Aim. To assess the quality of preventive consulting (PC) on non-communicable disease (NCD) risk factors (RF) at primary healthcare level, on the basis of medico-sociologic survey among working6age visitors of territorial ambulatory and out-patient departments.
Material and methods. The study was performed as a part of multi-center marketing survey of demand for doctoral PC on main NCD and their RF at two centers – territorial polyclinics in Moscow and Ivanovo. A special questionnaire was used for the survey of representative working-age patients of these polyclinics (men aged 20-59 years, women aged 20-54 years). In total, 641 subjects were included in the study.
Results. Four quantitative PC quality parameters were proposed and assessed in the real-practice settings – indicators of preventive service quality (availability, accessibility, satisfaction) – RF awareness, demand for, reach of, and satisfaction by PC. The patients were inadequately aware on their own RF, with high demand and readiness for doctoral PC recommendations, and low PC reach: in every fifth case only, the already formed motivation and
demand for lifestyle modification could be satisfied.
Conclusion. The study demonstrated inadequate PC quality and use of primary healthcare resources (direct patient-doctor contacts) for complex PC on main NCD RF.

Aim. To assess various antihypertensive agents’ effects on arterial hypertension (AH) severity in hypothyrosis
patients.
Material and methods. In total, 81 patients with moderate primary hypothyrosis and Stage I-III AH were examined. General clinical examination, hormone level measurement, thyroid ultrasound, blood biochemistry assay
(lipid profile, glucose, creatinine, potassium levels), electrocardiography, and echocardiography were performed.
The participants were divided into four groups, receiving imidazoline receptor agonist rilmenidine (Group 1),
ACE inhibitor spirapril (Group 2), diuretic indapamide (Group 3), and dihydropyridine calcium antagonist
amlodipine (Group 4).
Results. Spirapril reduced systolic and diastolic blood pressure (SBP, DBP) by 9,1% and 7,1%, amlodipine – by
10,7% and 9,6%, rilmenidine – by 8,3% and 7,8%, respectively. Antihypertensive effectiveness of indapamide
monotherapy was problematic to assess, as only 1/3 of the patients received this treatment. Nevertheless, in indapamide group SBP and DBP reduction was greater (10,5% and 8,4%, respectively) than in spirapril and rilmenidine groups, where 75% and 68,4% of the subjects received monotherapy, respectively.
Conclusion. Considering good antihypertensive effect of indapamide, mostly in combination with another antihypertensive agent, target BP level in hypothyrosis patients should be achieved by combined therapy, including
diuretic.

Aim. To study tianeptine monotherapy effects on circadian blood pressure profile (CBPP) and lipid profile (LP) in patients with arterial hypertension (AH) and depression.
Material and methods. Seventeen 34-50-year-old patients with AH (Stage I mostly) and anxiety-depressive disorders (ADD), were administered tianeptine for three months.
Results. ADD severity was linked to CBPP parameters. Three-month tianeptine therapy significantly reduced anxiety and depression severity, BP level and BP time load parameters, without any negative effects on LP.
Conclusion. Adding tianeptine to complex treatment of AH and ADD patients was pathogenetically sensible and could substantially improve antihypertensive therapy effectiveness.

Aim. To assess vascular reactivity and endothelial function (EF) in people with workplace hypertension (WPH) and arterial hypertension (AH) patients.
Material and methods. Fifty men with Stage I-II AH were examined, including 30 with WPH, according to 24- hour blood pressure monitoring (BPM) during workdays and weekends (20 subjects with low workplace stress levels). Mean age of the participants was 42,8±8,2 years. Cold stress test, psycho-mental reading test, and arithmetic counting (AC) test were performed. Healthy controls were 30 males (mean age 40,6±7,1 years). Endothelium- dependent vasodilatation (EDVD) was assessed during the cuff test.
Results. BP reaction during stress tests was similar in all patients. During AC test, WPH patients demonstrated greater systolic blood pressure (SBP) increase than controls and AH patients. Increased cardiovascular reactivity during cold stress test was associated with AH in family history. In WPH subjects, EDVD was lower than in AH patients, and brachial artery occlusion was associated with vasoconstriction in 50%. Patients with cuff test vasoconstriction had lower SBP increase in cold stress test and greater SBP increase during reading test; diastolic BP (DBP) increase was greater in AC test. There was a negative correlation between DBP increase during AC test and EDVD. 
Conclusion. WPH patients differed from AH patients in terms of increased stress reactivity, associated with EF. Participants with cuff test vasoconstriction demonstrated vascular reactivity different from that in other AH patients.

