Aim. To identify the first clinical signs of renal pathology in young patients (under 35) with initial stages of arterial hypertension (AH).
Material and methods. Fifty-seven men with Stage I-II AH, aged 15-35, were examined. Exclusion criteria were: secondary AH, chronic renal or urologic pathology, diabetes mellitus in anamnesis. In all participants, renal dynamic angioscintigraphy with DTPA-Tc99m, and ophtalmoscopy, to determine the stage of hypertensive rethinopathy, were performed. In 27 patients, 24-hour microalbuminuria (MAU) was assessed.
Results. Renal dynamic angioscintigraphy with DTPA-Tc99m revealed various renal hemodynamics abnormalities in 98% of the patients (n=56). In most individuals (94%; n=53), renal blood flow was reduced bilaterally. Significant bilateral reduction of renal blood flow, of Stage II-III (<420 ml/min, with norm of 690±60 ml/min), was registered in 39 individuals (68%). MAU was revealed in 8 out of 27 examined patients (30%); its mean level was 64.8±15.2 mg/l. Participants with MAU more often experienced Stage II-III decrease in renal blood flow (<420 ml/min, with norm of 690±60 ml/min).
Conclusion. At early AH stages, young male patients, aged under 35, experienced renal function remodeling, despite short AH duration. The remodeling manifested in renal blood flow decrease, glomerular filtration rate disturbances, and MAU development.

Aim. To assess efficacy of various pharmacotherapy schemes in arterial hypertension (AH) with metabolic disturbances (MD).
Material and methods. Open, randomized, comparative study in 3 parallel groups, including 90 patients with Stage I-II AH and MD, was performed. Group 1 was administered moxonidine and eprosartan; Groups 2 and 3 – standard monotherapy (diuretic, beta blocker, calcium antagonist, plus ACE inhibitor in case of low effectiveness); Group 3 additionally received a lipase inhibitor orlistat.
Results. Eight weeks later, target BP level was achieved in 86% patients from Group 1, 73% – from Group 2, and 57% - from Group 3. In Group 3, body mass index decreased by 5.3%, and waist circumference – by 3.5%. Total cholesterol level reduced in Groups 1 (by 7.3%) and 3 (by 9.6%). In Group 1, basal immunoactive insulin level declined by 25.2%. Fasting glycemia reduced in Groups 1 and 3 – by 6.3% and 8.6%, respectively. In Group 1, basal cortisol level decreased by 26.3%. All medications were well tolerated.
Conclusion. Imidazoline receptor antagonist was more effective than standard therapy: despite compatible antihypertensive effects, moxonidine improved metabolic parameters. Adding orlistat to antihypertensive treatment improved metabolic parameters and 24-hour BP profile in patients with AH and MS.

Aim. To compare effectiveness of controlled antihypertenive therapy (AHT) and standard outpatient care among Chernobyl male liquidators (ML) with mild to moderate arterial hypertension (AH).
Material and methods. This 12-month, open, comparative randomized study included 81 ML aged 37-70, with mild to moderate AH. The main group consisted of 42 patients, the control group – of 39; mean age 52.2±1.3 and 51.5±1.1 years, mean AH duration 10±1 and 9.6±1 years, respectively. In main group, patients received an ACE inhibitor spirapril, combined with hypothiazide (12.5-25 mg/d), and atenolol (12.5-100 mg/d), if necessary. In control group, AHT and its correction were performed by outpatient physicians. Medical history collection, physical examination, anthropometry, blood pressure (BP) measurement (three times), and electrocardiograpy were performed.
Results. During one-year controlled AHT, comparing to standard outpatient care, more effective decrease in systolic and diastolic BP was achieved. Antihypertensive effect was registered in 78.6% and 38.0% of the main and control group patients, respectively. At the end of the study, most participants from the main group ((78.6%) received combined therapy (2 or more drugs); in control group, this number was only 17.2%.
Conclusion. The results of the study demonstrated high effectiveness and benefits of long-term controlled AHT, comparing to standard outpatient care.

