Aim. To compare informative value of various blood pressure self-control (BPSC) and 24-hour BP monitoring (BPM) characteristics in long-term antihypertensive therapy effectiveness assessment.
Material and methods. A cross-over, randomized trial of enalapril (E) and diltiazem (D) included 22 menopausal women with arterial hypertension (AH). Daily doses were 5-20 mg for E, and 180-360 mg for D. 24-hour BPM was performed at baseline, at the end of each treatment phase, and between the phases; BPSC was performed during the whole study period. Dispersion sources were examined, to assess baseline data reproducibility. Informative values for individual BP parameters were investigated with Mahalonobis distance and t-test ranging.
Results. «Error» prevalence for dispersion of averaged 24-hour BPM data was 19-40%, averaged BPSC data – 7-22%. T test values were 3,2-1,2 for averaged 24-hour BPM data, 1,6-0,6 – for averaged BPSC data, 1,7-0,6 – for final/peak effect indices, 3,6-3,0 and 1,3-0,4 - for smoothness index, respectively. In logistic regression analysis, the following independent informative parameters were identified: averaged mean BP for BPSC (p=0,003); time index for mean BP (p=0,0007) and diastolic BP, DBP (p=0,02) (24-hour BPM); clinical DBP (p=0,003). BPSC was more «specific» than 24-hour BPM in diagnosing masked treatment ineffectiveness in the morning hours.
Conclusion. The benefits of 24-hour BPM include high formal informative value and a chance for assessing evenness of antihypertensive medication effects. BPCS facilitates more precise diagnostics of masked treatment ineffectiveness, and also provides highly reproducible results.

Aim. To investigate clinical effectiveness of imidazoline receptor agonist, moxonidine, in arterial hypertension (AH) treatment among women with menopausal metabolic syndrome (MMS).
Material and methods. In total, 38 women (mean age 51,4±0,3 years) with MMS received moxonidine (0,2-0,6 mg/d, according to antihypertensive effect) for 6 months. Detailed examination included: 24-hour blood pressure monitoring (BPM), electrocardiography (ECG), microcirculation and endothelial function, vasoactive hormone levels, and insulin resistance (HOMA IR) assessment. Carbohydrate and lipid metabolism parameters were also analyzed. None of the participants received hormone replacement therapy.
Results. Moxonidine therapy was associated with decreased mean systolic and diastolic BP levels (р<0,01). Circadian BP profiles improved, and BP variability reduced (р<0,05), as well as morning BP surge (p<0,01). Six-month moxonidine treatment resulted in microcirculation improvement. Positive dynamics of endothelium-dependent brachial artery vasodilatation in reactive hyperemia test was observed (p<0,05). Moxonidine therapy was also associated with insulin resistance decrease (p<0,05), and body mass index reduction by 6 months.
Conclusion. Moxonidine can be recommended as a basal antihypertensive medication in MMS patients.

Aim. To study arterial hypertension (AH) features in patients with recurrent stroke.
Material and methods. The population method of stroke registry (two-year follow-up (2003-2004) in the city with population of 245 000) was used. In total, 1018 stroke patients were identified, including 863 primary strokes and 155 recurrent strokes.
Results. Stroke incidence was 2,07 per 1000 per year: 1,76 for primary stroke, 0,31 for recurrent stroke; mortality - 1,08 per 1000 per year. Twenty-eight-day lethality was 31,7%, reaching 52,2% at one year. AH was diagnosed in 70% of stroke patients. In recurrent stroke individuals, AH was more prevalent, with higher blood pressure (BP) levels and hypertensive cerebral crises (HCC) rates. Pre-stroke BP increase was associated with stroke severity and functional recovery. In hypertensive stroke survivors, only 47% were treated regularly. Current smoking and alcohol abuse rates were 29% and 30%, respectively.
Conclusion. In stroke patients, AH was diagnosed twice as often as in general population, was characterized by higher BP levels and HCC rates. Less than one half of stroke survivors received antihypertensive medications regularly.