Aim. To study nifedipine and losartan effects on endothelial function (EF) during acute pharmacological test (APT) in arterial hypertension (AH) patients with several risk factors (RF). 
Material and methods. The study included 94 patients with Stage I AH. All participants were divided into three groups: Group I – 31 AH patients with obesity (mean body mass index (BMI) 34,7±3,37 kg/m2); Group II – 32 smokers with AH and mean BMI 23,5±2,19 kg/m2; Group III - 31 AH patients with two RF (smoking and obesity) and mean BMI 35,1±3,72 кг/м2. Mean age was 47,9±8,2 years, mean AH duration - 12,4±2,0 years in Group I, 11,0±1,8 years in Group II, and 11,8±1,7 years in Group III. Angiotensin II receptor antagonist losartan was used as a comparison agent. All participants underwent general clinical examination. Endothelium dependent vasodilatation, diameters of common carotid artery and brachial artery, BA (Duplex method), linear blood flow velocities (peak systolic, maximal end diastolic, time averaged maximal velocities), and peripheral resistance index were measured. The participants received nifedipine (20 mg/d) and losartan (100 mg/d) once.  
Results. Comparative analysis of two medications’ effectiveness demonstrated improved endothelium dependent vasodilatation during APT with nifedipine and losartan. After nifedipine APT, BA diameter significantly increased in Groups I and III, after losartan APT – in Group III.  
Conclusion. Nifedipine improved EF in AH patients with various RF

Aim. To study ozone therapy effects on blood biochemistry (NO metabolites, NOn-), pro6oxidant and anti-oxdant  systems in arterial hypertension (AH) patients.
Material and methods. The study was focused on ozone therapy effects on metabolic activity of vascular endothelium and lipid peroxidation (LP) activity in 126 patients with stage I-II AH. The levels of NOn- in serum, malone dialdehyde in plasma and superoxide dismutase in red blood cells were measured.
Results. In Stage I-II AH, NOn- concentration was reduced, especially in Stage II AH. After one-month combined treatment, plasma NOn- level was similar to that in controls. As early as after first 7 days, ozone therapy resulted in significant LP activity reduction and increased antioxidant potential (AOP), comparing to standard treatment group.
Conclusion. Ozone therapy facilitates normalization of vascular endothelium NO-producing function, decrease in LP activity, and AOP restoration.

Aim. To increase treatment effectiveness in patients with coronary heart disease (CHD) and arterial hypertension (AH).
Material and methods. In total, 104 patients with stable effort angina (SEA) and AH, including 52 subjects receiving combination standard antihypertensive and anti6ischemic therapy, and 52 also receiving trimetazidine, were included in the study. Cardiac patients were examined according to medical standard OST 91500.11.0002-2002. Quality of life (QoL) was assessed with a special questionnaire, «Quality of Life Index Cardiac Version IV».
Results. Increased clinical effectiveness and improved QoL was observed among SEA and AH patients receiving combination therapy including slow6release trimetazidine.
Conclusion. Adding trimetazidine MB to combination therapy of SEA and AH patients improved the quality of pathogenetic treatment.

Aim. To study prognostic value of plasma soluble CD40 ligand (sCD40L) level in patients with various coronary heart disease (CHD) forms.
Material and methods. In total, 65 CHD patients were examined, including 26 with stable effort angina  (SEA), functional class (FC) I6III; 23 – with unstable angina (UA), Stage II6IIIB; 15 – with myocardial infarction (MI). Levels of sCD40L, highly sensitive C-reactive protein (hsCRP), interleukin-6 (IL-6), and fibrinogen were measured. Follow-up period lasted for 24 months. End-points included death from any cause, non6fatal MI, ischemic stroke, myocardial revascularization, hospitalization due to SEA progression or UA development.
Results. In SEA, UA and MI patients, sCD40L levels were similar. Type 2 diabetes mellitus (DM-2) patients had significantly higher sCD40L levels, comparing to other CHD participants. Cardiovascular event (CVE)-free survival analysis demonstrated that in CHD patients with low sCD40L levels, survival was significantly better than in participants with its higher levels, even after DM-2 patients' exclusion.
Conclusion. In CHD patients, initially increased sCD40L level is an independent predictor of adverse CVE during two-year follow-up.

