Twenty centers from 19 Russian regions took part in ROSA 2, following the first ROSA study.
Aim. In arterial hypertension (AH) patients, to compare efficacy, safety, and impact on cardiovascular event (CVE) incidence for two treatment strategies: intensive stepwise therapy with four classes of antihypertensive agents (Group A), and non-standardized antihypertensive therapy (Group B), during two-year follow-up.
Material and methods. The study was national, multicenter, open, prospective, and included 1355 patients with AH, randomized into Groups A (n=697) and B (n=658). In total, 87.2% of the participants completed the study: 634 individuals from Group A, and 547 patients from Group B. There were 39.9% of males and 60.1% of females; mean age at baseline was 53.6±9.1 years, mean AH duration – 8.8±7.4 years. In Group A, patients received nifedipine retard monotherapy for 4 weeks, with 4-week intervals before adding enalapril, hydrochlorthiazide, and metoprolol. After target blood pressure (BP) level achievement, patients received the therapy at which this level was reached. Group B continued the same antihypertensive treatment that was administered before study recruitment.
Results. After two years of stepwise therapy with 4 classes of antihypertensive agents, target BP level was achieved and maintained in 98.3% of Group A patients, and 53.9% of Group B participants (р<0.0001). In Type 2 diabetes mellitus (DM) patients, these figures were 42.9% and 29.6%, respectively (р=0.05). During two-year follow-up, secondary endpoint was registered in 6.3% of participants: 0.9% in Group A, 5.4% in Group B (p<0.0001). In Group B, acute myocardial infarction (p=0.01), acute stroke or transitory ischemic attack (p=0.005), and hypertensive crises (p<0.0001) were significantly more frequent than in Group A. Drop-out rates were 12.8% for the whole group, 4.6% for Group A, and 8.2% for Group B (p=0.0001). Among drop-outs in Groups A and B, there were 2.7% and 4.4% refusals to continue the treatment (р=0.006); 1.8% vs 2.6% adverse effects (р=0.09); 0.1% and 1.2% secondary endpoint registration, respectively (p<0.001).
Conclusion. Stepwise antihypertensive treatment, comparing with non-standardized antihypertensive therapy, was more effective in achieving target BP level and CVE risk reduction, without increasing adverse effect rates.

Aim. To study prevalence of risk factors (RF), target organ damage (TOD), and associated clinical conditions (ACC) in arterial hypertension (AH) patients, for total cardiovascular risk assessment.
Material and methods. Epidemiological AH survey including 3661 males and 6334 males, aged 15+ years, from a representative national sample, was performed as part of the Program «AH Prevention and Treatment in the Russian Federation».
Results. AH males, comparing to hypertensive females, had lower education level, smoked and drunk alcohol excessively more often (48.3% vs 7.9%; 6.8% vs 1.9%, respectively). In females, obesity prevalence was higher: 34.9% vs 18.1% in males. One-fifth of hypertensive patients had hypertensive retinopathy, 41% - left ventricular hypertrophy. Coronary heart disease (CHD) prevalence was higher in males - 22.3% vs 17.6% in females; the prevalence of other ACC was similar in both genders. In females, Stage III AH was diagnosed more often: 6.3% vs 4.2% in males. Antihypertensive therapy was administered to 59.5% of males and 73.8% of females, but treatment effectiveness was low – 12.9% and 13.5%, respectively. In untreated hypertensive patients, very high risk was typical for women (6.0% vs 3.9% in men); in treated patients, more than 80% remained in high and very high risk groups.
Conclusion. In AH individuals, RF, TOD, and ACC, as well as poor BP control, are prevalent, that explained high risk level for the majority of patients.

Aim. To study and assess, with spiroergometry method, main parameters of physical stress (PS) oxygen (O2) support in arterial hypertension (AH) patients receiving combined and monotherapy with an ACE inhibitor perindopril.
Material and methods. The study included 30 patients (17 females, 13 males; mean age 55.1±8.4 years) with systolic blood pressure (SBP) 140-180 mm Hg, and diastolic blood pressure (DBP) 90-110 mm Hg. Mean AH duration was 5.4±2.2 years. Due to target organ damage, all participants had high cardiovascular event risk.
Results. Twelve-week perindopril monotherapy resulted in BP normalization at rest and in PS, significant increase of anaerobic threshold and O 2 pulse, as well as in non-significant improvement of peak O2 consumption, maximal minute lung ventilation, and breath reserve. Combination of perindopril and nebivolol or indapamide resulted in improving of all PS O2 support parameters. Choosing antihypertensive therapy, individually achieved PS level should be taken into account: if maximal O 2 support levels are achieved in >50% of predicted PS, combined therapy with diuretics and beta-blockers is optimal.
Conclusion. Perindopril as combined and monotherapy significantly improved PS O2 support parameters in patients with essential arterial hypertension.

