on diet modification. Doctor, as a main source of information on healthy diet, was identified by 7 % and 26 % of the younger and older respondents, respectively. High blood pressure (BP) was registered in 700 participants (42,8 %). Almost 50 % of the respondents reported having their cholesterol measured, but cholesterol levels were known only by every fourth participant (26,6 %). Hyperglycemia awareness was very low, reaching only 10,2 % among all participants with high blood glucose levels.
Conclusion. Modifiable RFs, such as low physical activity, smoking, unhealthy diet, and alcohol, remain an important healthcare problem, together with low healthy lifestyle awareness. Active participation of local health professionals in health promotion, counseling, and education is necessary to tackle this problem.

Aim. To study the levels of biochemical markers of cardiovascular risk (CVR) and the ultrasound-assessed target organ damage (TOD), such as intima-media thickness (IMT), atherosclerotic plaques (AP) in carotid arteries (CA), and left ventricular myocardial mass index (LVMMI), in patients with low and intermediate risk by the SCORE scale (ESH/ ESC 2003, 2007).
Material. The study included 600 individuals aged 30-65 years (445 women, 155 men) with low and intermediate CVR by SCORE scale, without manifested atherosclerotic pathology or diabetes mellitus.
Methods. CVR was stratified by: SCORE scale and clinical recommendations by ESH/ESC (2003, 2007); duplex CA ultrasound, IMT and CA AP assessment; Doppler echocardiography with LVMMI calculation (Penn-cube method); blood biochemistry with lipid profile, blood glucose, and serum creatinine (Cr) level assessment.
Results. Dyslipidaemia was observed in all clinical groups; however, no significant differences between the groups were observed for the participants aged ≤45 years. In participants aged 45-55 and ≥55 years, there was a statistically significant IMT difference between low and intermediate risk groups (р=0,03 and 0,01, respectively).
Conclusion. The proportion of people with dyslipidaemia was high in all risk groups, regardless of age. CA AP were registered across all groups, regardless of risk level and age. No statistically significant differences were observed for the groups “intermediate risk, one AP” and “high risk, 1 AP”.

Aim. To perform an additional assessment of cardiovascular risk (CVR) levels in patients with low and moderate risk by SCORE scale (European Society of Hypertension/European Society of Cardiology, 2003, 2007), in order to identify the individuals with high CVR; to study the effectiveness of Liptonorm (atorvastatin) in lipid profile correction among these patients.
Material and methods. At 12 policlinics (Moscow City, Western Autonomic City District), all patients visiting GPs were examined, with SCORE CVR levels assessed. The study included 600 patients with low and moderate risk. Additional examination at the Russian Cardiology Scientific and Clinical Centre took place one month later. All participants underwent duplex ultrasound of carotid arteries, with intima-media thickness (IMT) and atherosclerotic plaque (AP) assessment; computed sphygmography and automatic assessment of brachial-ankle pulse wave velocity (PWVba); blood assay and lipid profile assessment.
Results. AP prevalence was 59 % (358 patients out of 600), while the prevalence of IMT increase >0,9 mm was only 5 % (28/600), which suggested a modest impact of IMT on total CVR. Pre-clinical arterial wall pathology was registered in 337 participants (56 %). The results obtained support the role of subclinical atherosclerosis as an independent risk factor (RF).
Conclusion. Subclinical atherosclerosis diagnostics with duplex ultrasound of brachiocephalic arteries could be recommended for risk stratification.

The authors review the current evidence on the effectiveness of a highly selective b-adrenoblocker bisoprolol in the treatment of arterial hypertension and/or coronary heart disease. The issues of bisoprolol therapy in the specific clinical subgroups of cardiac patients (such as elderly people and smokers) are discussed.

Aim. To differentiate angiotensin II receptor blockers (ARBs) by vascular effects and outcomes in trials on cardioprotective endpoints.
Data sources. MEDLINE searches were conducted from January 2003 to March 2009 using the following search terms: renin-angiotensin-aldosterone system (RAAS) blockade or inhibition; angiotensin II receptor blocker (ARBs); cardioprotection; vascular protection; end-organ protection; candesartan; eprosartan, irbesartan; losartan; olmesartan; telmisartan; and valsartan. Ongoing and recruiting clinical trials were identified via Clinicaltrials.gov (July 2008).
Study selection and data abstraction. Pertinent basic science research and clinical trials with cardiovascular endpoints and information from reviews, American Heart Association 2009 statistics, and The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines were included in this review.

Data Synthesis. ARBs differ in their vascular protective pleiotropic effects and pharmacokinetic properties, which may contribute to their pharmacological protection to reduce cardiovascular morbidity and mortality, independently of their blood pressure (BP)-lowering effects.
Conclusion. Emerging data show that ARBs are effective in hypertension, left ventricular hypertrophy, postmyocardial infarction, and heart failure. To what extent their pleiotropic effects, independent of BP lowering, contribute to these outcomes will be the focus of research in the coming years. Well-designed, comparativeeffectiveness studies are needed to clinically differentiate this class of agents. The future will be marked by multifunctional ARBs that will pharmacologically do more than antagonize the angiotensin type I (AT1) receptor.

This literature review is focused on psycho-emotional status in patients with various clinical forms of coronary heart disease (CHD), as well as the specifics of autonomic regulation and clinical course, including CHD prognosis. The authors describe selected methods for objective dynamic assessment of these characteristics and their interrelations.

According to the modern views, coronary heart disease (CHD) is a heterogeneous disease with pathophysiological and pathomorphological features. In clinical practice, CHD often is combined with other cardiac and extracardiac pathology, which results in certain clinical CHD types. The review describes the best-known of these types, as well as suggests the potential new types, which might affect early diagnostics and effective treatment of CHD.