Aim. To analyze antihypertensive effectiveness and safety of angiotensin (AT1) receptor blocker losartan, as well as its combination with ACE inhibitor enalapril, in arterial hypertension (AH) patients.
Material and methods. This 12-week open, comparative, randomized, prospective study included 60 AH patients aged 30-65 years. Two parallel groups included 30 individuals each. Group I (intervention) received losaratan (Losap), 50 mg once per day; Group II (control) - enalapril, 20 mg once per day. If target blood pressure (BP) level, <140/90 mm Hg, was not achieved, Group I patients were administered a fixed combination of losartan (50 mg/d) + hydrochlorthiazide (12,5 mg/d) once per day; Group II patients received enalapril plus hydrochlorthiazide (12,5 mg/d) once per day. Without any effect 8 weeks later, losartan and enalapril doses were titrated again. BP, electrocardiogram, and microalbuminuria (MAU) dynamics was assessed.
Results. Target BP level was achieved in 76% Group I patients and in 73,3% of Group II participants. Percentage of individuals on combined therapy was 63,3% in Group I, and 66,7% in Group II. In moderate AH patients (n=50), systolic BP (SBP) normalized in 96% of Group I participants and in 72% of Group II individuals (р=0,015). MAU reduced significantly.
Conclusion. Losap and Losap plus facilitated target BP level achievement in patients with mild to moderate AH, effectively controlled SBP, demonstrated nephroprotective effects.

Aim. To study the effects of fixed4dose combined trandolapril and verapamil SR (Tarka) therapy on blood pressure (BP) and renin-angiotensin-aldosterone system (RAAS) patients with in essential arterial hypertension (EAH) and renal AH.
Material and methods. The study included 20 patients with mild to moderate AH; 16 completed the study. EAH was diagnosed in 9 participants, secondary AH and chronic pyelonephritis – in 7. At baseline and 8 weeks later, office BP measurement, 24-hour BP monitoring (BPM), vectorcardiography and decartography parameters, renin activity (RA), aldosterone, potassium, microalbuminuria (MAU) level measurement were performed.
Results. Target systolic BP (SBP) levels, <140 mm Hg, were achieved in 93,7%, and target diastolic BP (DBP) levels, <90 mm Hg – in 62,5% of the cases. Total target BP level achievement rate was 62,5%. According to 24-hour BPM data, positive day and nighttime SBP and DBP dynamics was observed. Mean MAU reduced significantly, from 27,6±23,9 mg/d to 17,2±14,5 mg/d. RASS status improved, as the number of patients with initially decreased RA halved.
Conclusion. Antihypertensive effectiveness was demonstrated for Tarka medication in patients with mild to moderate AH. Its effectiveness was similar in participants with EAH and renal AH. Positive MAU dynamics confirms Tarka nephroprotective action.

Aim. To study pulse wave velocity (PWV) disturbance prevalence in arterial hypertension (AH) patients, to compare PVW to AH, myocardial structure, and autonomous nervous system parameters.
Material and methods. The study included 132 Stage I-II AH patients, 66 men and 66 women; mean age 46,9±7,2 years. In all participants, PWV, heart rate variability (HRV) were measured, 24-hour blood pressure monitoring (BPM) and echocardiography were performed.
Results. PWV for elastic and muscular type vessels (Ve, Vm) was increased in 41,7% and 58.3% of the patients, respectively. PWV correlated with age, AH duration, HR and some 24-hour BPM parameters. In particular, Vecorrelated with systolic BP load, and Vm - with diastolic BP load in nighttime. PVW was associated with relative left ventricular (LV) wall thickness, LV myocardial mass index. Ve and Vm were linked to sympathetic and parasympathetic reactivity, respectively.
Conclusion. PWV increase correlated with LV remodeling signs. PVW assessment could be recommended for better ambulatory diagnostics of target organ damage in AH patients.

Aim. To study implementation experience of arterial hypertension (AH) diagnostics, monitoring, and control technology in Vologda Region primary healthcare system.
Material and methods. AH Registry was formed in primary healthcare system by clinic visit principle - blood pressure (BP) measurement in all visitors of out-patient departments and units. The analysis included 2003-2004 data, 45344 BP measurements, and 18656 AH patients.
Results. AH prevalence was 41%, with 6% of newly diagnosed AH, and 84,5% of moderate to severe AH. As many as 43,6% of AH men were smokers, comparing to 2,3% of AH women. Obesity rates were 35,9% and 53,2%, hypercholesterolemia rates - 48,3% and 47,6%, respectively. Clinical AH severity was also assessed.
Conclusion. Implementing clinic visit-based AH diagnostics technology facilitates dynamic AH control on population level, timely correction of diagnostics, prevention and treatment programs, improved access to and quality of care in rural healthcare settings.

