The paper discusses the definition and classification of cardio-renal syndrome (CRS) — a pathological process in heart or kidneys, characterised by acute or chronic dysfunction of one organ which results in acute or chronic failure of the other organ. The pathophysiological mechanisms, diagnostics, and treatment are described for each clinical variant of CRS.

Aim. To assess the risk of fatal cardiovascular (CVD) events in medical doctors of various specialities, using modern risk scales, and to identify the target groups for primary prevention with a fixed-dose combination of enalapril / hydrochlorothiazide (HCT) and simvastatin. Material and methods. The programme included 12 non-teaching Russian hospitals and was divided into epidemiological, educational, therapeutic, and control phases. In 699 doctors, aged >40 years and representing 43 specialities (22,8% men; mean age 50,5±11,7 years), the risk of fatal CVD events and coronary events was assessed with SCORE and Framingham scales, respectively. All doctors were informed about their individual risk and target levels of risk factors (RFs), and also taught to self-control their blood pressure, physical activity, and body mass. In total, 287 doctors participated in the therapeutic phase (6 months): 52 were included in the antihypertensive therapy (AHT) group (enalapril/HCT); 38 – in the simvastatin group; and 197 – in the combined therapy group (AHT and simvastatin). Six months after the end of the therapeutic phase, the prevalence of continuing pharmaceutical and non-pharmaceutical primary prevention was analysed. Results. The prevalence of the main RFs was high: dyslipidemia was observed in 69,2% of the participants, AH – in 55,6%, abdominal obesity – in 34,5%, and smoking – in 14%. As many as 54,5% of the doctors had at least 3 RFs, while 25,8% had high SCORE-assessed risk, and 47,1% had indications for pharmaceutical primary prevention. The most adverse RF profile was registered in surgeons. Pharmaceutical primary prevention with a fixed-dose combination of enalapril/HCT and/or simvastatin significantly reduced both SCORE and Framingham risk levels. Six months after the therapeutic phase, 30,2% of the doctors stopped the treatment, and 37,2% continued pharmaceutical primary prevention. Conclusion. The results of the programme point to the high prevalence of modifiable RFs in middle-aged medical doctors. The data obtained could be a basis for the programs of primary CVD prevention.

Aim. To assess effectiveness and tolerability of combined antihypertensive therapy with various doses of an ACE inhibitor ramipril and hydrochlorothiazide (HCT) in patients with Stage 1-2 arterial hypertension (AH). Material and methods. In 3 clinical centres of Moscow City, 70 patients (50 % men, 50 % women; mean age 59±13,5 years) were randomised into 2 groups: Group I (n=27), receiving ramipril (5 mg) and HCT (25 mg); and Group II (n=32), receiving ramipril (10 mg) and HCT (12,5 mg). After 4 weeks of therapy, patients not achieving target blood pressure (BP) levels were administered ramipril in the dose of 10 mg and HCT in the dose of 25 mg. Therefore, the further 16-week follow-up was focused on 3 groups: Group I (n=18), receiving ramipril 5 mg and HCT 25 mg; Group II (n=19), receiving ramipril 10 mg and HCT 12,5 mg; and Group III (n=22), receiving ramipril 10 mg and HCT 25 mg. Treatment effectiveness was assessed by clinical BP levels after 4, 12 and 20 weeks. At baseline and in the end of the study, 24-hour BP monitoring (BPM), blood and urine biochemical assays were performed. Results. After 20 weeks of the therapy, clinical BP levels were reduced by -18,9±8,2/-10,8±7,5 mm Hg in patients receiving ramipril 5 mg and HCT 25 mg (p<0,001). In participants receiving ramipril 10 mg and HCT 12,5 mg, clinical BP levels decreased by -20,3±9,7/-11,6±6,0 mm Hg (p<0,001). The therapy with ramipril 10 mg and HCT 25 mg was associated with a reduction in clinical BP by -23,4±9,8/-10,6±7,8 mm Hg (p<0,001). According to 24-hour BPM data after 20 weeks of the treatment, mean circadian BP levels were reduced by -9,9±7,9/- 5,9±7,0 mm Hg (p<0,01) in Group I, by -15,8±13,2/-9,5±6,8 mm Hg (p<0,001) in Group II, and by -20,6±14,7/- 10,8±10,8 mm Hg (p<0,001) in Group III, respectively. Conclusion. In total, 92 % of the patients achieved target BP levels: 100 % in Group I, 100 % in Group II, and 86 % in Group III. Good and excellent therapy tolerability was observed in 96 %. Among patients with microalbuminuria at baseline, 41 % demonstrated its normalisation.