Aim. To study clinical effectiveness of eprosartan mesylate in treating patients with Stage I-II arterial hypertension (AH).
Material and methods. In total, 28 patients (20 males, 8 females) with Stage I-II AH, risk 2-3, aged 28-56 years (mean age 40.0±1.3), were examined. All participants received eprosartan monotherapy (600 mg once per day) for 8 weeks. At baseline and 8 weeks later, 24-hour ECG and blood pressure (BP) monitoring, stress echocardiography with counting test, cognitive functions and quality of life (SF-36 Questionnaire) assessments were performed.
Results. Eprosartan monotherapy was associated with moderate antihypertensive and sympatholytic effects, decreased diastolic dysfunction during psycho-emotional stress, and no negative influence on cognitive processes.
Conclusion. Eprosartan could be used for treating patients with Stage I-II essential AH, whose professional activity demands intact superior neuro-psychic functions.

Aim. To assess potential of corrected orthogonal vectorcardiography (VCG) in diagnostics of right heart dilatation in various pulmonary hypertension (PH) forms.
Material and methods. VCG examination was performed with corrected orthogonal lead system by MacFeeParungao, in 77 patients aged 14-77 years: 35 individuals with primary PH (PPH), 42 participants with secondary PH (CPH) due to congenital and acquired valve disease (CVD, AVD), or chronic obstructive pulmonary disease (COPD).
Results. According to VCG results, right atrium dilatation was observed in 80.5% of PH patients, right ventriculum dilatation – in 90.9%. Prevalence of right heart dilatation was maximal in PPH – 94.3%, being lower in COPD (80%), CVD, and AVD (59.1%). VCG predictors of right heart dilatation in PH were: P loop spatial area, P loop diameter in optimal approach plane, and total R wave amplitude regarding z and S in lead x.
Conclusion. According to the results obtained, VCG method could be recommended for right heart size assessment in patients with various PH forms.

Aim. To compare sotalol and bisoprolol efficacy for post-cardioconversion sinus rhythm maintaining in patients with chronic heart failure (CHF) and paroxysmal atrial fibrillation (AF).
Material and methods. For 6 months, 45 patients (mean age 60.3±3.2 years) with non-rheumatic AF were observed. In individuals with CHF and paroxysmal AF, after restoring sinus rhythm, preventive antiarrhythmic therapy included sotalol (mean daily dose 160 mg; Group I, n=23) and bisoprolol (mean daily dose 7.5 mg; Group II, n=22).
Results. In one patient from Group II and 3 patients from Group I (4.5% and 13%, respectively), AF became permanent. CHF functional class decreased by 7% in Group I, and by 10.2% in Group II. Six-minute walking test results improved by 10.2% and 9.3%; left ventricular ejection fraction increased by 1.3% and 9.3%; left atrium size reduced by 2.1% and 6.8%, respectively. In sotalol group, functional activity of β-adrenoreceptors (β-AR) increased by 16.5% (р>0.05), in bisoprolol group, it significantly reduced by 34% (р<0.05). There was direct correlation between β-AR and heart rate (r=0.58, р<0.01), and inverse linear correlation between β-AR and physical stress tolerance improvement (r=-0.43, р<0.05).
Conclusion. Sotalol and bisoprolol were equally effective in maintaining restored sinus rhythm in patients with CHF and paroxysmal AF.

Aim. To compare prevalence of metabolic syndrome (MS) by WHO and ATP III criteria, in patients with arterial hypertension (AH) and obesity.
Material and methods. MS prevalence in obese AH patients was studied in 517 males and 1041 females aged 20- 75 years. Two most well-known definitions of MS, proposed by World Health Organization (WHO) and National Cholesterol Education Program’s Adults Treatment Panel III, National Institutes of Health, USA (ATP III, USA) were used.
Results. Among 1558 participants, MS was diagnosed in 72% by ATP III criteria, and in 17% by WHO criteria. MS prevalence was gender-specific: in males, it was 62% (ATP III) or 19% (WHO), in females - 76% or 16%, respectively. MS diagnostic agreement was observed in 44% of the participants: MS was diagnosed by both definitions in 16%, and not diagnosed by both definitions in 28%. 58% of the patients had MS verified by only one diagnostic version.
Conclusion. For wider use in clinical practice, unified MS definition should be created, or methods integrating different diagnostic criteria, should be introduced.

Aim. To study endothelial functional status dynamics in metabolic syndrome (MS) patients receiving Noliprel® therapy.
Material and methods. In 39 patients with diagnosed MS, endothelial functional status (reactive hyperemia and nitroglycerin tests), microcirculation (MC) and 24-hour blood pressure monitoring (BPM) parameters were assessed during 6-month Noliprel ® therapy.
Results. After 6 month of Noliprel® therapy, systolic and diastolic BP levels significantly decreased (р<0.01 and р<0.05, respectively), 24-hour BPM parameters improved. Endothelium-dependent vasodilatation increased, that was a symptom of endothelial function improvement. MC parameters also improved, initially reduced prostacyclin level increased (р<0.01), and initially increased thromboxane concentration decreased (р<0.01). Microalbuminuria and proteinuria levels significantly reduced (р<0.01).
Conclusion. Noliprel® improved endothelial function in MS patients. Endothelial dysfunction correction changed vascular reactivity to vasoconstrictors, regardless of vessel size, and therefore, improved hemodynamic and hemostatic parameters.