Aim. To study the complex somato-typological and psycho-typological features of coronary heart disease (CHD) patients, to assess prognostic value of these features, to evaluate the potential of genetic markers in persons with high CHD risk.
Material and methods. In 215 patients with Functional Class I-IV stable angina, anthropometry parameters, phenotypical markers, dysembryogenesis stigmas, and psycho-typological personality structure were examined. The control group included 120 healthy persons.
Results. In CHD patients, the following constitutional and genetic markers were combined: isteroid personal psycho-type, obesity, protruded ears, low hair borderline, blood group A (II), chin dimple, moderate joint hypermobility, moist cerumen, hair lines, and dark hair color. Linear function classification equation was developed, where Y parameter classified individuals with increased CHD risk.
Conclusion. The complex of constitutional, psycho-typological and somato5typological features of CHD patients was used for creating high CHD risk identification model. In out-patient clinical practice, this model could facilitate primary CHD prevention measures in risk groups.

Aim. To investigate left and right ventricular (LV, RV) myocardial contractility in patients with coronary heart disease (CHD), Type 2 diabetes mellitus (DM-2), and various body mass index (BMI) levels.
Material and methods. The study included 120 patients: 66 with CHD + DM-2 (Group I), and 54 with CHD only (Group II). All participants underwent standard clinical examination and balanced radioventriculography (BRVG).
Results. In CHD and DM-2 patients with normal LV ejection fraction, EF (>50%), regardless of obesity level, LV and RV diastolic dysfunction (decreased 1/3 diastolic filling) was observed, pointing to increased myocardial stiffness, compared with CHD individuals. In CHD, DM-2, and moderate obesity (IMT<29 kg/m2), hyperkinetic contractility type was registered. Obesity progression was associated with significant increases in LV and RV volumes among CHD and DM-2 participants. Moreover, obesity progression was linked to substantial reduction in LV and RV inotropic function (reduced 1/3 systolic LV and RV output, decreased RV EF).
Conclusion. In obesity progression, the most sensitive BRVG parameters were 1/3 systolic output, end-systolic and diastolic LV and RV volume, RV EF.

Aim. To study the effects of ACE inhibitor perindopril on circadian dynamic of heart rate variability (HRV) in patients with coronary heart disease (CHD) and stable effort angina.
Material and methods. The study included 68 patients with stable effort angina, without myocardial infarction in anamnesis, as well as 30 controls. Circadian HRV was assessed by Holter monitoring method, during isosorbide dinitrate and aspirin therapy, and 31 days after adding perindopril (4-8 mg/d).
Results. At baseline, temporal and spectral HRV parameters were decreased in CHD patients with stable angina, improving during perindopril therapy (4-8 mg/d). Positive dynamics was maximal for parasympathetic activity markers. Perindopril therapy also reduced ventricular extrasystole number in CHD patients.
Conclusion. Perindopril (4-8 mg/d) improved circadian BP dynamics in CHD patients with stable effort angina, especially in individuals with advanced functional classes. Perindopril also demonstrated antiarrhythmic effect.

Aim. To study clopidogrel effects on thrombolysis (TL) effectiveness and 30-day prognosis in patients with ST elevation myocardial infarction (STEMI).
Material and methods. The study included 111 patients with ECG-verified STEMI. Before hospital admission, all participants received loading aspirin dose (250 mg/d); 60 patients additionally received loading clopidogrel dose (300 mg/d): before admission (n=25) or at hospital, before TL (n=35). For the next 30 days, these patients received combined antiplatelet therapy (APLT): clopidogrel (75 mg/d) and aspirin (100 mg/d). Group 2 (n=51) included MI patients receiving aspirin only (loading dose followed by 100 mg/d dose). During 30-day follow-up, therapy effectiveness was assessed by cumulative incidence of cardiovascular events (CVE). Therapy safety was assessed by hemorrhage rates in two groups.
Results. ST normalization rates at 60, 90, and 180 minutes post-TL were similar in two groups. Further analysis demonstrated a tendency for better ST normalization in pre-hospital clopidogrel administration. Hemorrhage rates were similar in two groups. During the follow-up, 8 patients died (7,2%). All fatal cases were registered during hospitalization. Cumulative CVE incidence was significantly lower in combined APLT group: 6,7% vs 23,5% (р=0,01) and 21,7% vs 41,2% (р=0,02), respectively. This beneficial effect of combined APLT was registered as early as the first days of the follow-up.
Conclusion. Adding clopidogrel to standard treatment of STEMI patients who underwent TL is associated with significant improvement in 30-day clinical outcomes.

