In Russia, non-communicable disease (NCD) burden is very important in morbidity and premature mortality, significant losses of healthy life-years or expected longevity. Among NCD, the leading position is occupied by cardiovascular disease, external causes, oncopathology – in total, they explain up to 82.9% of NCD mortality. Prevention of NCD risk factors might improve the present demographic situation in Russia. 

Aim. To study clinical efficacy of hypertensive crise (HC) complex therapy and prevention in patients with combination of essential arterial hypertension (EAH) and coronary heart disease (CHD), at hospital and posthospital levels. Complex management program included treatment with antioxidant-cytoprotector, Mexicor®, as well as 24-hour blood pressure monitoring (BPM), ECG monitoring, and various BP self-monitoring variants.
Material and methods. In total, 157 patients with HC, EAH, and CHD, were examined. The participants were randomized into three groups: standard post-hospital follow-up (Group A, n=45); BP self-monitoring, without (Group B, n=54) or with (Group C, n=58) weekly telephone control by a doctor, and correction of therapy regimen, if necessary. At hospital and post-hospital levels, 20 patients from group B (sub-group B1), and 20 patients from group C (sub-group C1), were additionally administered antioxidant-cytoprotector. Post-hospital follow-up time varied from 1 month (uncomplicated HC) to 2-3 months (HC with cardiac complications). Treatment efficacy assessment included bi-functional 24-hour BPM and ECG monitoring at Day 1, Day 7-10, and Day 40-50 of the follow-up.
Results. Among patients with HC and CHD, BP self-monitoring and dynamic medical control facilitated BP normalization (83.1%), and decrease in post-hospital incidence of pre-crise states or recurrent HC (5.2% and 1.7%), compared to standard post-hospital follow-up – 68.9%, 20.0%, and 11.1%, respectively. Adding to complex hospital and post-hospital management was associated with BP normalization, decrease in total cardiovascular event risk, and reduction in pre-crise state or recurrent HC incidence.
Conclusion. Efficacy of HC treatment and prevention in patients with EAH and CHD was improved by posthospital BP self-monitoring and additional administration of antioxidant-cytoprotector.

Aim. During 12-week perindopril (PR) and hypothiazide (HT) therapy, to study its antihypertensive efficacy, as well as its influence on endothelial function (EF) and angiotensin-converting enzyme (ACE) serum activity, in patents with essential arterial hypertension (EAH).
Material and methods. The study included 20 males (mean age 48.8±8.4 years) with mild to moderate AH. Antihypertensive efficacy was assessed during office BP measurement (Korotkoff method) and 24-hour blood pressure monitoring (BPM). EF was assessed by endothelium-dependent vasodilatation (EDVD) during reactive hyperemia test (RHT).
Results. According to office BP measurements, target BP level (<140/90 mm Hg) was achieved in 75% patients on PR monotherapy, and 65% on HT monotherapy. According to 24-hour BPM, PR influenced BP levels more beneficially than HT. During PR and HT monotherapy, antihypertensive effect was more pronounced in patients with moderate AH (p=0.06). PR monotherapy caused some EDVD increase in patients with moderate AH (by 10%; NS), but did not affect EDVD in individuals with mild AH. HT treatment substantially increased EDVD in patients with mild AH (by 24%, from 7.13 to 9.18) and even more in participants with moderate AH (by 54%, from 6.52 to 10.02). PR therapy significantly reduced ACE activity, increased at baseline, to 28.1 nmol/min•ml (-43%, p<0.01). In patients with initially low ACE activity, it remained at the same level (reduction to 21.16 nmol/min•ml, NS). HT treatment did not affect this parameter in participants with low or high initial ACE activity.
Conclusion. PR and HT antihypertensive effects were associated with EDVD correction. PR and HT antihypertensive efficacy depended on baseline ACE activity. Both drugs could be used for BP correction in individuals with low ACE activity; for patients with initially high ACE activity, PR is more effective.

Arterial hypertension (AH) is the most prevalent disease worldwide, with general population prevalence of 15-20%. Despite being typically diagnosed after the age of 50, recently AH becomes more prevalent in adolescents and young adults.
Aim. To identify the first clinical signs of renal pathology in young patients (under 35) with initial stages of AH.
Material and methods. Forty-two men with Stage I-III AH, aged 15-35 (mean age 21.7±5.6 years), were examined. AH duration varied from 1 to 7 years (3.6±3.0). Mean systolic blood pressure (BP) level was 149.35±9.03 mm Hg, diastolic BP – 93.48±5.32 mm Hg. In all participants, general clinical examination, renal dynamic angioscintigraphy with DTPA-Tc99m, and ophtalmoscopy were performed.
Results. Renal dynamic angioscintigraphy with DTPA-Tc99m revealed various renal hemodynamics abnormalities in 98% of the patients (n=41). In most individuals (94%; n=39), renal blood flow was reduced. Ophtalmoscopy revealed initial stages of hypertensive retinopathy in 22 patients (52%). Participants with hypertensive retinopathy experienced decrease in renal blood flow of Stage II-III more often, by 17%: the decline was registered in 77% and 50% of the patients with or without hypertensive retinopathy, respectively. Therefore, retinopathy was associated with more severe abnormalities of renal hemodynamics.
Conclusion. In early AH stages, young patients, aged under 35, experience vascular remodeling even with high BP anamnesis as short as 1-7 years. There is a need for early administration of antihypertensive therapy, especially ACE inhibitors.

