Aim. To assess effectiveness of Health School for arterial hypertension (AH) patients in NOCTURNE Program. Material and methods. An open, multi-center, prospective study was performed in 14 Russian regions, involving 140 primary health doctors and 1195 mild-to-moderate AH patients. The authors studied real-world clinical practice perspectives of total cardiovascular risk modification by pharmaceutical treatment regimen modification – administration of combined agent Noliprel®, once per day, and main risk factors (RF) control – educating patients at Health School. Total follow-up period lasted for 48 weeks. Results. In total, 66.5% of the participants had Stage II AH, 32.5% – Stage I AH; 78.3% were overweight (OW); 21.2% were smokers; 76.0% had increased stress levels; 66.3% had hypercholesterolemia (HCH). Follow-up was completed by 83.4% of the patients (n=997). During the follow-up period (mean duration 39.4±12.1 weeks), 85.1% of participants continued to take the medication. The treatment was associated with decrease in prevalence of OW (from 79.0% to 70.2%), smoking (from 21.6% to 14.6%), increased stress levels (from 81.0% to 71.0%), and HCH (from 65.9% to 49.2%). More than a half of the patients (53.9%) demonstrated decrease in total cardiovascular risk by SCORE scale. In the whole group, the total risk decreased from 2.5% to 1.3%. Conclusion. Real-world reduction of fatal cardiovascular disease total risk was confirmed. It was achieved by combination of complex therapeutic and preventive measures: optimal medication therapy regimen and nonpharmaceutical RF correction during patients’ education at Health School.

Aim. To analyze effectiveness of “Health School” (First Out-Patient Department, Yekaterinburg Central City Hospital No. 6) activity in arterial hypertension (AH) patients. Material and methods. The study included 120 patients (85 females), attending School sessions. Attendees’ questionnaire survey was performed at first and sixth sessions. Target blood pressure (BP) level achievement was assessed by office BP measurement and diary BP registration. Six-month results after stopping the program were also registered. Results. Among all participants, there were 70.8% females; 67 individuals under 60 were still working (58.3%), 41 had Stage I AH (34%). By the program’s end, 30 patients (25%) achieved target BP levels; in 42 individuals (35%), BP decreased by 30% from the baseline level. Six months later, 67 patients (55.8%) maintained target BP level. Increase in combination therapy usage, by the end of the program, was associated with increased administration of diuretics and angiotensin II receptor antagonists. Conclusion. Optimal program outlay included interactive lectures and individual consultation sessions, that gave a chance to reach wide audience of AH patients and achieve real-life positive results in their treatment.

Aim. To investigate heart remodeling features and chronic heart failure (CHF) incidence in patients with hypertensive encephalopathy (HE). Material and methods. In total, 113 HE patients with Stage I-III essential arterial hypertension, as well as 26 healthy individuals (control group) were examined. CHF was diagnosed according to National Recommendations by Heart Failure Specialists’ Society (2002). Patients with coronary heart disease, heart valve disease, atrial fibrillation, inflammatory and toxic heart disease were excluded. Heart remodeling type, state and parameters of left ventricular (LV) contractility were assessed by echocardiography method. Results. Stage I CHF (isolated diastolic dysfunction) was diagnosed in 65 (57.5%) patients, Stage IIA CHF – in 36 (31.9%) participants. CHF was registered in majority of patients with Stage II HE (97.5%), and in all individuals with Stage III HE. Dominating heart remodeling type was concentric LV remodeling with diastolic dysfunction and normal systolic function. Neurological disturbances were associated not only with HE stage, but also with CHF presence and severity. Conclusion. In HE patients, cardiac examination and active CHF diagnostics should be stressed. Basal antihypertensive therapy in Stage II-III HE should include medications recommended for CHF treatment: ACE inhibitors, beta-blockers.

Aim. To improve diagnostics of arterial hypertension (AH) at early stages. Material and methods. In 34 relatively healthy individuals and 72 AH patients, 24-hour blood pressure monitoring (BPM) was performed. In all hypertensive patients, no target organ damage was registered, office BP levels were below 159/94 mm Hg. Results. Using the program imitating artificial neuronal nets, a model was developed that correctly diagnosed early AH stages, by 24-hour BPM data, in people without evident BP increase. Conclusion. Non-linear multiple modeling substantially improved early AH diagnostics in people without evident BP increase at rest.