Aim. To examine the changes in left ventricular (LV) local contractility (LC) and systolic function at rest and during cold stress test in patients with acute myocardial infarction (AMI).
Material and methods. The study included 67 AMI patients (mean age 56,41±1,06 years). The standard echocardiography examination took place at Day 10 after acute coronary syndrome (ACS) development. LC analysis was based on dividing LV into 16 segments.
Results. With similar baseline LC and global contractility (GC), cold stress test identified various reactions in AMI patients, which might reflect various mechanisms for each reaction type. In groups 1 and 2, cold stress test caused
different two6phase reactions. At the same time, in Group 1, negative inotropic response and decreased LC were observed; in Group 2, both LC and GC inotropic effects were positive. Group 3 was characterized by unchanged LV LC. Younger AMI patients (40-49 years) typically demonstrated reaction 1, with reduced LC and "early" angina clinics. In older ages, reaction 2, with improved LC and increased LV volume at rest, was more typical. Cold stress test reaction, described by decreased LV LC, is associated with poor prognosis, due to high frequency of recurrent ACS (33,3%).
Conclusion. Cold stress test could be used for prognosis assessment in AMI patients.

Aim. To study dynamics of vegetative reflex tests (VRT) during sanatorium rehabilitation in patients with noncomplicated myocardial infarction (MI).
Material and methods. In total, 106 men (mean age 48,6±1,0 years) were examined 44,3±3,2 days after MI, before
and after sanatorium6based rehabilitation. Heart rate variability (HRV) was assessed during 24-hour electrocardiography (ECG), ECG at rest, active orthostatic test (AOT) and controlled breath rate test (CBRT). Physical stress tolerability (PST) and echocardiography parameters were also assessed.
Results. After rehabilitation course, low frequency HRV component was increased in rest ECG (by 19 % for absolute values (p=0,06), by 5 % for normalized values (p=0,08)) and during AOT (by 27,3 % (р=0,015) and 6,2 % (р=0,011), respectively). CBRT results remained the same. Veloergometry PST increased by 10,1 %, end-systolic and end-diastolic left ventricular (LV) volumes decreased by 8,7 % and 6,6 %, respectively, asynergic area reduced by 6,0 %, and LV ejection fraction increased by 6,1 %. Rehabilitation adequacy was also confirmed by some decrease in mean HR and ventricular extrasystole rate during 246hour ECG monitoring.
Conclusion. The results obtained could facilitate HRV data use in physical rehabilitation effectiveness assessment,
optimizing and individual tailoring of rehabilitation programs.

Aim. To study the effects of long6term carvedilol treatment on left ventricular (LV) remodeling and glycemia control parameters in patients with chronic heart failure (CHF) due to post6infarction cardiosclerosis, and Type 2 diabetes mellitus (DM-2).
Material and methods. This 12-month study included 30 patients with functional Class (FC) II-III CHF by NYHA classification, LV ejection fraction (EF) <40% and DM-2. Carvedilol was administered in the daily dose of 6,25-
25 mg.
Results. Carvedilol therapy was associated with substantial heart rate reduction: from 103,5±4,6 to 79,7±2,3 bpm (р<0,001). After 12 months, end-diastolic and end-systolic volumes decreased from 199,4±32,7 to 182,7±36,8
and from 132,0±27,9 to 112,8±31,3 ml, respectively (р<0,001), LV EF increased from 34,22±3,80 to 39,04±5,39%. Carvedilol therapy did not affect glycemia levels: 178,0±12,97 mg/dl at baseline, 180,27±12,72 mg/dl in the end of the study (р>0,05).
Conclusion. Long-term carvedilol therapy was associated with improved clinic and hemodynamic status, as well as delayed LV remodeling, without affecting glycemia levels in patients with CHF and DM-2.