Aim. To study left ventricular (LV) remodelling features in patients with arterial hypertension (AH) and excess salt consumption. Material and methods. In total, 440 patients with essential AH and no clinically manifested heart failure were examined: 230 with no AH complications and 210 with myocardial infarction (MI) 6 months ago or earlier. In all participants, assessment of salt taste sensitivity threshold (STST) and 24-hour sodium excretion with urine, echocardiography and 24-hour blood pressure (BP) monitoring were performed. Results. The majority of AH patients had excessive salt consumption. In AH individuals with high STST and salt consumption >16 g/d, a specific LV remodelling type was observed, characterised by increased end-diastolic volume and myocardial mass. Conclusion. The main cause of LV remodelling in AH patients could be volume overload, due to excess salt consumption.

Aim. To investigate the variants of left ventricular (LV) remodelling in men aged 18-25 years, with and without arterial hypertension (AH). Material and methods. In total, the study included 211 men aged 18-25 years (mean age 21,1±0,14 years), with random blood pressure (BP) elevation at previous clinical examinations. All participants underwent repeat BP measurements, 24-hour BP monitoring (BPM), echocardiography with calculation of LV myocardial mass index (LVMMI) and relative wall thickness (RWT), and evaluation of LV diastolic function (DF). Results. According to the results of clinical BP measurements and 24-hour BPM, normal BP levels were observed in 36 participants (17 %), stable AH — in 124 (58,7 %), and unstable AH — in 51 (24,3 %). In patients with stable AH, LVMMI was significantly higher than in individuals with normal BP. Among participants with stable AH, 43 (34,7 %) had normal LV geometry, 75 (60,5 %) had concentric LV remodelling, and 6 (4,8 %) — concentric LV hypertrophy. Among participants with unstable AH, 14 (27,5 %) had concentric LV remodelling. Comparing to normotensive individuals, patients with stable and unstable AH had lower transmitral flow ratio E/A, and significantly higher peak A velocity. Conclusion. In young 18-25-year-old men with stable AH, the typical LV remodelling variant was concentric remodelling, with a tendency towards LV diastolic dysfunction development.

Aim. To study the safety and tolerability of long-term anti-aggregant therapy in patients with coronary heart disease (CHD), comparing enteric-coated acetylsalicylic acid (ASA) and standard ASA forms. Material and methods. The study included 100 CHD patients, with myocardial infarction in anamnesis. All participants received ASA and were retrospectively divided into two groups: Group I (n=50) received entericcoated ASA (Aspirin Cardio 100 mg/d) for two years; Group II (n=50) received standard ASA (125 mg/d) for two years. The incidence of dyspeptic symptoms and gastro-duodenal ulcers and erosions was assessed. Gastric and duodenal endoscopy was performed at baseline, as well as 6, 12 and 24 months later. Results. Long-term Aspirin Cardio therapy, according to endoscopy data, was less frequently associated with gastro-duodenal ulcers and erosions, or dyspeptic symptoms, than the treatment with standard ASA. Conclusion. The results obtained support better tolerability and safety of enteric-coated form of ASA, Aspirin Cardio.

Aim. To assess the effectiveness of pharmaceutical secondary prevention in ambulatory patients with stable angina (SA), in the real-worl clinical settings. Material and methods. Retrospective analysis of randomly selected ambulatory medical histories (n=1067; year 2006) of SA patients attending Bishkek centres of family medicine. Results. The main groups of anti-anginal medications (AAM), prescribed by primary healthcare doctors, were beta-adrenoblockers (BAB; 43,0 %), nitrates (28,6 %), and calcium antagonists (CA; 27,9 %). Anti-aggregants were prescirbed to 86,8 % of the patients, and ACE inhibitors — to 82,2 %. Myocardial cytoprotectors were prescribed less often (0,5 %), as well as lipid-lowering agents (8,4 %). The prescribed doses of lipid-lowering agents were inadequately low (minimal effective doses). Generic lipid-lowering medications were prescrbed more often (93,3 %) than the original ones (6,7 %). Conclusion. Pharmaceutical secondary prevention in SA patients was not adequate and did not comply with the modern clinical guidelines.