Aim. To investigate arterial hypertension (AH) clinical features in patients who suffered stroke (S) in previous 12 months.
Material and methods. Prevalence of various risk factors (RF), target organ damage and associated pathology, was compared in two groups: Group I – 500 S-free AH patients, mean age 64.8±6.2 years; Group II - 467 AH patients with S, mean age 66.2±4.3 years. 24-hour blood pressure monitoring, brachiocephalic artery duplex scanning, and echocardiography were preformed in all participants.
Results. In pre-S period, a syndrome of “poor prognosis” could be identified, that included some clinical and instrumental symptoms of aggressive RF influence and cardiovascular remodeling. In AH patients with high S risk, circadian BP profiles were disturbed, with increased prevalence of non-dippers, over-dippers, and night-peakers.
Conclusion. Long-term antihypertensive therapy with eprosartan in AH patients with or without S, demonstrated multiple beneficial effects: target BP level achievement, and circadian BP profile normalization.

Aim. To assess the effects of combined lisinopril and betahistidine dihydrochloride therapy on quality of life (QoL) and blood pressure (BP) in patients with stable, mild to moderate arterial hypertension and vertigo.
Material and methods. The study included 67 patients with stable, mild to moderate AH and vertigo. BP dynamics was assessed by 24-hour BP monitoring, QoL – by Marburg University Questionnaire, vertigo severity – by the questionnaire of State Research Center for Preventive Medicine.
Results. Both antihypertensive treatment (lisinopril monotherapy) and combined treatment (lisinopril plus betahistidine dihydrochloride) equally decreased BP levels. Lisinopril monotherapy improved only a few of QoL parameters, and combined therapy beneficially influenced virtually all of them. Long-term combined treatment decreased severity of vertigo and accompanying symptoms in both study groups. The most typical vertigo cause was disturbance of vestibular structures’ blood flow and metabolism, including restricted venous reflow due to BP increase. Long-term combined therapy was effective and well-tolerated.
Conclusion: Combined betahistidine dihydrochloride and lisinopril therapy was similar to lisinopril monotherapy, regarding BP reduction and vertigo symptoms improvement. At the same time, combined therapy improved more QoL parameters than monotherapy.

Aim. To assess perspectives of decreasing individual cardiovascular event (CVE) risk and surrogate end-point incidence (blood pressure, BP; left ventricular hypertrophy, LVH; pulse wave velocity, PWV), in high- and very high-risk patients with Stage II-III arterial hypertension (AH), during 6-month rilmenidine monotherapy.
Material and methods. This open clinical trial included 20 high- and very high-risk patients (6 males and 14 females; mean age 63.2±10.4 years), with Stage II-II AH, who were administered rilmenidine, 2 mg/d, for 6 months. At baseline and in the end of the treatment phase, all participants underwent 24-hour blood pressure monitoring (BPM), echocardiography (EchoCG), PWV measurement, biochemical examination, and individual CVE risk assessment by Framingham Scale. 
Results. After 6 months of rilmenidine monotherapy, target BP level was achieved in 78% of the patients. According to 24-hour BPM results, mean circadian systolic and diastolic blood pressure (SPB, DBP) levels had decreased by 10.5% and 7.4% (р<0.05), respectively. SBP and DBP morning surge rate had declined by 51.2% and 18.4% (p<0.05), respectively. For SBP and DBP, T/P coefficient was 76.0% and 63% (p<0.05), respectively. Rilmenidine therapy was associated with decrease in LV posterior wall thickness (from 10.2±0.2 to 9.8±0.1 mm), as well as carotid-femoral and carotid-radial PWV (by 21.7% and 20.1% (p<0.05), respectively). At baseline, total 10-year coronary heart disease (CHD) risk, calculated in Framingham model for SBP level, was 23.9% (standard risk 4.4%), for DBP level – 28.6% (standard risk 5.9%). After 6 months of rilmenidine monotherapy, the risk had decreased by 10.0% and 10.9% (p<0.05), respectively.
Conclusion. Rilmenidine possessed not only strong antihypertensive and organ-protective effects, but also decreased 10-year CHD risk in high- and very high-risk AH patients.

