The article contains information on main pharmacological properties of nifedipine, its indications, specific features of various medicinal forms. The present experience of long-term nifedipine treatment is analyzed, according to its influence on clinical outcomes.

Aim. To study stroke risk factors (RF), morbidity, mortality, and lethality in the Krasnoyarsk Region.
Material and methods. The Stroke Register (National Stroke Association Form 01) was used for adult population (25-74 years) of Krasnoyarsk Region pilot territories in 2001-2003. Results. Leading RF for stroke were arterial hypertension (51.4%-82%) and heart disease, including atrial fibrillation (40.7%-60%). Stroke morbidity varied from 4.1 to 5.8 per 1000 people annually, both in big industrial cities and country districts, and tended to be increasing. Mortality varied from 0.77 to 2.01 per 1000, and was significantly higher in country districts. At-home lethality was 35.5% in Krasnoyarsk City and 86.4% in country districts, due to deficit in neurologists and hospital places for patients with acute cerebrovascular pathology in city and country clinics. Percentage of ante-mortem acute stroke verification was 8-10% in Krasnoyarsk City and Achinsk, and 0% in country districts.
Conclusion. In 2001-2003, cerebrovascular pathology, RF prevalence, stroke morbidity and mortality remained high in Krasnoyarsk Region.

Aim. To study cardiovascular morbidity, temporary disability, medical care organization in the military personnel, observed by the medical service of Serpukhov Institute for Rocket Forces.
Material and methods. A complex of social and hygienic methods was used: registry data selection, expert assessment of medical documentation, sociological survey (medical staff interview), and statistical analysis.
Results. In various age and professional profile groups of the military personnel, prevalence and structure of morbidity and temporary disability were not homogenous. Medical service organization features influenced temporary disability and morbidity levels.
Conclusion. To optimize diagnostics and treatment process, it is necessary to develop Russian guidelines on diagnostics and management of patients with atypical or mildly manifested cardiovascular disease, whose working specialty requires initial and continuous professional selection.

Aim. To assess cerebral blood flow and cholesterol (CH) metabolism in postmenopausal women with arterial hypertension (AH); to evaluate dynamics of cerebral blood flow and lipid profile during 6-month antihypertensive and hypolipidemic therapy.
Material and methods. Postmenopausal women (n=47) with Stage I-II AH were examined. Leading clinical symptoms were explained by cerebrovascular pathology. All participants were divided into two groups: moexipril monotherapy (7.5-15 mg/d; n=15) and fosinopril monotherapy (10-20 mg/d; n=15). Women with dyslipidemia were administered atorvastatin, 10 mg/d: 10 patients in moexipril group, and 7 in fosinopril group. At baseline and 6 months later, Doppler ultrasound and lipoprotein profile assessment were performed in all participants.
Results. At baseline, increased systolic blood flow velocity (S), decreased pulse index (PI), and increased cerebral vascular resistance index (RI) were observed in hypertensive women, comparing to age-specific normal levels. Six-month antihypertensive therapy was associated with S decrease, PI increase, and RI reduction, without any significant difference in cerebral hemodynamics parameters between two groups. At the same time, positive dynamics was more manifested in combined antihypertensive and hypolipidemic treatment. In these patients, cerebral hemodynamics improvement was combined with improvements in lipid profile and quality of life. Conclusion. In women with long-term AH duration, cerebral hemodynamics is typically disturbed. Combined antihypertensive and hypolipidemic therapy has the greatest beneficial effect on cerebral perfusion.

Aim. To investigate stress-induced hemodynamic and neuro-humoral reactions, as well as clinical efficacy of various antihypertensive monotherapies in patients with arterial hypertension (AH) and different hemodynamics types (HT).
Material and methods. Effects of dosed intellectual and emotional stress (IES) on central and peripheral hemodynamics parameters, variation pulsometry, stress-adaptive hormones’ levels, were studied in 60 patients with borderline AH (BAH) and hyper- or hypokinetic HT (HyperHT and HypoHT). In 173 middle-aged patients with Stage I-II AH, clinical efficacy of nifedipine, diltiazem, propranolol monotherapy was assessed, according to HT. In 44 young patients with Stage I AH, moxonidine therapy influence on circadian blood pressure (BP) profile was studied.
Results. During IES, BAH patients with HyperHT demonstrated a significant increase in cardiac output and adrenaline secretion, patients with HypoHT – an increase in peripheral vascular resistance and noradrenalin concentration. In AH patients with HyperHT, BP level and sympathic hypertonus were effectively corrected by propranolol; in patients with HypoHT, nifedipine and diltiazem were more effective. Moxonidine significantly improved circadian BP profile (pressure load, BP variability, BP nocturnal decline) in individuals with AH and HyperHT.
Conclusion. Emotion-induced cardiovascular and neuro-humoral reactions in AH patients are partially explained by their HT. AH patients with HyperHT should be administered sympathico-inhibiting antihypertensives (beta blockers, I1 imidazoline receptor agonists). HypoHT AH patients require vasodilatator therapy, in particular, calcium antagonists.