Aim. To identify the factors determining homocysteine (HMC) levels in Russian patients with stable coronary heart disease (CHD). Material and methods. The study included 506 patients (388 men; mean age 59,4±12,2 years) with stable CHD. Classical risk factors (RFs) of cardiovascular disease (CVD), renal function (creatinine clearance by Cockroft-Gault formula), and atherosclerotic pathology of other localizations were assessed. The levels of plasma HMC, folate, and cobalamin were measured. Genetic analysis was performed using the real-time polymerase chain reaction method. Results. In 432 patients (85,4 %), hyperhomocysteinemia was diagnosed. The mean HMC level was 14,3±4,6 mkmol/l. According to multifactor analysis results, HMC level was independently associated with folate level (beta coefficient -3,86, p<0,0001), cobalamin level (beta -5,73, p<0,0001), and MTRR 66AA genotype (beta 10,71, p<0,0005). In addition, HMC concentration was linked to the following combinations: MTRR 66G allele + folate level (beta 1,12, p<0,0001), MTRR 66AA allele + cobalamin level (beta 0,012, p<0,0001), TCN 776G allele + cobalamin level (beta -0,03, p<0,0001), TCN 776G allele + folate level (beta 0,58, p<0,0009), MTR 2756G allele + cobalamin level (beta 0,004, p<0,002), MTRR 66G allele + creatinine clearance <90 ml/min (beta 0,08, p<0,001), and TCN 776G allele + creatinine clearance <90 ml/min (beta 0,07, p<0,0007). Conclusion. In Russian patients with stable CHD, HMC level was associated with folate and cobalamin concentrations and MTRR 66AA genotype, as well as with MTR 2756G, MTRR 66G, and TCN 776G alleles combined with vitamin concentrations and renal function.

Aim. To compare laboratory parameters and biopsy morphology of gastric and proximal duodenal mucosa samples in patients with various clinical forms of coronary heart disease (CHD). Material and methods. In total, 150 CHD patients were included in the main group (MG), and 50 individuals without diagnosed CHD were included in the control group (CG). All participants underwent gastroduodenoscopy, morphological examination of biopsy samples, general and biochemical blood assay, and measurement of Helicobacter pylori IgG antibody levels. Results. CHD was linked to long-term, HP-associated chronic atrophic pangastritis. Progression of HP infection to all gastric and duodenal areas, active chronic inflammation, as well as systemic inflammation, could be risk factors of unstable CHD course. Conclusion. In CHD patients, elevated levels of Helicobacter pylori antibodies point to progressing HP infection and act as a predictor of unstable CHD course, with high risk of acute coronary syndrome.

Aim. To study the effects of hormonal replacement therapy (HRT) with a combined medication (1 mg 17В-estradiol and 2 mg drospirenone; Angeliq) among women in early post-menopause. Material and methods. In total, 30 postmenopausal patients with climacteric syndrome were examined and prescribed HRT. The following parameters were studied: blood pressure (BP) level, vegetative disorder severity, visceral obesity, metabolic status after 6 months of Angeliq therapy, microcirculation (MC) and carotid artery intima-media thickness (IMT) after 1 year of Angeliq therapy. Results. After 6 months of the treatment, BP level was reduced, metabolic status improved, and vegetative disorders were less severe. After 1 year, MC parameters improved, and carotid IMT levels were reduced. Conclusion. Angeliq demonstrated vegeto-corrective and antihypertensive effects, together with improvement in metabolic status, visceral obesity, MC, and carotid IMT parameters among female patients in early postmenopause.