Aim. To investigate the influence of С825Т-polymorphism of G-protein β3 subunit (GNB3) gene on circadian blood pressure (BP) profile among young hypertensive patients with arterial hypertension (AH) in family anamnesis.
Material and methods. Sixty-seven young hypertensive patients with AH in family anamnesis, aged 18-33, underwent 24-hour BP monitoring, echocardiography, and GNB3 С825Т-polymorphism genotyping. Then all participants were divided into two groups, according to presence/absence of T allele (ТТ+ТС and СС genotypes, respectively).
Results. Prevalence of 825Т allele in the studied population was 0,36. In individuals with 825Т allele, significantly higher levels of systolic BP (SBP), and nighttime temporal index of increased SBP, plus inadequate nighttime SPB decrease, were observed. Patients with ТТ and ТС genotypes demonstrated substantial increase in total peripheral vascular resistance.
Conclusion. Individuals with 825Т allele have a high risk of nighttime systolic AH, with poor circadian BP profile.

Aim. To assess heart diastolic function in patients with familial arterial hypertension (AH).

Material and methods. Echocardiography was performed in 103 individuals with familial AH and their relatives.

Results. Heart diastolic dysfunction was registered in 80% of the patients and 40% of their relatives. ACE inhibitors and diuretics were used for AH treatment. In patients with familial AH, treatment efficacy manifested in regression of left ventricular (LV) hypertrophy.

Conclusion. Patients with familial AH typically had concentric LV hypertrophy, and early developing myocardial diastolic dysfunction. Up to 40% of their relatives had signs of LV diastolic dysfunction, that must be remembered during medico-genetic consulting. 

Aim. To study the episodes of acute heart rate variability (HRV) decrease in patients with coronary heart disease (CHD) and healthy people, at normal levels of physical stress (PS) – stairs climbing.
Material and methods. The study included 30 patients with CHD, who underwent coronaroangiography, and 17 relatively healthy people (control group). Non-stop ECG monitoring was performed during stairs climbing at normal pace.
Results. Episodes of acute HRV decrease were registered in 29 CHD patients and 12 healthy people. In CHD patients, the episodes developed at lower PS and HR levels, than in healthy subjects, regardless of compromised vessels’ number and stenosis severity. HR at the start of HRV decrease episode was 50% from submaximal HR in patients with unstable angina; 64% - in patients with stable angina, and 87% - in healthy individuals.
Conclusion. Moderate PS test helped to identify, by registering episodes of acute HRV decrease, CHD patients and healthy people. Ratio “HR at the start of the episode” / “Submaximal HR” (HR LF<40 ms2 / HR submax) in patients with unstable angina was significantly lower than in individuals with stable angina.

Aim. To investigate dynamics of QT interval variability during physical stress (PS) test in coronary heart disease (CHD) patients with various stages of arterial hypertension (AH).
Material and methods. The study included 196 working-age males with earlier diagnosed CHD, divided into 4 groups: Group I (no AH; n=65), Group II, III, and IV (with Stage I, II, and III AH, respectively; n=41, n=43, and n=47). All subjects underwent echocardiography, veloergometry. Corrected QT interval dispersion (dQTс) at rest and during maximal PS; recovery time of baseline dQTc, and original stress tolerance coefficient (STC) were calculated.
Results. CHD patients, regardless of AH presence and stage, had greater myocardial electric heterogeneity at baseline. Its increase in PS, as well as recovery time increase, were determined by AH presence and stage, being maximal in severe AH (1.76-fold increase). Myocardial electric heterogeneity, especially in PS, correlated with left ventricular (LV) hypertrophy, LV diastolic function, and the overall functional status of cardiovascular system.
Conclusion. AH raise causes increase in myocardial hemodynamic workload. Compensatory increase in LV myocardial mass and myocardial O2 demand result in defective myocardial blood flow, myocardial ischemia, and increased QT interval variability, especially during PS. Taking into account dynamics of myocardial electric heterogeneity during PS may raise the informative value of ECG-controlled stress tests.

Aim. To study risk factors (RF) of acute myocardial infarction (AMI), their significance and interplay in a “closed” population – people with chronic low-dose ionizing radiation (IR) exposure at their workplace.
Material and methods. According to WHO AMI Registry, 1 370 AMI cases were analyzed, including 327 cases in people exposed to long-term low-dose IR at their workplace. A prospective cohort study of AMI morbidity in a “closed” population (1998-2002) was performed.
Results. It was demonstrated that total dose of external radiation, duration of working in radiation-dangerous environment, and traditional cardiovascular RF, were independently distributed in IR-exposed AMI patients. Maximal total doses of external radiation were registered in young AMI patients. Individual dose negatively correlated with arterial hypertension (AH) duration before AMI development.
Conclusion. Among persons with long-term IR exposure, psycho-emotional stress, smoking, and AH were the leading cardiovascular RF in AMI pathogenesis. Long-term, low-dose IR enhanced traditional cardiovascular RF (dyslipidemia, AH) aggression in AMI pathogenesis.