Aim. To examine continuous positive airway pressure (CPAP) therapy effects on carbohydrate and lipid metabolism in patients with metabolic syndrome (MS) and obstructive sleep apnea syndrome (OSAS).
Material and methods. The study involved 62 MS patients: 20 females and 42 males, aged 39-66 years (mean age 52.4±7.6 years). Control group included 15 patients without OSAS, another 47 had OSAS of varying severity (main group). CPAP therapy was administered to 11 OSAS patients for 12 weeks. At baseline and 12 weeks later, height, body weight (BW), waist and hips circumference (WC, HC) were measured, with body mass index calculation (BMI); levels of total cholesterol (TCH), high-density lipoprotein (HDL) CH, triglycerides (TG), glucose, leptin, resistin, adiponectin were assessed; glucose tolerance test and 24-hour blood pressure (BP) monitoring were performed.
Results. BW, BMI, WC, WC/HC, TCH decrease wasn’t statistically significant. HDL CH level increased from 0.99±0.2 to 1.12±0.1 mmol/l (р<0.05). TG concentration decreased from 4.18±3.3 to 2.31±1.2 mmol/l (р<0.05). Fasting glucose level fell from 5.8±0.8 to 5.3±0.3 mmol/l (р<0.05), and after glucose load test – from 8.3±1.8 to 6.5±1.9 mmol/l (р<0.05). Adipocytokine levels significantly improved: leptin level decreased from 15.14±4.6 to 11.17±5.2 ng/ml (р<0.05); resistin concentration – from 3.02±0.87 to 2.5±0.51 ng/ml (p<0.05), and adiponectin level increased form 2.44±0.6 to 3.34±0.9 ng/ml (p<0.05).
Conclusion. Effective CPAP therapy significantly improved metabolic parameters in patients with MS and OSAS.

Aim. To study indapamide retard 1,5 mg effects in women with menopausal metabolic syndrome (MMS) after hysterectomy.
Material and methods. The study involved 25 women (mean age 43.82±4.08 years), who underwent subtotal hysterectomy, with one or two ovaries intact, and suffered from Stage I-II arterial hypertension for 2-5 years. In all participants, 24-hour blood pressure (BP) monitoring, the assessment of central hemodynamics, plasma electrolytes and metabolites were performed. The treatment with indapamide retard 1,5 mg lasted for 16 weeks.
Results. During the treatment, BP levels significantly decreased: for 24-hour systolic BP (SBP) - by 7.9%, for 24-hour diastolic BP (DBP) – by 9.5%; for daytime SBP and DBP – by 9,5% and 10.8%, respectively; for nighttime SBP and DBP – by 8.9% and 9.0%, respectively. Mostly due to positive dynamics in «overdipper» group, 24-hour BP profile had improved. Stroke and cardiac indices, total peripheral vascular resistance did decrease, with heart rate unchanged. Indapamide retard 1,5 mg did not significantly affect plasma levels of electrolytes, glucose, total cholesterol, uric acid, and immunoreactive insulin. Triglycerides and C-peptide levels declined by 24.68% and 41.59%, respectively.
Conclusion. The study confirmed antihypertensive efficacy of indapamide retard 1,5 mg and its beneficial influence of central hemodynamics. Metabolic and electrolytic neutrality gives an opportunity to use indapamide for arterial hypertension management in MMS women.

The article is devoted to high prevalence of psychoemotional and somatic (especially cardiovascular) disease association. Diagnostic criteria for most prevalent psychoemotional disorders (asthenic syndrome, anxiety, and depression) are reviewed.

Pre-diabetes includes impaired glucose tolerance (IGT) and fasting hyperglycemia. According to epidemiologic data, the number of ITG patience is twice as high as the number of diabetes mellitus (DM) patients. Cardiovascular event (CVE) risk in IGT patients is by 1.32 times higher than that in normoglycemic individuals. IGT is one of the 5 metabolic syndrome components. The crucial task of IGT management is postprandial hyperglycemia control. Together with lifestyle modification, three groups of antihyperglycemic agents are used: acarbose, metformin, and thiazolidines. Acarbose locally inhibits α-glucosidase, an intestinal enzyme, and prevent glucose absorption at the early digestion stages. According to the results of STOP-NIDDM and APREL trials, acarbose is a medication of choice in treating IGT patients. IGT diagnostics and treatment are among priority areas of modern cardiology

Nitrates are widely used in cardiology since XIX century. In modern urgent cardiology, intravenous nitrates are administered most often. Numerous studies confirm high clinical efficacy and safety of intravenous nitrates in acute coronary syndromes, acute heart failure, or acute decompensation of chronic heart failure.