Aim. To study antihypertensive effectiveness of indapamide retard, its effects on carbohydrate, lipid, purine, electrolyte metabolism in patients with mild arterial hypertension (AH) and metabolic syndrome (MS).
Material and methods. The study included three phases: initial (screening), 12-week active treatment, and 36-week self-control phase. In total, 619 patients were randomized into two groups. Active treatment group received indapamide retard combined with non4pharmaceutical weight reduction measures; control group received non-pharmaceutical intervention only. At baseline, total cholesterol (CH), low-density lipoprotein CH (LDL-CH), uricacid, potassium, sodium levels were measured; glucose tolerance test was performed. After active treatment phase, all patients receiving indapamide retard and achieving target blood pressure (BP) levels were recommended to continue the treatment under self-control. Individuals failing to achieve target BP levels were recommended to take perindopril in addition. If needed, control group patients were also administered antihypertensive therapy.
Results. After 12-week therapy, target BP levels were achieved in 61,8% of patients receiving indapamide retard, and 48,4% participants of control group; after 12 months - in 69,4% and 52,7%, respectively. Body weight significantly reduced in both groups, by 3 kg on average, waist circumference - by 3 cm. Carbohydrate and lipid metabolism parameters also improved: in 37% of active treatment patients and 25,2% of control group individuals glucose tolerance improved, atherogenicity index decreased. Indapamide retard therapy was well tolerated.
Conclusion. Indapamide retard demonstrated good antihypertensive effectiveness and beneficial effects on carbohydrate and lipid metabolism in MS patients.

Aim. To assess perindopril antihypertensive effects and its influence on metabolic disturbances, myocardial structure, and cerebral perfusion (CP) in patients with mild to moderate arterial hypertension (AH) and metabolic syndrome (MS) (AH + MS).
Material and methods. Thirty patients with mild to moderate AH + MS participated in the study. At baseline and 24 weeks later, 24-hour blood pressure monitoring (BPM), carbohydrate and lipid metabolism, insulin sensitivity, myocardial structure and function, as well as CP parameters were assessed.
Results. Target BP levels were achieved in 70% of the patients receiving perindopril: 9 and 21 patients were administered 4 and 8 mg/d, respectively. Fasting and postprandial glucose levels decreased significantly (both p<0,05). Insulin sensitivity index (Si) increased from 0,5 х 10-4 min-1(mcUml)-1 to 1,3 х 10-4 min-1(mcUml)-1 (р<0,05). High-density lipoprotein cholesterol (HDL-CH) level increased significantly (p<0,05). Initially reduced CP substantially improved. In all participants, perindopril therapy resulted in regressed left ventricular (LV) hypertrophy and improved LV geometry.
Conclusion. Perindopril demonstrates good antihypertensive effect, improved carbohydrate and lipid metabolism, as well as tissue insulin sensitivity, CP, LV structure and function in AH + MS patients.

Aim. To investigate the effects of angiotensin II receptor antagonist irbesartan on blood pressure (BP), tissue insulin sensitivity, carbohydrate and lipid metabolism, cerebral perfusion parameters in patients with arterial hypertension (AH), metabolic syndrome (MS), and Type 2 diabetes mellitus (DM-2).
Material and methods. The study included 20 patients with AH only, 20 participants with AH + MS, and 20 individuals with AH + DM-2. At baseline and 24 weeks later, physical examination and measurement of body weight, blood glucose, immune-reactive insulin levels, insulin sensitivity index (intravenous insulin4modified glucose tolerance test) were performed. Cerebral perfusion was assessed by single-photon emission computed tomography with 99mTc-HMPAO.
Results. Irbesartan therapy demonstrated good antihypertensive effect: target BP levels were achieved in 80% of AH patients, 70% of AH + MS participants, and 50% of AH + DM-2 individuals. Waist circumference reduced in all participants; blood glucose and lipid levels, initially increased, reduced significantly in AH + MS and AH + CD-2 patients. Blood insulin level, increased at baseline, decreased in AH + MS individuals, and insulin secretion improved in AH + DM-2 patients. Insulin sensitivity improved in all participants, but only in AH + MS it was statistically significant. Irbesartan therapy also improved cerebral perfusion, initially reduced, in all patient groups.
Conclusion. Irbesartan demonstrated not only good anihypertensive effectiveness, but also positive metabolic and organo-protective effects.

Aim. To assess omega-3-polyunsaturated fatty acids (w-3-PUFA) effects on atrial arrhythmogenicity in patients with coronary heart disease, who underwent coronary bypass surgery (CBS).
Material and methods. In total, 50 patients, who underwent CBS, were examined. All participants were divided into two groups. Group I included 25 patients with atrial fibrillation (AF) episodes in anamnesis, who were administered w-3-PUFA (2 g/d) one week before and 7 days after CBS. Group II, control group, included 25 patients without AF in anamnesis, who did not receive w-3-PUFA. Atrial conduction abnormalities were registered by non-invasive, high-definition transesophageal electrocardiography.
Results. In Group II, 7 AF cases (28%) were registered during early post-CBS period. AF paroxysm incidence was maximal in the first two days after CBS. In Group I, AF paroxysms were registered in 4 patients (16%), on Day 2-3 after CBS. Clinical symptoms were less severe in Group I than in Group II: in the former, two patients had asymptomatic AF episodes. No AF cases required cardioversion, terminating spontaneously. Group I patients demonstrated increased right and left atrium conductivity.
Conclusion. In patients with post4CBS AF risk, w-3-PUFA therapy was associated with arrhythmia risk reduction, pontaneously terminating AF episodes, and less severe hemodynamic disturbances. Adding w-3-PUFA to standard therapy is effective and safe in CBS patients.