Aim. To study clinical, hemodynamic, and metabolic effects of 12-week therapy with Noliprel® (perindopril 2 mg plus indapamide 0.625 mg) in patients with arterial hypertension (AH) and metabolic syndrome (MS).
Material and methods. Twenty-five patients with AH and MS were enrolled in the study. At baseline, as well as after 12 weeks of Noliprel® and Noliprel Forte® therapy, 24-hour blood pressure monitoring (BPM), metabolic and hemostatic parameters’ assessments were performed.
Results. Twelve-week therapy with Noliprel® and Noliprel Forte® resulted in decrease of circadian BP, day- and night-time pressure load indices, and BP bi-phase profile normalization. Treatment with Noliprel® and Noliprel Forte® did not significantly influence plasma levels of lipids, glucose, or insulin. Initially increased platelet aggregation substantially improved during the treatment.
Conclusion. The results obtained demonstrate good antihypertensive effects during the whole day, and metabolic neutrality for both medications.

Aim. To assess the implementation of international guidelines on coronary heart disease (CHD) treatment and secondary prevention into Russian clinical practice, by examining Moscow- population patients with myocardial infarction (MI).
Material and methods. Five thousand out-patient medical cards of the individuals, who attended the Moscow City Cardiology Dispanser in 2001, were randomly selected. Among them, 623 patients had MI in anamnesis. According to medical documents data, the prevalence of CHD risk factors (RF), drug therapy administered, invasive CHD diagnostics and treatment, and CHD secondary prevention advice, were analyzed.
Results. Among Moscow physicians, inadequate awareness on CHD RF was observed. International guidelines were not followed: in particular, under-treatment with statins, antiplatelet agents, effective doses of antihypertensives, as well as over-treatment with first-generation calcium antagonists, were registered. Invasive CHD diagnostics and treatment were still used rarely, comparing to developed countries in Europe and worldwide.
Conclusion. In the area of CHD secondary prevention for MI patients, a huge gap between international guidelines and actual clinical practice was observed.

Aim. To analyze efficacy of out-patient, auto-translation (AT) ECG home monitoring for early, differential diagnostics of cardiac arrhythmias (CA) and antiarrhythmic treatment control in myocardial infarction (MI) patients.
Material and methods. The follow-up results for 136 Q-MI patients are presented. In 70 individuals, AT ECG was performed for 6 months, in “state-adjusted” and “ set discrete time” regimens. Sixty-eight patients underwent standard rehabilitation, controlled by out-patient cardiologists. Both groups were comparable by clinical severity and administered treatment (aspirin, beta blockers, ACE inhibitors, nitrates, etc.).
Results. In AT ECG group, CA (including potentially dangerous CA) were registered more often, that gave a chance to correct antiarrhythmic therapy. Sudden death (SD) incidence reached 27.2% in AT ECG group, and 40% in control group (percentage from all-cause mortality group rates).
Conclusion. AT ECG, as a variant of ECG home monitoring, substantially widens perspectives for out-patient CA diagnostics and management in MI patients, and possibly decreases SD incidence in early post-MI period.

Aim. To investigate parameters of physical working capacity (PWC) and central hemodynamics in myocardial infarction (MI) patients who underwent coronary artery bypass grafting (CABG), coronary balloon angioplasty (CBA), or no vascular intervention.
Material and methods. All 125 MI patients (mean age 51.6±1.8 years) underwent bicycle stress test and echocardiography (EchoCG) at baseline, and after 3, 6, and 12 months of the follow-up. The main group (n=90) was divided into three subgroups: A – after CABG, B – after CBA, and C – without any vascular intervention. All patients from the main group attended bicycle training sessions, with free-choice workload regimen.
Results. In subgroup A, PWC had increased by Month 6 and remained at this level up to Month 12; regression of left ventricular remodeling (LVR) was also observed. In subgroups B and C, PWC increased during the whole rehabilitation period. According to dynamic EchoCG, in subgroup B, LVR was delayed, and in subgroup C, LFR had regressed by Month 3 and remained at that level up to Month 12.
Conclusion. Bicycle training in free-choice workload regimen improved PWC and facilitated LFR regression.