Aim. To study salt role in essential arterial hypertension (EAH) pathogenesis.
Material and methods. In total, 230 patients with EAH were examined. Taste sensitivity to salt (TSS), sodium urinary excretion, 24-hour blood pressure (BP) profile (24-hour BP monitoring, BPM), main echocardiography parameters, psychological status (SMOL questionnaire), and quality of life were assessed. Patients with low (n=50) and high TSS (n=110) were compared. Control group included 102 healthy individuals.
Results. High TSS was registered in 52% of patients (22.5% of controls), low TSS – in 22% of patients (37.3% of controls). In individuals with high TTS, daily urinary excretion of sodium was higher, cardiovascular complaints, cardiovascular pathology in family history, hypertensive and autonomous crises were more prevalent, and hypertension developed earlier (by 8 years) than in persons with low TTS. In patients with high TTS, BP did not adequately decrease in the nighttime; end-diastolic volume, ejection fraction, myocardial mass, and SMOL score were higher, and quality of life – lower, comparing to low TTS subjects.
Conclusion. In every second EAH patient, the disease was linked with increased salt consumption. In this group, EAH developed earlier, its clinical course was more severe, often accompanied with neurosis-like state.

Aim. To investigate antihypertensive efficacy of losartan (Lozap®), as monotherapy and in combination with a diuretic hydrochlorothiazide (Lozap® Plus), according to its influence on circadian blood pressure profile (CBPP) in patients with arterial hypertension (AH).
Material and methods. In 25 patients with Stage I-II AH, the influence of 8-week Lozap® monotherapy (n=12), 50 mg/d, and its fixed-dose combination with hydrochlorothiazide, Lozap® Plus (n=13), on CBPP was studied. Office BP (BPo) measurement, and 24-hour BP monitoring (BPM) were performed.
Results. After 4 weeks of Lozap® monotherapy, BPo decreased by -8.4±10.7/-11.2±10.7 mm Hg (p<0.001); target BP level was reached in 48% of participants. By Week 8, BPo decreased by -13.0±9.0/-5.8±9.2 mm Hg (p<0.0001/0.01); target BP level was achieved in 92% of the patients. According to 24-hour BPM, daytime BP decreased by -22.3±12.1/13.8±11.2 mm Hg (р<0.0001), nighttime BP - by -25.9±16.7/16.4±11.3 mm Hg (р<0.0001). Daytime, nighttime, and 24-hour target BP levels were reached in 80%, 72%, and 88% of the participants, respectively. Т/Р ratio 71.6%/72.9% is an evidence of sufficient, even antihypertensive effect of Lozap® and Lozap® Plus. These medications significantly increased nighttime BP decline and normalized BP circadian rhythm (CP) in most patients. The therapy was well tolerated, with minimal adverse reactions, and side effects.
Conclusion. Antihypertensive therapy with Lozap® and Lozap® Plus provides prolonged and even antihypertensive effect, corrects CBPP by reducing pressure workload, pulse BP, and improving BP CR. The maximal-dose therapy gives an opportunity to achieve target BP levels in 92% of the patients.

Aim. To investigate correlation between anemia and long- and short-term prognosis in patients with unstable angina.
Material and methods. The study included 96 patients (34 females), aged 63.3±10.3 years, with unstable angina. All patients received conservative treatment. Individuals with severe associated pathology and hemorrhages in anamnesis were excluded from the study. Anemia was diagnosed according to WHO criteria; unstable angina class was registered. Short-term, in-hospital prognosis assessment included registering severe, recurrent angina, myocardial infarction (MI), number of ischemic episodes during 24-hour ECG monitoring before discharge. Long-term prognosis was assessed during 6 post-discharge months: death, MI, and combined endpoint (cardiac death, MI, recurrent angina) were registered.
Results. Anemia was diagnosed in 38 patients (39.58 %). Angina at rest was associated with lower mean hemoglobin (Hb) level and greater anemia prevalence (46%), comparing to the group of progressing effort angina (25%). Participants with prolonged angina episodes had significantly lower Hb level (122.23±13.3 g/l) than the others (130.9±13.56 g/l). Among patients with ischemic episodes at 24-hour ECG monitoring, anemia was registered in 50%, among individuals without such episodes – in 30.4%. Recurrent unstable angina during 6 post-discharge months was associated with higher anemia prevalence: 57.6% vs 21.05% in participants with better outcome. Logistic regression analysis demonstrated negative independent influence of anemia on combined endpoint.
Conclusion. Patients with anemic syndrome were characterized by severe in-hospital course of unstable angina. Anemia was associated with increased risk of MI and recurrent unstable angina in the first 6 months after discharge.

