Aim. To investigate the effects of perindopril and indapamide combination (Noliprel® forte) on circadian blood pressure profile (CBPP) and cerebral hemodynamics (CH) among patients in late post-ischemic stroke (IS) period.
Material and methods. In total, 30 patients with arterial hypertension (AH) were examined, including 15 with previous IS. At baseline and 21 days later, neurological status and cognitive function assessment, experimental psychological examination, 24-hour BP monitoring, rheoencephalography, brachial and cerebral Doppler ultrasoundwere performed. Both groups received Noliprel® forte, 1-2 tablets, once per day.
Results. Stroke in anamnesis substantially influenced CH and CBPP parameters in AH patients.
Conclusion. Noliprel® forte is an effective antihypertensive medication, not only reducing BP, but also improving CH and cognitive function in patients with AH and stroke.

Aim. To assess and compare 6-month monotherapy effectiveness for losartan and lisinopril, according to their effects on blood pressure (BP), vascular elasticity, and cognitive function in patients with Stage I-II arterial hypertension (AH).
Material and methods. This open clinical trial included 15 patients (10 women, 5 men; mean age 62,5±2,1 years) with Stage I-II AH who received losartan, as well as 15 individuals (11 women, 4 men; mean age 64,4±4,1 years) with Stage I-II AH who received lisinopril. Monotherapy lasted for 6 months. At baseline and 6 months later, all participants underwent 24-hout BP monitoring (BPM), echocardiography, pulse wave velocity (PWV) measurement, and neuro-psychological testing to assess cognitive function.
Results. Six-month monotherapy with losartan or lisinopril resulted in significant systolic and diastolic BP reduction. Target BP levels were achieved in 40% and 37% of the participants, respectively. According to 24-hour BPM, losartan was more effective than lisinopril: after-action coefficient was 62% and 51%, respectively (p<0,05). Losartan monotherapy significantly improved cognitive function (including perception, short and long-term memory). PWV effects were similar for both medications. Losartan and lisinopril improved vascular rigidity and left ventricular hypertrophy parameters.
Conclusion. Losaratan improved cognitive function more effectively than lisinopril, independently of its antihypertensive action. Therefore, losaratan should be recommended for cognitive function correction.

Aim. To develop highly sensitive prognostic methods for coronary heart disease (CHD) and acute coronary event (ACE) risk stratification, on the basis of biophysical hemorheological system assessment.
Material and methods. Seven-year follow-up data on CHD patients were analyzed: re-hospitalization rate and reasons; main hemorheological parameters, their temporal and velocity characteristics; hemorheological system modeling by creating phase fragments in multi-dimensional phase space.
Results. Whole blood viscosity was significantly higher in patients with 3 or more ACE, comparing to ACE-free individuals or participants with <3 ACE. Velocity parameter dynamics correlated with ACE hospitalization rate. Phase fragment method demonstrated hemorheological system destabilization, maximal in patients with 3 or more ACE.
Conclusion. Prognostic value of whole blood viscosity and velocity assessment was demonstrated in CHD patients. Various CHD therapy algorithms, depending on hemorheological parameters and ACE risk, were developed.

Aim. To develop a test system measuring β₁-adrenoreceptor antibody (anti- β₁-AR) level. To study the effects of autoantibody removal on left ventricular (LV) contractility.
Material and methods. Peptides, according to second human extracellular β₁-AR loop fragments (197-222 amino acid fragments), were synthesized by modified hard-phase method and then lyophilized. Molecular mass control was performed by laser desorption mass spectrometry. In total, 47 patients were examined, with the aim of anti- β₁-AR detection. Dilated cardiomyopathy (DCMP) was diagnosed in 22 patients, ischemic CMP – in 8, post-infarction cardiosclerosis – in 6, myocarditis – in 3, alcohol CMP – in 1, and post-transplantation CMP – in 7 participants. Anti- β₁-AR were removed in 4 DCMP patients, by plasmapheresis (PF; n=3) or immunoadsorption (IA; n=1).
Results. A new immune-enzyme test system for autoantibody detection has been developed, using the second extracellular β₁-AR loop 26 amino acid peptide as the antigen. Anti- β₁-AR removal by IA or PF methods resulted in improved LV contractility among DCMP patients.
Conclusion. It is important to determine whether LV contractility improvement is explained by anti-β₁-AR removal exclusively. More advanced methods for anti- β₁-AR and other anti-myocardial antibody detection should be developed, and auto-antibodies’ role in impaired myocardial contractility should be studied.