Aim. To study structural and functional heart model in patients with high fibrillation activity of atrial myocardium.
Material and methods. The study included 123 patients with paroxysmal and persistent atrial fibrillation (AF) and sinus rhythm. Fibrillation activity of atrial myocardium was assessed as high in case of AF induction (>2 min) during transesophageal electrophysiological investigation. Persistent AF (>2 min) was induced in 36 individuals. In another 87, AF was not induced, or lasted for >2 min. Structural and functional heart model was examined during stress-echocardiography, with transesophageal electrocardiostimulation (120/min).
Results. Patients with induced persistent AF were characterized by initially increased left ventricular (LV) enddiastolic volume, LV end-systolic volume, long LV axis, as well as by decreased LV wall thickness and LV sphericity index in diastole. During stress test, these patients demonstrated decreased LV end-systolic volume, LV end-systolic size, increased velocity of circular contraction (Vcf st), and percentage of its increase (Vcf st %).
Conclusion. In patients with recurrent AF and high fibrillation activity, eccentric hypertrophy of LV myocardium is combined with its hidden hyperkinetic properties and decreased diastolic elasticity, diagnosed during stress test.

Aim. To investigate health attitudes and readiness for preventive measures in an open population of Tumen City, by mail survey.
Material and methods. Before mail survey, a randomized representative sample was formed (n=3200), based on voting lists of Central administrative area, Tumen City. The sample was stratified by gender and age: 400 people per each age-gender group (eight groups: males and females aged 25-34; 35-44; 45-54; and 55-64). Response rate was 70.3% (n=2248). Subjective and objective parameters were assessed – population awareness of cardiovascular risk factors and health attitudes.
Results. Mail survey results demonstrated high population levels of health responsibility, as well as high readiness to participate in preventive programs. In younger people, personal health responsibility was maximal. In younger females, attitude towards healthy lifestyle was the most positive. Among older participants, especially women, a substantial proportion of responders doubted ideas of medical prevention and healthy lifestyle.
Conclusion. The present situation facilitates the activity of Tumen preventive service. This service should focus on younger, working-age population groups, as the most prospective and responsible to lifestyle modification audience.

Aim. To compare the influence of standard and complex (including metformin) antihypertensive therapy on 24- hour blood pressure monitoring (BPM), biochemical and hormonal parameters in patients with metabolic syndrome (MS).
Material and Methods. The study included 54 patients with MS: 34 males and 20 females aged 30-61, without manifested Type 2 diabetes mellitus (DM). Group A (28 MS patients) received antihypertensive drugs only – verapamil, if necessary combined with ACE inhibitors and diuretics. Group B (25 MS patients) was additionally administered metformin. At baseline and after 8-week therapy, 24-hour BPM was performed; basal levels of insulin, C-reactive protein (CRP), cholesterol, triglycerides (TG), high-density lipoproteins (HDL), and uric acid were measured.
Results. In Group A, there was no significant dynamics in lipid and carbohydrate metabolism parameters. In Group B, basal levels of CRP (p<0.05), TG (p<0.1) had decreased, and HDL concentration has increased (p<0.01).
Conclusion. In MS patients without DM, adding minimal therapeutic doses of metformin to standard antihypertensive treatment significantly improved lipid and carbohydrate metabolism parameters.

Aim. To investigate prevalence and structure of cardiac arrhythmias in railway workers of working age.
Material and methods. Holter monitoring of ECG (ECG HM) was performed in 136 males — train machinists and machinist assistants, aged 19-55 (mean age 37±2.9 years), without any cardiovascular complaints. ECG HM was performed with computer system “Labetex” (“Meditex”, Hungary). At standard ECG registration, arrhythmias (mostly extrasystoles) were observed in 17 participants only (12.5%).
Results. Various cardiac arrhythmias were observed in 62 participants. Conductive abnormalities were identified in 6 individuals (10.6%): supraventricular pacemaker migration (n=4), and Stage I atrioventricular blockade (n=2). Episodic, low-grade ventricular and supraventricular extrasystolia (VES, SVES) was registered in 32 males (51.6%). Twenty-four individuals (37.8%) had high-grade VES, frequent SVES, in various combinations, as well as episodes on non-persistent V and SV tachycardia (VT, SVT).
Conclusion. The observed high prevalence (45.6%) of cardiac arrhythmias in the working-age people without cardiovascular clinical symptoms reflects a need of more detailed examination in this population. ECG HM gives an opportunity to register cardiac arrhythmic episodes more often than standard ECG.