Aim. To evaluate the safe use of a new calcium channel blocker, lercanidipine, in patients with chronic renal failure (CRF); the protective effect of calcium channel blocker on renal function in CRF patients previously treated with ACE inhibitors or angiotensin receptor blockers (ARB). Material and methods. The study included 203 CRF patients (creatinine >1,4 mg/dL for men, >1,2 mg/dL for women; or creatinine clearance <70 mL/min). All patients were receiving ACE inhibitors (63,4 %) or angiotensin II antagonist (36,6 %) therapy, but they had higher blood pressure than recommended for CRF (130/85 mmHg). No patients received diuretics. Patients were clinically evaluated 1, 3, and 6 months after starting treatment with lercanidipine. Urine and blood samples were taken during the examination. When needed, a third drug was added to the treatment, excluding diuretics. Creatinine clearance was measured using 24 h urine collection. Results. 175 patients completed the study protocol (age 63,9±11,9 years, 52,9 % males and 47,1 % females). Blood pressure (BP) significantly decreased from 162±17/93±8.3 mm Hg to 132±12/78±6 mm Hg. 89,2 % of patients showed a significant BP reduction, and 58,1 % achieved optimal BP control (<130/85 mmHg). Seven patients (3,4 %) showed adverse effects. No single case of oedema was detected, and the prevalence of adverse effects related to vasodilatation was extremely low (3 patients, 1,48 %). Plasmatic creatinine did not change (1,9±0,5 baseline vs.1,9±0,6 mg/dL), but creatinine clearance increased at the end visit (41,8±16,0 baseline vs. 45,8±18,0 mL/min, p=0,019). Plasmatic cholesterol also decreased from 221±46 to 211±35 mg/dL (p=0,001). Conclusion: Lercanidipine showed a high antihypertensive effect in CRF patients. It had a good tolerability profile and showed an interesting effect on plasmatic lipids. An improvement in renal function, assessed by creatinine clearance, was detected.

The history of thiazide diuretics’ use during the last 50 years is reviewed. The effects of thiazide diuretics on arterial hypertension treatment effectiveness, cardiovascular mortality and cardiovascular morbidity are discussed. In addition, their hemodynamic effects and safety profile are assessed.

The beneficial effects of the combination of trandolapril and verapamil (combined medication Tarka) on endothelial function in arterial hypertension (AH) are presented. Antihypertensive effectiveness of the medication is discussed, in particular, among AH patients with renal disease, other target organ pathology, and diabetic nephropathy.

According to the latest recommendations by the European Society of Hypertension and the European Society of Cardiology, in patients with high cardiovascular risk (including individuals with diabetes mellitus and metabolic syndrome), the first-choice agents for arterial hypertension (AH) treatment are combined medications. Ideally, one medication should combine blockers of renin-angiotensin system and a metabolically neutral diuretic. The combined medication Noliprel A fulfils these requirements, being a fixed low-dose combination of ACE inhibitor perindopril arginine and thiazide-like diuretic indapamide. Noliprel A demonstrates not only good antihypertensive effects, but also beneficial metabolic and organo-protective activity. Therefore, it can be recommended as firstchoice medication in this clinical group.

Achieving target levels of low-density lipoprotein cholesterol (LDL-CH) with lipid-lowering therapy is the main component of the complex cardiovascular risk reduction, according to the Russian and international clinical guidelines. High-density lipoprotein cholesterol and triglycerides are regarded as secondary targets for lipidlowering therapy. High-dose statin monotherapy and combined therapy could achieve target LDL-CH levels only in 30—50 %. The available evidence demonstrates that to achieve target LDL-CH levels more effectively, statin should be combined with other lipid-lowering drugs, or fixed-dose combined lipid-lowering therapy should be prescribed. In particular, the maximal LDL-CH reduction is achieved when statin is combined with ezetimibe, or when the fixed-dose combination (simvastatin 20 mg and ezetimibe 10 mg) is used. Specific aspects of combined lipid-lowering therapy in various clinical situations are discussed, in accordance with current clinical guidelines. To improve lipid-lowering therapy compliance, patients should be involved into assessing their cardiovascular risk and discussing potential ways of risk reduction.

Currently, one of the important clinical issues is the combination of chronic heart failure (CHF) and anaemia, which aggravates CHF course and prognosis. The main pathogenetic mechanism of anaemia development in CHF is absolute or relative erythropoietin deficit, due to pro-inflammatory cytokine effects, and renal dysfunction. The recent studies have demonstrated that correcting even moderate anaemia in CHF results in increased exercise tolerance, reduced NYHA functional class, improved quality of life, cardiac morphology and function, decreased need for diuretics, and reduced hospitalization incidence. However, there are no available data on anaemia correction effects on long-term survival, as well as on haemoglobin levels needed to start the anaemia treatment, or safe target levels of haemoglobin.