Aim. To study clinical and metabolic effects of selective serotonin re‑uptake inhibitor (SSTI) sertraline in complex treatment of metabolic syndrome (MS) patients.
Material and methods. Thirty‑six MS patients were divided into two groups, according to treatment program and psychological symptoms. Intervention group received basic therapy and, in case of depressive disorders (DD) diagnosed, sertraline (50 mg/d), once per day in the morning, for 8 weeks. Control group received basic therapy only. In all participants, clinical, biochemical, and psycho‑physiological parameters were assessed.
Results. DD of varying severity were diagnosed in 77,8% of MS patients. Clinical and metabolic MS symptoms correlated with depression severity. Adding sertraline to complex treatment was associated with hemodynamics stabilization, clinical and psychopathological symptom regression, glucose and serum lipoprotein level normalization.
Conclusion. Adding sertraline to complex treatment of MS associated with DD improved therapy effectiveness and demonstrated beneficial clinical and metabolic effects.

Aim. To investigate quantitative assessment of myocardial, coronary and neuro-vegetative reserves in coronary heart disease (CHD) and chronic heart failure (CHF) patients before planned interventional myocardial revascularization, to objectivize peri-intervention complication risk.
Material and methods. In total, 62 CHD patients with macrofocal cardiosclerosis and NYHA Functional Class (FC) III CHF were examined before planned interventional myocardial revascularization. Instrumental tests included: coronarography, echocardiography, 24-hour ECG monitoring, heart rate variability analysis, 6-minute walking test with short-term Holter monitoring.
Results. Risk objectivization potential for peri-intervention cardiovascular complications is discussed. The authors propose to qualitatively assess cardiovascular system adaptation ability in clinical settings, in addition to traditional EUROSCORE system.
Conclusion. The proposed qualitative adaptation reserve assessment, not complicating pre-intervention examination, not only evaluates risk level, but also provides insights on protection of the most vulnerable cardiovascular system components.

Aim. To compare long-term results of coronary artery (CA) angioplasty and stenting. To assess dyslipidemia, diabetes mellitus and systemic inflammation effects on angina recurrence during five post-intervention years.
Material and methods. During 1989-2005, five-year follow-up results for 793 patients with CA stenting and 272 patients with angioplasty were analyzed.
Results. At five years after endovascular intervention, comparing to hospitalization period, the number of patients with recurrent angina substantially increased. Long-term recurrent angina rates were affected by increased levels of total cholesterol, low-density lipoproteins, alpha-lipoprotein, C-reactive protein, and concomitant diabetes mellitus.
Conclusion. Comparing to conservative treatment, coronary intervention was associated with better quality of life, reduced rates of III-IV functional class angina and death. In five-year follow-up, repeated endovascular intervention is as effective as coronary artery stenting, but as many as 2,6 repeated angioplasty procedures might be needed.

Aim. To study lipid-lowering and pleiotropic atorvastatin effects on lipid metabolism, endothelial function, fibrinogen level in coronary heart disease (CHD) patients who underwent myocardial revascularization (percutaneous coronary intervention).
Material and methods. The study included 40 CHD patients who underwent successful coronary angioplasty and stenting. Inclusion criteria were: primary hyperlipidemia with total cholesterol (CH) level >4,5 mmol/l, low-density CH (LDLCH) level >2,5 mmol/l, and triglycerides level ≤3,5 mmol/l. Initial atorvastatin dose was 20 mg/d. Endothelial function was assessed in reactive hyperemia test, with calculation of endothelium-dependent vasodilatation (EDVD) parameter. Carotid artery ultrasound, with intima-media thickness assessment, was performed.The participants were examined at baseline and after 26 therapy weeks.
Results. By the end of 14-week therapy period, target LDL-CH level <2,5 mmol/l was achieved in 56% of the patients, and by the end of Week 26 – in 74%. Mean EDVD was 2,8±1,23 at baseline and 2,984±0,881 26 weeks later (р=0,12). Baseline and control negative EDVD percentage was 56,5% and 34,78%, respectively. Therefore, long-term atorvastatin therapy was associated with improved EDVD, decreased negative EDVD percentage, and improved vasoactive endothelial function. Atorvastatin dose of 20 mg/d caused no clinically significantly adverse events during 26-week therapy course.
Conclusion. Lipid-lowering therapy with atorvastatin is highly effective and safe. Due to its pleiotropic action, the medication should be used in patients after myocardial revascularization.