Aim. To compare efficacy of simvastatin, a II generation statin, and ciprofibrate, a III generation fibrate, in various types of hyperlipidemia (HLP) and fibrate pharmacokinetic variants.
Material and methods. The authors examined 156 males with primary HLP, aged 41-59. Inclusion criteria were: initial cholesterol (CH) >190 mg/dl; triglycerides (TG) >150 mg/dl; high-density lipoprotein CH >35 mg/dl. Clinical, biochemical, pharmacokinetic, and statistical methods were used.
Results. Analysis of lipid-transport system in patients with isolated hypertriglyceridemia (HTG) during 8-week ciprofibrate therapy demonstrated decreases in TG (by 39.2%; pIII-V<0.05), and atherogenicity index, AI (by 28.6%; pIII-V<0.05). In patients with HTG and hypercholesterolemia (HCH), CH level was significantly reduced (by 13.1%; pIII-V<0.05), mostly due to 33.1% decrease in low-density lipoprotein CH (pIII-V<0.001). Analysis of the association between ciprofibrate-induced TG decrease and oxidative parameters demonstrated greater numbers of the patients with inadequate hypotriglyceridemic effect among “fast” oxidative metabolisers than among “slow” ones. Among individuals with “fast” oxidation phenotype, ciprofibrate therapy had a moderate hypotriglyceridemic effect in 67% of subjects (p<0.05).
Conclusion. In combined HTG and HCH, substantial hypotriglyceridemic activity of ciprofibrate was observed among patients with “slow” oxidation phenotype: TG concentration decreased by 35% (р<0.001). In “fast” oxidation phenotype group, TG level was reduced by 30% (р<0.05). Participants with both isolated and combined HTG demonstrated a substantial hypolipidemic effect of ciprofibrate in “slow” oxidation phenotype.

Aim. To assess cerebrovascular reserve (CVR) in males aged under 50, who had extracranial coronary artery (ECA) atherosclerosis, according to the results of preventive medical examination.
Material and Methods. The study included 140 males aged under 50, who had cardiovascular disease (CVD) risk factors (RF). Laboratory and ultrasound methods were used
Results. In males examined, CVD RF prevalence, ECA plaque localization, and plaque role in cerebral blood flow disturbances were evaluated. Ultrasound plaque characteristics, and CVR dynamics in tests examining metabolic and myogenic cerebral blood flow autoregulation, were investigated.
Conclusion. High prevalence of CVD RF points to the need of including ultrasound ECA evaluation into preventive medical examination algorithms. CVR assessment will increase prevention and treatment efficacy.

The review is devoted to an actual problem of modern cardiology – atrial fibrillation (AF) treatment in patients with chronic heart failure (CHF). Multicenter clinical trials demonstrated that CHF patients have AF more often than individuals without CHF. Algorhythms for choosing optimal antiarrhythmic therapy in AF and CHF are proposed. Possible therapeutic strategies, including use of ACE inhibitors and angiotensin II receptor antagonists, are discussed.

According to the latest literature data, the authors analyze pathogenesis of viral myocardial impairment, leading to pathological complex process, called “viral myocarditis”. Ethiopathogenetic role of viruses in various cell and molecular myocardial abnormalities is described.
A critical review of a new term, “inflammatory cardiomyopathy”, proposed by some foreign researchers, is performed, as “cardiomyopathy” is related only to diseases of unknown ethiology.

Based on registry statistics, the author analyzes dynamics and structure of cardiovascular morbidity in Russian adults for the period 1993-2003. Russian and international data are reviewed, and cardiovascular risk factor prevalence is compared.

About 150 million men worldwide suffer from erectile dysfunction (ED). In the next 25 years, this figure could double. High ED prevalence is explained not only by ageing problems, but also by increased prevalence of diseases and taking medications, causing sexual dysfunction. Therefore, ED is not only a factor determining male quality of life, but also one of the principal social parameters of the health care system in general.