Aim. To study quality of life (QoL) dynamics in out-patient individuals with stable angina pectoris, receiving standard basal therapy plus isosorbide dinitrate (ID) in aerosol form: Isoket® aerosol.
Material and methods. In total, 547 patients with effort angina were examined: 351 males (64.2%) and 196 females (35.8%); mean age – 61.2±9.9 years; mean disease duration – 8.9±1.9 years. A questionnaire, previously used in an international study of QoL in stable angina patients treated with nitrates, IQOLAN, was used. Standard basal therapy in most participants included beta-adrenoblockers and heart rate-reducing calcium antagonists. For treatment and prevention of anginal episodes, Isoket® aerosol was administered (12.7 g of ID in 15.0 ml), instead of nitroglycerin and nitrosorbide; the effect was assessed after three months of therapy.
Results. Therapy with ID aerosol was associated with substantial improvement in physical stress tolerance. QoL dynamics differed in patients with various angina functional classes (FC). Severity of anginal symptoms reduced, as well as their frequency: in females - from 79.8% to 41.4%; in males – from 80.7% to 41.1%. In subgroup with IV FC, the percentage of “substantial QoL deterioration” decreased: in females - from 100% to 60%, in males – from 94.6% to 47.8%.
Conclusion. ID aerosol was highly effective for treating angina episodes in virtually all patients. Its preventive administration improved QoL, especially in patents with angina-related restriction of physical activity.

Aim. To investigate autonomic regulation and personality traits in pregnant women with increased blood pressure (BP), for better predicting possible pregnancy complications.
Material and methods. Seventy-eight women were examined: 30 women with chronic arterial hypertension (CAH), 16 – with high normal BP (HNBP), and 32 – with normal BP (controls). All participants underwent heart rate variability (HRV) assessment and psychological testing. Pregnancy course was monitored in 69 women; nephropathy was diagnosed in 25 (36.2%), and feto-placental insufficiency (FPI) – in 18 (26%).
Results. HNBP patients had significantly more autonomous dysfunction complaints, significantly increased SMOL test (mini-MMPI) points, for scales 1, 3, 6, 7, comparing to the other two groups. CAH patients demonstrated disturbed general functional status and non-adequate reaction to physical stress. During trimester I, women with nephropathy and FPI had higher impulsivity and anxiety scale points, and lower total spectral HRV frequency – that could be predicting poor pregnancy outcome.
Conclusion. Women with HNBP and CAH need post-partum follow-up and rehabilitation.

The article contains systematized literature data on arterial hypertension (AH) treatment in acute and residual stroke periods. Results of the original studies on cerebral hemodynamics in chronic hypertensive cerebrovascular pathology are presented. The authors review rational approaches for antihypertensive treatment of cerebrovascular pathology patients. These approaches are based on the results of multi-center, randomized studies on AH treatment in recurrent stroke prevention, and take into account functional features of cerebral hemodynamics in this patient group.

Coronary heart disease (CHD) is characterized as a pathology substantially worsening life prognosis. The typical manifestation of chronic CHD is stable effort angina. Main principles of chronic CHD management are reviewed, with focus on antianginal drug therapy.

Summarizing and analyzing the information on the role of neurotrophic and growth factors in vascular pathology, arterial hypertension (AH), and organ damage (OD) pathogenesis, enables us to set new targets for treatment strategy. It is more and more evident that, besides the systems of peptide regulators (angiotensin II, endothelin-1, atrial natriuretic factors), catecholamines, etc., cardiovascular pathology pathogenesis is influenced by polypeptide growth and neurotrophic factors, participating in the complex chemical regulation process. They act as regulators of normal and pathological processes, and are directly linked with the triade “oxidative stress-inflammation-endothelial dysfunction”, that is crucial in AH and OD pathogenesis. Among these factors, the most prospective are: endothelial vascular growth factor, insulin-like growth factors, platelet growth factor, transforming growth factors, fibroblast growth factor, tumor necrosis factor. Structural and functional features of these substances, together with their role as possible mediators and/or predictors and targets in vascular pathology processes, are described in this article.

The article is devoted to the role of modern beta-adrenoblockers (BB) in arterial hypertension (AH) treatment. Their indications include not only AH, but also coronary heart disease, heart failure (HF), and some cardiac arrhythmias. At present, it is widely accepted that BB are important in HF treatment: they decrease the negative effects of sympathic myocardial stimulation – myocardial overload, hypertrophy, fibrosis, and apoptosis. Beta-1 antagonist, bisoprolol, is a highly cardioselective agent. Therefore, it is often used in patients with AH and HF. This medication does not provoke hypoglycemia in diabetic individuals, or require oral anti-diabetic medication dosage correction. Concor® can be successfully combined with other medications, to effectively decrease cardiovascular morbidity and mortality

An ACE inhibitor, spirapril, is widely used in modern cardiology practice. Its pharmacokinetics is characterized by prolonged elimination half-life, >24 hours. There is no need for dose titration, even in patients with chronic renal failure. The medication is effective in treating individuals with chronic heart failure. Various aspects of spirapril therapy are being studied in Russian-based clinical trials.