Aim. To investigate regulatory vasoactive mediators – endothelin-1 (ET-1), 6-ketoprostaglandin F1α (6-keto-PGF1α), thromboxane В2 (TXВ2) – in young patients with minor heart anomalies (MHA) and non-differentiated connective tissue dysplasia (CTD).
Material and methods. Fifty-three patients, 37 men and 16 women (mean age 22,0±0,8 years) were examined. Plasma concentrations of ТХВ2, 6-keto-PGF1α and ET-1 were measured by immune-enzyme methods.
Results. Some specific features of vasoactive mediators in MHA were observed. In patients with three MHA, ET-1 level was increased. In Stage II mitral valve prolapse (MVP), combined with atopic chord (AC) and/or Stage II mitral regurgitation, TXB2 level was increased, without any significant thromboxane-prostacyclin dysbalance. In patients with mixomatous MV degeneration, plasma ET-1 concentration was increased, and TXB2 level was higher than that of 6-keto-PGF1α.
Conclusion. In MHA patients, functional endothelial status is disturbed. Disturbance severity is maximal in three MHA and mixomatous MV degeneration.

Aim. As a part of ARGUS-2 program, to demonstrate the reserves for arterial hypertension (AH) control improvement, by rational monotherapy or combined therapy with diuretics in patients with uncontrolled AH in anamnesis: individuals with isolated systolic AH (ISAH), diabetes mellitus (DM), chronic nephropathy (CN), and metabolic syndrome (MS).
Material and methods. This open, non-comparative study, without washout period, included 1438 patients (mean age 57,3±10,7 years, blood pressure, BP 158,8±14,2/93,4±10,0 mm Hg), not achieving target BP levels (<140/<90 mm Hg or <130/<80 mm Hg for DM or CN), and receiving non-diuretic therapy. Slow-release indapamide (Arifon® retard), in the dose of 1,5 mg, was administered once per day. Follow-up period lasted for 3 months. To achieve target BP levels, the physician could modify antihypertensive treatment regimen.
Results. In total, 1399 patients (97,3%) completed the study. Arifon® retard was administered as monotherapy in 13,7% of the participants; as an alternative to previous ineffective monotherapy – in 6,8%; in addition to inadequately effective monotherapy – in 31,9%; and in addition to inadequately effective non-diuretic therapy – in 47,6%. Three months later, target BP level rate was 84,5%, mean BP level reduced to 131,8±9,7/80,5±6,9 mm Hg. Target BP was achieved in 91,9% (n=477) of ISAH patients, in 74,8% (n=214) of DM participants, in 75,6% (n=82) of CN individuals, and in 85,1% (n=745) of MS patients.
Conclusion. The study results confirmed the importance of low-dose thiazide diuretic therapy, as a part of combined treatment, in achieving target BP levels among patients with high or very high cardiovascular risk.

Aim. To study atorvastatin (10 and 20 mg/d) effects on lipid, C-reactive protein, and fibrinogen levels, vascular wall structure and function in patients with coronary heart disease (CHD) and primary hyperlipidemia (PHL).
Material and methods. In total, 50 CHD and PHL patients were randomized into two stable-dose atorvastatin groups (10 or 20 mg/d) for 24 weeks. Atorvastatin effects on lipid levels, endothelial function, vascular wall distensibility and stiffness, as well as treatment tolerability, were examined.
Results. Twenty-four-week atorvastatin therapy (10 or 20 mg/d) reduced low-density lipoprotein cholesterol (LDL-CH) level by 34,9% and 43,9%, respectively (p<0,001). At baseline, vascular wall functional parameters did not differ significantly, reaching 7,2% and 6,4% for endothelium-dependent vasodilatation (EDVD), 21,3 and 18,7 10-3/kPa for vascular wall distensibility (DC) of common carotid artery (CCA); 8,0 and 9,1 Units for vascular wall stiffness (beta-index), respectively. Three-month therapy was associated with significant increase in EDVD – by 40,2% in 10 mg/d group, and by 51,3% in 20 mg/d group. After 24 weeks of the treatment, CCA distensibility increased by 45,3% (p<0,01) and 43,6% (p<0,01) in 10 and 20 mg/d groups, respectively. Vascular wall stiffness decreased by 23,4% (p=0,008) and 25,7% (p=0,002), respectively. There was no significant association between LDL-CH decrease and EDVD, distensibility or stiffness dynamics. During 24-week follow-up, 2 adverse events (4%), linked to atorvastatin therapy, were registered.
Conclusion. In CHD and PHL patients, atorvastatin (10-20 mg/d) increased EDVD by 40-51%, CCA distensibility by 43-45%, reduced vascular wall stiffness by 23-26%, and was well tolerated.