Aim. To investigate clinical efficacy of nebivolol and metoprolol in the complex treatment of patients with coronary heart disease (CHD) and II-III functional class chronic heart failure (CHF).
Material and methods. The study involved 110 patients with CHD and CHF, functional class II-III, by NYHA classification. All participants, aged 47-79 years, had ejection fraction <45%. The patients were divided into three groups. Group I (n=38) received nebivolol (2.5-5 mg/d) plus standard therapy; Group II (n=36) – metoprolol tartrate (50-100 mg/d) plus standard therapy; Group III (n=36) – only standard therapy. During 4-month followup, the following parameters were assessed: clinical efficacy, physical stress tolerance (PST), quality of life (QoL), number and duration of silent myocardial ischemia episodes (SMIE), left ventricular (LV) structural, functional and hemodynamic parameters, blood rheology, platelet aggregation, and lipid profile.
Results. At baseline, no significant decrease of LV total contractility was observed. Four month later, in all treatment groups PST increased, number and duration of SMIE reduced, patients’ condition, central hemodynamics and LV remodeling parameters improved, as well as lipid profile, blood rheology and platelet hemostasis. Positive dynamics was greater in nebivolol group.
Conclusion. In complex treatment of patients with CHD and CHF, nebivolol acts similar to metoprolol. Nebivolol increased treatment efficacy, increased PST, reduced number and duration of SMIE, prevented LVH progression, improved clinical status, QoL, lipid profile, platelet hemostasis, blood rheology.

Aim. The principal objective of this randomized, comparative, open clinical trial PRESTIGE was to determine the time of achieving optimal therapeutic dozes of ACE inhibitors. The secondary goal was to assess dynamics of chronic heart failure (CHF) functional classes (FC) during the treatment.
Material and methods. The study involved 125 patients with Q-wave acute myocardial infarction (MI): 68 males, 57 females; mean age 67 years. All participants were randomized into perindopril or captropril groups (n=63 and 62, respectively). In dose titration, starting doses were 2 mg/d and 18.75 mg/d, respectively. Recommended daily doses were 4-8 mg once per day for perindopril, and 75-150 mg, three times per day, for captropril. Treatment and follow-up period lasted for 6 months. ACE inhibitor efficacy was assessed by measuring brain natriuretic peptide (BNUP) levels - at baseline, Weeks 8 and 24. Quality of life (QoL) was assessed by two methods: by “health line” and standard Minnesota University Questionnaire for heart failure patients. Incidence of death and hospitalization due to cardiovascular causes was also registered.
Results. At Week 8, there was a significant reduction in BNUP level (to 296.5±16.7 pmmol/l; or by 25.4%; р=0.004) in perindorpil group, and to 342.7±13.8 pmmol/ml (by 19.1%; NS; р=0.06) in captopril group. At 6 months, QoL improved in perindopril group (reduced total QoL score, 23.8; р=0.047), and did not change comparing to Week 3, in captopril group (31.4).
Conclusion. MI patients with left ventricular dysfunction, early administered ACE inhibitors, achieved target dose of perindopril faster than that of captopril. That was associated with improved clinical course (CHF FC, QoL) in perindopril group.

Aim. To study efficacy and safety of propafenone in restoring and maintaining sinus rhythm (SR), comparing to
placebo, in patients with recurrent atrial fibrillation (AF).
Material and methods. The study included 60 patients with recurrent AF. For restoring SR, all patients were administered propafenone (300-600 mg/d). Twenty-four hours later, all participants with normalized SR were randomized into two groups: Group I (n=31) received propafenone (450 mg/d), Group 2 (n=15) – placebo. Follow-up lasted for 3 months.
Results. Twenty-four hours after propafenone administration (300-600 mg), SR was registered in 46 individuals (76.6%), including 2 patients (3%) with SR normalization 2 hours later, 5 patients (10.9%) – 4 hours later, 23 (50%) – 6 hours later, and 16 (34.8%) – 8 hours later. Mean time to SR normalization was 364±22 minutes. Adverse effects included moderate hypotension to 105-100/70 mm Hg in 2 patients (3.3%), and transitory atrioventricular block II in 1 patient (1.7%). No other adverse reactions were registered. During 3-month propafenone treatment (450 mg/d), SR was maintained in 80.6% of patients, compared to 26.6% in placebo group. No adverse reactions were observed.
Conclusion. Oral propafenone treatment is effective and safe for restoring and maintaining SR in patients with recurrent AF.