Aim. To investigate risk factors (RF) of chronic heart failure (CHF) in patients with various stages of chronic kidney pathology (CKP).
Material and methods. All participants (n=154) were divided into three groups: Group I 52 patients with mild CKP, Group II 52 individuals with moderate CKP, and Group III 46 persons with severe CKP. In all participants, lipid profile, lipid peroxidation and antioxidant system parameters, left ventricular (LV) structure and function (by echocardiography) were examined.
Results. According to multivariate regression analysis, in Group I systolic and diastolic blood pressure (SBP, DBP) independently affected LV diastolic function (DF). In group II, hemoglobin (Hb) level was an independent predictor of some LV DF parameters. In Group III, Hb level predicted some LV DF parameters, albumin predicted peak early diastolic filling (p=0,01), glomerular filtration rate predicted peak systole6diastolic filling (p=0,001), and SBP predicted LV ejection fraction (p=0,001).
Conclusion. In severe CKP, “non-traditional” CHF RF become more important in myocardial dysfunction progression.

Aim. To assess the effects of combination therapy with ACE inhibitors and carvedilol on cardiac remodeling, cardiac arrhythmias, and quality of life (QoL) in patients with mild to moderate chronic heart failure (CHF).
Material and methods. The study included 109 patients with mild to moderate CHF, developed in arterial hypertension, coronary heart disease, or their combination with diabetes mellitus and obesity. Initial carvedilol dose was 6,25-25 mg/d. At baseline, 3, 6, and 9 months later, physical examination, biochemical assay,  lectrocardiography,
QoL and clinical outcome assessment were performed. Doppler echocardiography and 24-hour electrocardiogram (ECG) monitoring were performed at baseline and 6 months later.
Results. CHF therapy, including the combination of ACE inhibitor and carvedilol, was associated with reduction in structural left ventricular (LV) remodeling, as well as with systolic and diastolic LV function normalization. According to 24-hour ECG monitoring data, the total number of supraventricular (including paired and grouped) and ventricular (including paired ectopic complexes) extrasystoles significantly decreased. Combination, carvedilol-including CHF therapy resulted in significant QoL and clinical prognosis improvement.
Conclusion. In patients with mild to moderate CHF, carvedilol demonstrated its clinical effectiveness, including reduced structural and electric remodeling progression.

Aim. To assess cardiovascular disease (CVD) prevalence in climacteric women with carbohydrate metabolism disturbances.
Material and methods. The case-control study included 468 climacteric women (median age 54,0 years) giving their informed consent. The main group included 234 women with fasting hyperglycemia, FHG (n=133), impaired glucose tolerance, IGT (n=46), and Type 2 diabetes mellitus, DM-2 (n=55). The control group included 234 women without carbohydrate metabolism disturbances, matched by age and post-menopause duration. Anthropometric and lipid profile parameters were measured, arterial hypertension (AH), coronary heart disease (CHD), chronic heart failure (CHF) were registered, as well as strokes and myocardial infarctions in anamnesis.
RESULTS. In the main group, prevalence of abdominal obesity, AH, CHD, CHF, and chronic disability was significantly higher. Main group participants also had substantially more severe climacteric syndrome. In FHG females, CHD and CHF were significantly more prevalent than in women with undisturbed carbohydrate metabolism.
Conclusion. In climacteric women, carbohydrate metabolism disturbances increase CVD prevalence and aggravate climacteric syndrome.

Aim. To assess heart rate variability (HRV) in response to 24-hour sleep deprivation (SD) among nurses with various work schedules.
Material and methods. The study included 24 healthy nurses from cardiac hospital departments (mean age 35,5 6,5 years). HRV was registered in the morning: in the main group – before and after 24 hours on duty, in the controls – before work and the next day, after a normal night sleep. HRT was analyzed by a time-frequency method: spectral powers for high, low, and very low frequencies (HF, LF, and VLF, respectively) were measured, as well as  LF/HF.
Results. In the main group, background LF/HF was significantly higher than in the controls (р=0,0410). 24-hour SD was associated with substantial decrease in LF power (р=0,0267), with unchanged HF power. Consequently, LF/HF reduced significantly (р=0,0150).
Conclusion. 24-hour SD reduced activity of sympathetic regulation of chronotropic cardiac function and changed autonomic balance towards relative increase of parasympathetic effects on heart rate. Chronic SD enhanced background sympathetic activity and reduced its adaptive potential, which could be one of the factors of increased cardiovascular morbidity and mortality as a result of working shifts.