Aim. To study effectiveness of ACE inhibitor therapy in coronary heart disease (CHD) combined with chronic obstructive pulmonary disease (COPD). Material and methods. In total, 89 males with CHD and COPD were examined. All participants had Stage I-II arterial hypertension (AH). For antihypertensive therapy correction and secondary prevention of heart failure, ACE inhibitors were administered (spirapril, fosinopril, and enalapril), combined with dihydropyridine calcium antagonists and M-cholinolytics. ACE inhibitor therapy lasted for 12 weeks. At baseline and during the treatment, 24-hour blood pressure monitoring was performed, mean pulmonary artery pressure (MPAP), lung function, endothelium-dependent and independent vasoreactivity, hemorheology parameters, and quality of life (QoL) were measured. Results. In CHP and COPD patients, ACE inhibitors spirapril and fosinopril were more effective than enalapril. The first two agents demonstrated positive effects on vasoreactivity and hemorheology, facilitating facilitated decrease in systemic and pulmonary hypertension, as well as QoL improvement. After 12 weeks of the therapy, spirapril decreased MPAP by 16.4%, fosinopril - by 6.5%, enalapril – by 2.8%. Fibrinogen and hematocrit levels decreased by 18.7% and 13.4%, respectively, after spirapril therapy, by 5.8% and 9.2% after fosinopril therapy, and by 4.1% and 4.8%, respectively, after enalapril therapy. Conclusion. In complex calcium antagonist and M-cholinoblocker therapy among CHD and COPD patients, an ACE inhibitor spirapril is the most effective agent.

Aim. To study associations among risk factors (RF) of cardiovascular disease (CVD) (increased body mass index, BMI; left ventricular hypertrophy, LVH; increased serum level of total cholesterol, TCH; alcohol abuse), psychological traits and cerebral hemodynamics parameters in healthy men aged 20-29 years, in regard to 10-year risk of arterial hypertension (AH) development. Material and methods. During 10-year follow-up, among 886 initially healthy males aged 20-29 years, AH developed in 80 (9%). According to Multiphasic Personality Inventory (MPI), two psychologically different groups were identified. FR and psychological trait effects on AH incidence were studied in regression analysis. Results. By MPI profile, two groups were different in scales of correction, pessimism, rigidity, anxiety, individualism, and introversion. AH incidence was affected by: personality traits mentioned above, alcohol intake, BMI, TCH, CVD in family anamnesis, LVH, cerebral vascular dystonia, low physical activity out of work. MPI scales correlated with alcohol intake, BMI, and TCH. Conclusion. Identified psychological personality traits could be regarded as AH RF in men aged 20-29 years. CVD RF and rheoencephalography parameters might be divided into psychological reactivity-related (alcohol intake, BMI, TCH), and unrelated (CVD in family anamnesis, cerebrovascular dystonia, and low physical activity out of work).

Aim. To compare clinical and coronaroangiography results in patients with coronary atherosclerosis risk factors (RF). Material and methods. The study included 124 patients with coronary atherosclerosis RF. All participants were divided into four clinical groups. Group I included 66 patients with negative maximal stress tests (ST). Group II included 10 males with overt isolated painless myocardial ischemia (IPMI). Group III consisted of 14 patients with coronary heart disease (CHD), with mildly manifested stable effort angina (SEA). Group IV included 34 CHD patients with overt angina syndrome. All participants underwent selective coronaroangiography (CAG). Results. In 42.2% of patients with negative ST results, hemodynamically significant (at least, 75%) stenosis of one or more main coronary arteries (CA) was observed. According to CAG data, all CHD patients had hemodynamically significant CA pathology. In IPMI individuals, one main CA lesion was most prevalent; two-vessel pathology was typical for patients with mildly manifested SEA, and three-vessel pathology was prevalent in participants with overt angina syndrome. Conclusion. There was a clear link between chromic CHD clinics and CA obstruction severity. IPMI and SEA were two consequent stages in stenosing coronary atherosclerosis progression.