Aim. With duplex scanning method, to compare clinical symptoms of non-specific aorto-arteriitis (NAA) to aortic arch pathology registered.
Material and methods. In total, 32 women with NAA were examined. Twenty-four patients underwent duplex scanning of aortic arch branches, carotid intima-media thickness measurement (high-definition ultrasound method; Vivid 7 device, GE, USA). All participants underwent clinical and neurological examination, with inflammation activity assessment.
Results. Isolated pathology of aortic arch branches (Type I NAA) was observed in 6 (25%) out of 24 patients; Type III NAA (pathology of aortic arch branches, thoraco-abdominal aorta, and its visceral branches) - in 16 (66,7%); Type IV NAA (pulmonary artery pathology, regardless of any other lesion location) - in 2 (8,3%). Arterial hypertension (AH) was diagnosed in 18 (75%) out of 24 participants. In Type I NAA, AH clinical course was milder than in Type III and IV NAA. Functional neurological and emotional-affective disturbances were typical for NAA. Common carotid artery pathology was registered in 19 (79,2%) patients, and cerebral blood flow pathology - in 2 (8,3%) out of 24 participants.
Conclusion. In NAA patients, brachiocephalic artery and common carotid artery pathology prevalence is relatively high. At the same time, strokes and transient ischemic attacks are rare.

The article is devoted to methodical recommendations on sample selection in regions with varying population size; representativeness assessment criteria; standard diagnostic methods for arterial hypertension (AH), risk factors, target organ status, and concomitant pathology; total cardiovascular risk assessment, as a part of the Target Federal Program «Arterial hypertension prevention and treatment in Russian Federation, 2002-2008».

This review is devoted to coronary restenosis after stent implantation in metabolic syndrome (MS) patients. It is known that some clinical factors increase restenosis risk, first of all, diabetes mellitus. Recently, MS has also been regarded as a pathology enhancing coronary restenosis risk. Certain MS features (reduced NO release after oral glucose tolerance test; increased leptin level; hyperinsulinemia, insulin resistance) are important predictors of intra-stent restenosis in coronary heart disease (CHD) patients with normal fasting levels of glucose and glycated hemoglobin. In CHD and MS patients, new, antiproliferative drug-coated stent use could be recommended.

The review is devoted to natriuretic peptides perspectives in left ventricular (LV) systolic and diastolic dysfunction assessment and LV hypertrophy diagnostics in arterial hypertension (AH) patients. The data describing possible antihypertensive therapy effects on brain natriuretic peptide level in AH patients are presented.

The authors review therapeutic action mechanisms of nitrates and their use in cardiology practice. Nitrate effects are discussed, clinical data and modern recommendations on nitrate treatment in angina, acute myocardial infarction, heart failure, and arterial hypertension are presented. Nitrate tolerance mechanisms and their prevention are emphasized. Modern retard forms, isosorbide dinitrate, in particular, have some benefits, e.g., lower chances of tolerance development and withdrawal syndrome.

The review is devoted to ACE inhibitor therapy in arterial hypertension (AH) management. The mechanisms of ACE inhibitors’ effects on oxidative stress, endothelial dysfunction, insulin and glucose metabolism are discussed. The data on pharmacological characteristics of zofenopril and its use in AH are presented.

The review focuses on various aspects of isolated systolic arterial hypertension (ISAH). Main principles of ISAH diagnostics and treatment in the elderly are presented.

More frequent statin prescription, to achieve lower target low-density lipoprotein levels, as well as statin dose increase, is associated with inevitable raise in adverse event rates. The article compares statin benefits and the risk of adverse liver, muscle, brain, and kidney effects.

Calcium antagonist nifedipine, an antihypertensive and anti-anginal medication with vasodilating action, is widely used in cardiology practice. According to the recommendations on cardiovascular disease management in pregnancy, by the European Society of Cardiology (2003) and Society of Cardiology of the Russian Federation (2003), nifedipine could be used for hypertension treatment in pregnancy. Positive experience of nifedipine use as an antihypertensive and tocolytic agent has been obtained. The medication has been proved as safe in III pregnancy trimester; its teratogenic and embryotoxic effects in the first pregnancy half have not been confirmed in clinical practice. Oral nifedipine effectively reduces increased blood pressure (BP) in hypertensive crises. Regular nifedipine therapy in pregnancy-associated hypertension facilitates effective BP control and prevents hypertensive crises.