Aim. To study structural cerebral changes in patients with arterial hypertension (AH), taking into consideration 24-hour blood pressure monitoring (BPM) results and their dynamics during antihypertensive therapy.
Material and methods. In total, 212 AH patients aged 40-60 years (mean age 48,3±5,7 years) were examined. Cerebral magnetic resonance tomography, cerebral emission computed tomography, and 246hour BPM were performed. The therapy included enalapril (5-20 mg/d; n=32) and indapamide retard (1,5 mg/d; n=32) for 24 weeks.
Results. Structural cerebral changes, observed in 89,5% of AH patients, were significantly associated with 24-hour BPM parameters. Indapamide and enalapril therapy was associated with significant BP reduction, according to 24-hour BPM data, as well as with cerebral perfusion improvement (primarily in occipital region) and decreased disturbances of liquor circulation and periventricular edema. The parameters studied improved to a greater extent in the indapamide group.
Conclusion. Circadian BP profile normalization, during indapamide retard therapy, was associated with improved cerebral perfusion and structure. Positive dynamics of cerebral parameters was manifested to a lesser extent in the enalapril group.

Aim. To determine objective criteria for stress reaction phases during psycho-emotional stress (PES), taking into account adaptation reserves of regulatory systems: neuro-autonomic regulation (NAR) and cognitive function (CF). 
Material and methods. Stress-associated profession representatives were examined (46 businessmen; mean age 44,1±2,32 years), with the control group of healthcare professionals (n=22; mean age 43±1,93 years). All partic ipants underwent psychological testing, including psycho6mental tests, psycho-emotional stress test (Stroop test), as well as heart rate variability (HRV) assessment. 
Results. Regulatory system changes (NAR, CF) were examined at various phases of PES stress reaction. Objective criteria for stress reaction phases, associated with certain NAR and CF changes, were identified based on computerized Stroop test data. 
Conclusion. The approach proposed could facilitate timely, quantitative assessment of stress reaction phases at various adaptation levels. The method may be used in clinical, sports, and extreme states medicine.

The ADVANCE Study, started in early 2001, included 11140 patients aged over 55 years, with Type 2 diabetes mellitus (DM-2) and one more risk factor (RF): age 65 years and above, macro- or microvascular pathology in anamnesis, DM-2 duration over 10 years, etc. In patients with DM-2 and arterial hypertension (AH), blood pressure control could be achieved with perindopril + indapamide combination (4,0/1,25 mg), regardless of clinical and demographical parameters. Long-term combination therapy (4,5 years) was associated with substantial decrease in cardiovascular risk among DM-2 individuals, regardless of AH presence or absence and treatment characteristics.

Clinical trial and meta-analyis data demonstrate the important role of lipid-lowering therapy in reducing the risk of coronary heart disease (CHD) complications and CHD death. Practitioners need additional information to select from the already available statins the one that is not only effective and safe, but also the most acceptable from the pharmaco-economical point of view. The research data available support high efficacy, good safety profile, and clinic-economical effectiveness of a new synthetic statin - rosuvastatin.

Recently, high effectiveness of long-term statin therapy has been demonstrated not only for hyperlipidemias, but also for various forms of coronary heart disease and high cardiovascular risk. Low therapy compliance restricts statins’ effectiveness substantially. Awareness of the factors determining low compliance facilitates prediction of patients’ attitude towards treatment, as well as planning of therapy monitoring and patient education. Choosing an effective statin, e.g., atorvastatin, gives an opportunity to achieve target lipid levels faster and provides adequate treatment compliance.

The features of various statins’ use are analysed taking into consideration their clinical and pharmacological parameters. The present evidence base on atorvastatin and rosuvastatin is emphasised. The author compares various statins in regard to their potential in atherosclerotic plaque reduction, according to intravascular ultrasound data. Substantial benefits of lipid-lowering monotherapy by “new” vs “old” statins are demonstrated.

Clinical pharmacology of ACE inhibitors is described, comparing pharmacological effects of agents with or without sulfhydryl groups in their molecules. Sulfhydryl group-containing ACE inhibitors – captopril and especially zofenopril – are characterized by greater antioxidant properties and, potentially, stronger cardio- and vasoprotective action. Literature data confirm benefits of these sulfhydryl ACE inhibitors as first-line medications for treating acute myocardial infarction, other coronary heart disease forms, arterial hypertension and diabetes mellitus, due to important pathogenetic role of oxidative stress.