Aim. To study the effects of three-month propafenone antiarrhythmic therapy (daily dose 450 mg) on inotropic myocardial function in patients with recurrent atrial fibrillation (AF). Material and methods. The study included 18 (100%) patients aged 39-59 years (mean age 51.7±6.7 years), receiving propafenone (450 mg/d) for 3 months, to prevent recurrent AF. To assess antiarrhythmic therapy effects on inotropic myocardial function, all participants underwent balanced radionuclide ventriculography at baseline; in patients with maintained sinus rhythm, it was repeated after 3 months of treatment. Results. In first 3 days after restoring sinus rhythm in recurrent AF patients, diastolic function dynamics was observed: significant reduction in 1/3 diastole filling and peak filling velocity. After 3 months of propafenone treatment, left ventricular (LF) 1/3 diastole filling (p<0.05), as well as LV and right ventricular (RV) filling peak velocity (p<0.05), significantly increased. Ejection fraction, systolic and volumic parameters of LV and RV stayed within the normal range and did not change significantly. After 3-month propafenone therapy, recurrent AF patients demonstrated significant increase in atrial input into LV diastole – from 17.1±5.7% to 22.1±6.5%, and RV diastole – from 17.3±5.1% to 21.1±6.2% (р<0.05). Conclusion. Propafenone therapy (450 mg/d) facilitated 3-month sinus rhythm maintenance in 77% patients with recurrent AF. The therapy did not affect LF and RV inotropic myocardial function. Maintaining sinus rhythm for 3 moths facilitated normalization of atrial contractility and ventricular diastolic dysfunction improvement. 

Aim. To study inotropic myocardial function of left and right ventriculum (LV, RV) in patients with recurrent atrial fibrillation (AF), according to balanced radionuclide ventriculography (BRVG) data. Material and methods. The study included 72 patients: 30 individuals with coronary heart disease (CHD) and recurrent AF (Group I), as well as 42 CHD patients without cardiac arrhythmias (Group II). Participants’ age varied from 39 to 79 years (mean age 60.3±2.5 years). To assess systolic and diastolic LV and RV function, all participants underwent BRVG. Results. LV and RV ejection fraction was normal in all subjects. LV peak filling velocity was significantly reduced in patients with recurrent AF, comparing to arrhythmia-free individuals (p<0.05). LV end-diastolic volume in Group I was substantially lower than in Group II (p<0.05). At echocardiography, left and right atrium sizes were increased in patients with recurrent AF. Conclusion. Heart remodeling in patients with recurrent AF manifested by diastolic LV and RV dysfunction, combined with atrium size increase.

Aim. To study carbohydrate, hormonal, and lipid parameters in patients with mild to moderate arterial hypertension (AH) and metabolic syndrome (MS) components. Material and methods. In total, 265 males (mean age 53.4±4.2 years) with mild to moderate AH and MS components were examined. Comparison group included 27 males with excess body mass (BM) without AH and carbohydrate metabolism disturbances, control group – 20 healthy males with normal BM. All participants underwent office blood pressure (BP) measurement, anthropometry, glucose tolerance test; lipid profile, levels of fasting and postglucose load insulin, leptin, thyroid hormones, cortisol, thyrotropic (TTH) and adrenocorticotropic hormone (ACTH) were measured. Results. Basal hyperinsulinemia was observed in 59% patients with isolated AH, and 52% of normotensive males with excess BM. In 93% of normotensive males with excess BM, hyperleptinemia was registered; insulin resistance (IR) was observed only in 52%. In AH and MS men, subclinical hypothyrosis (76%), increased levels of insulin, leptin, ACTH and cortisol were observed more often than in men with isolated AH or healthy participants. In obese individuals, there was a positive correlation of leptin level with BM, TTH, ACTH, cortisol, insulin, and triglycerides. Conclusion. In patients with AH and MS, increased cortisol, ACTH, insulin, and leptin production was linked to obesity severity, and was associated with subclinical hypothyrosis. In its turn, chronic increase in cortisol and insulin levels could facilitate IR and fat tissue percentage increase.