The article is focused on choosing optimal doses and combinations of neuro-humoral modulators in systolic left ventricular dysfunction and heart failure. The results of CHARM-Added, Val-HeFT, RALES, and EPHESUS studies are analyzed, as well as their effect on modern recommendations on chronic heart failure diagnostics and treatment.

Characteristics and classification of various paroxysmal atrial fibrillation (AF) forms are presented. Main indications for sinus rhythm restoration are listed, together with characteristics of principal medications used for AF management. Antiarrhythmic choice issue is discussed, with emphasis on individual approaches in choosing treat ment tactics.

Modern views on various β-adrenoblockers (BB) place in clinical practice are presented. BB class is a clinically heterogeneous group. Recent criticism of BB should not disorient practitioners, who must understand which BB are mentioned. Some BB, mostly non-selective, demonstrate adverse effects and cannot be used in certain clinical situations: metabolic disturbances, chronic obstructive pulmonary disease (COPD), peripheral artery atherosclerosis. At the same time, modern super-selective BB are safe and can be administered even in individuals with metabolic syndrome, diabetes mellitus, COPD, or peripheral artery atherosclerosis.

Chronic heart failure (CHF) prevalence is maximal in the elderly. There are some important practical aspects of β-adrenoblocker therapy in this patient group. SENIORS study results provide new data on selective β-adrenoblocker / NO-dependent vasodilator nebivolol therapy perspectives in CHF patients aged over 70 years. Nebivolol safety and effectiveness in this population is discussed.

The authors assess relative risk (RR) of coronary heart disease (CHD), stroke (S), cardiovascular disease (CVD), and total mortality, according to smoking status, alcohol intake, and educational level in women. In ex-smokers and current smokers, mortality RR was significantly and dose-dependently increased. In occasional and low-dose drinkers, RR of CVD, CHD, and total mortality was reduced. At the same time, in moderate drinkers, RR was similar to that in frequent and high-dose drinkers. Mortality RR was inversely linked to educational level: in highly educated women, RR was substantially lower than in participants with lower educational levels. The authors assess relative risk (RR) of coronary heart disease (CHD), stroke (S), cardiovascular disease (CVD), and total mortality, according to smoking status, alcohol intake, and educational level in women. In ex-smokers and current smokers, mortality RR was significantly and dose-dependently increased. In occasional and low-dose drinkers, RR of CVD, CHD, and total mortality was reduced. At the same time, in moderate drinkers, RR was similar to that in frequent and high-dose drinkers. Mortality RR was inversely linked to educational level: in highly educated women, RR was substantially lower than in participants with lower educational levels.

Sudden cardiac death (SCD) remains the principal cause of coronary heart disease (CHD) deaths. Therefore, studying SCD mechanisms, implementing new prognostic and preventive approaches are the main aims of modern cardiology. The review analyzes modern approaches to myocardial electrical instability correction and prognosis improvement in CHD patients. It has been proved that among all antiarrhythmics, beta-adrenoblockers only, and perhaps amiodaron, can reduce SCD incidence. Total mortality and SCD rate reduction has been demonstrated for ACE inhibitors, aspirin, statins, aldosterone antagonists. Recent clinical trials have proved that implanted cardioverters-defibrillators are more effective than pharmaceutical treatment in SCD prevention among high-risk patients.

The review is devoted to modern problems of nitrate therapy in coronary heart disease (CHD) management. The author focuses on the results of randomized clinical trials on nitrate therapy in CHD, as well as on nitrate position in clinical guidelines. Benefits of isosorbide-5-mononitrate are emphasized. Effectiveness of various dosing regimens and nitrate safety in cardiac patients, especially in combination with other medications, are discussed.

Angiotensin II receptor blockers are antihypertensive medications demonstrating some benefits in the treatment of high-risk arterial hypertension (AH). Principal clinical trials’ results are presented; organo-protective action of this drug class, with irbesartan as an example, is demonstrated for AH and Type 2 diabetes mellitus combination treatment.