Aim. To investigate the influence of dynamical and low-extremity static physical exercise of varying intensity on serum lipoprotein (LP) and apolipoprotein (apo) levels in healthy individuals.
Material and methods. Twelve males without clinical or coronaroangiography signs of coronary heart disease (“healthy”) were examined. Participants underwent dynamical physical exercise (DPE) at veloergometer, with maximal (100%) and submaximal (80%, 70%, 60% of individual maximal tolerance level) workload. In other days, males underwent low-extremity static physical exercise (SPE), with maximal (100 kg; 100%) or submaximal workload (70 and 60 kg; 70% and 60%, respectively).
Results. DPE of high intensity (≥80%) and SPE of maximal (100 kg) to moderate (60 kg) intensity resulted in atherogenic changes of blood lipid transport system: total cholesterol, low-density lipoprotein cholesterol, triglycerides, apoB levels, and apoLP atherogenity index (apoB/apoAI) increased. High-intensity SPE caused more severe and stable atherogenic dyslipoproteinemia, than DPE of similar intensity. DPE of 70% intensity was borderline for antiatherogenic effect on blood LP and apo profiles. Moderate DPE (60%) resulted in antiatherogenic dynamics of lipid transport system, decreasing apoB LP and increasing apoAI levels.
Conclusion. Moderate-level DPE can be included into complex prevention of atherosclerosis in healthy individuals. Lower-extremity SPE (≥60 kg), as a component of strength training programs, can be combined with moderate-level DPE, to prevent post-exercise atherogenic dyslipidemia.

Aim. To investigate psychological personality traits in relatively healthy people with various types of fat tissue distribution.
Material and methods. The study included 482 clinically healthy males and females. Participants were divided into six groups, by gender and fat tissue distribution (identified by measuring waist/hips circumference index, WHI): intermediate, gynoid, and abdominal fat tissue distribution in males and females. Psychological personality traits were assessed by SMOL questionnaire (short form of Multiphasic Personality Inventory).
Results. In women, the most unfavorable psychological profile was observed for abdominal type of fat tissue distribution. This group demonstrated symptoms of hypochondria, depression, and neuroses. This type of fat tissue distribution might be a predictor of future cardiovascular disease. Similar psychological traits were observed in men with abdominal fat tissue distribution. Nevertheless, men tended to resist high anxiety level by developing effective psychological adaptation mechanisms (p<0.01).
Conclusion. Psychological correction methods can be useful in primary prevention of cardiovascular events among clinically healthy women with abdominal fat tissue distribution and increased arterial hypertension risk.

In Russia, high prevalence of cardiovascular disease (CVD) and objective difficulties in its primary and secondary prevention make actual the issue of creating a new prevention branch – urgent CVD prevention. Urgent prevention includes: prevention of CVD pathology when its risk is increasing; patient self-help manipulations in case of emergency, according to doctor-created, individual programs; early, complex medical support according to unified recommendations; additional measures on preventing cardiovascular emergency complications. Creating such a new preventive branch should facilitate utilization of present limited resources and improve CVD management results.

The role of sympathic autonomous system in arterial hypertension (AH) pathogenesis is described. Predictive value of left ventricular hypertrophy (LVH) in cardiovascular event prognosis is emphasized. The results of clinical trials assessing imidazoline receptor agonists’ influence on LVH during AH management are discussed.

Metabolic cardioprotection is an important part of treating patients with coronary heart disease (CHD). The most widely used drug in this group is trimetazidine. Its mechanism of action is based on fatty acids metabolism inhibition, glucose oxidation activation, intracellular ATP deficit prevention. Numerous randomized, controlled clinical studies demonstrated trimetazidine antiischemic efficacy, similar to that for beta-adrenoblockers or calcium antagonists. Trimetazidine improves myocardial contractility, reduces clinical manifestations of heart failure. The medication beneficially influences ischemia-associated myocardial dysfunction: stunning, hybernation, preconditioning. Trimetazidine is recommended for treating patients with stable angina and ischemic left ventricular dysfunction, in combination with other drugs. Perspectives of trimetazidine therapy in myocardial revascularization and acute myocardial infarction should be examined in future trials.

The review is devoted to the role of psychosomatic status factors in the development of pathological cardiovascular remodeling in essential arterial hypertension. Cell mechanisms of left ventricular hypertrophy, cardiovascular risk factors’ influence on its progression are analyzed in detail.