Aim. To study effects of long-term, moderate-intensity controlled physical training (CPT) on blood pressure (BP) level and metabolic disturbances (MD) in young men with Stage I arterial hypertension (AH). Material and methods. The study included 49 men aged 18-45 years, with I Stage AH and MD, adhering to nonpharmaceutical lifestyle modification recommendations. Twenty-three patients additionally underwent long-term, moderate-intensity CPT for at least 6 months. Every 3 months, 24-hour BP monitoring, Doppler echocardiography (EchoCG), treadmill test, anthropometry with body mass index (BMI) calculation, lipid and carbohydrate profile assessment were performed. Results. Systematic moderate-intensity CPT course lasting for at least 3 months promoted decrease in systolic and diastolic BP (SBP, DBP). Long-term (6 months or longer) moderate-intensity CPT significantly reduced SBP and DBP levels, normalized SBP and DBP variability, restored circadian BP profile, beneficially influenced lipid and carbohydrate metabolism. Conclusion. Long-term, systematic moderate-intensity CPT in young men with Stage I AH demonstrated antihypertensive, anti-atherogenic, and metabolically neutral effects.

Aim. To assess nebivolol clinical effects on intravascular platelet activity in patients with arterial hypertension (AH) and metabolic syndrome (MS). Material and methods. In total, 21 patients were administered nebivolol (5 mg/d) for one month. Dynamics of anthropometry parameters, lipid profile, plasma and platelet lipid peroxidation, blood an platelet antioxidant potential, and intravascular platelet activity, was evaluated. Results. In patients with AH and MS, nebivolol reduced lipid peroxidation and intravascular platelet activity. Longterm therapy could enhance these beneficial effects. Conclusion. To reduce body weight in patients with AH and MS, nebivolol should be combined with nonpharmaceutical methods.

Antihypertensive effects of an ACE inhibitor perindopril were analyzed. In ASCOT-BPLA Study, blood pressure (BP) level for amlodipine ± perindopril treatment was lower than for atenolol ± bendroflumethiazide treatment (mean difference 2.7/1.9 mm Hg). Maximal BP difference was 5.9/2.4 mm Hg, by Month 3 of the therapy. Results of large-scale studies, confirming perindopril high efficacy and safety in arterial hypertension patients, were presented.

The review is devoted to ivabradine – the first If selective and specific inhibitor, reducing heart rate (HR). It is well known that HR is an independent risk factor, increasing incidence of all-cause, sudden, and cardiovascular death. Ivabradine specifically and dose-dependently binds to f-channels of sinus node cells, inhibits them, and facilitates HR reduction at rest or during maximal physical workload, without affecting mean blood pressure. In three large clinical trials, ivabradine was well-tolerated and demonstrated substantial antianginal and antiischemic effectiveness, at least similar to that for modern antianginal medications – beta-blockers or calcium antagonists. Therefore, ivabradine could be regarded as alternative to modern antianginal medications, in case of contraindications to or adverse effects of standard therapy.

The results of large, epidemiologic studies and clinical trials, e.g., GISSI-Prevenzione, demonstrate that highly purified omega-3 polyunsaturated fatty acids should be included into secondary prevention among myocardial infarction patients. Their positive clinical effects include: all-cause mortality reduction by 21%, mostly due to sudden death risk reduction by 45%.

Controlling antihypertensive therapy effectiveness by traditional office blood pressure (BP) measurement only is linked to evident restrictions. Therefore, recently, BP self-control (BPSC) has gained more attention. Its benefits include affordability, registration of long-term spontaneous BP variations, prognostic value of results obtained. Its disadvantages include no information on manifold characteristics of circadian BP profile. In particular, assessment of antihypertensive effect evenness is a prerogative of 24-hour BP monitoring (BPM). Relevant tasks for future studies include development of optimal BPCS regimens, and comparison of 24-hour BPM and BPCS informative value in controlled clinico-pharmacological studies.

The review contains data on prevalence, clinics and clinical value of anxiety disorders (AD) in cardiology practice. Differential diagnostics of pathological anxiety somatic symptoms and cardiovascular disease symptoms are reviewed. AD screening principles in cardiac patients are described. Clinical trials’ results on AD input in coronary heart disease and arterial hypertension pathogenesis, as well as on cardiovascular death risk increase in patients with pathological anxiety, are analyzed. Potential pathogenetic mechanisms explaining this link are discussed. Finally, practical recommendations on AD treatment in cardiac patients are delivered, according to international consensus on anxiety in cardiology.