Aim. To study combined cardiac arrhythmias (CCA) and heart rate variability (HRV) in patients with recurrent atrial fibrillation (AF).
Material and methods. In 41 patients with verified recurrent AF and 41 AF-free patients, 24 and/or 48-hour electrocardiogram monitoring (24hM, 48hM) was performed.
Results. In 48hM, serious and life-threatening CCA (atrio-ventricular blocks, brief ventricular tachycardia episodes, frequent ventricular extrasystoles, asystolia episodes) were registered more often than in 24hM. In AF patients, HRV was significantly reduced, due to sympathetic activity of autonomous nervous system.
Conclusion. 48hM could be used in patients with recurrent AF for CCA diagnostics. HRV reduction, typical for these patients, should be taken into account in selecting therapeutic strategies.

Aim. To assess quality of life (QoL) in young persons with mitral valve prolapse (MVP) and various blood pressure (BP) levels.
Material and methods. In total, 65 individuals with connective tissue dysplasia (CTD) syndrome and MVP (mean age 22,4±2,1 years), as well as 20 healthy controls were examined. Using a modified questionnaire, QoL was examined in MVP patients with normal BP, arterial hypertension (AH) and arterial hypotension.
Results. In MVP patients, QoL was worse than in controls. Dysregulated BP impaired QoL in MVP individuals. QoL features in males and females with MVP, according to BP dysregulation type, were determined.
Conclusion. Dysregulated BP impaired QoL in MVP patients, especially in males with high BP and females with
low BP.

Aim. To assess enalapril effectiveness in myocardial remodeling correction among patients after mitral valve replacement.
Material and methods. In total, 54 patients (mean age 46,3±7,6 years) with isolated or prevalent mitral valve stenosis were examined. All participants underwent surgical valve disease correction. In early post-surgery period, all subjects without contraindications started enalapril therapy (2,5-20,0 mg/d). Mean follow-up lasted for 17,1±5,2 months after valve replacement. Clinical and functional status was assessed by NYHA classification and 6-minute walking stress results. Before the surgery and during dynamic follow5up, all patients underwent electrocardiography and echocardiography. Statistical analysis was performed with Statistica 6.0 software (StatSoft, Inc).
Results. Assessing post-surgery hemodynamic parameters in atrial fibrillation (AF) patients, the authors observed that enalapril therapy demonstrated more beneficial hemodynamic effects than in sinus rhythm participants. In patients with sinus rhythm, enalapril therapy significantly reduced only pulmonary artery pressure (PAP).
Conclusion. Enalapril therapy in patients after mitral valve replacement improves heart chamber size and PAP dynamics, especially in persistent AF participants.

Aim. To investigate central and peripheral hemodynamics in rheumatoid arthritis (RA) patients during aerobic physical training (APT) program.
Material and methods. The study included 20 women, aged 37-65 years, who suffered from sero-positive RA with mild-to-moderate activity, for at least 3 years. The control group included 35 healthy women aged 35-64, without any cardiovascular pathology. All participants underwent individual APT programs (gymnastics, brisk walking for 30-40 minutes per day) for 4 and 12 weeks. Six-minute walking test, echocardiography (EchoCG), post-occlusion test with reactive hyperemia were performed in all participants.
Results. At 12 weeks, walking distance in 65minute walking test increased by 12,5% (p<0,05). Cardiac hemodynamics, according to EchoCG data, did not differ significantly from that in healthy controls, without any substantial systolic left ventricular (LV) dysfunction, local myocardial dyskinesia, or impaired peripheral vascular resistance registered. APT did not affect LV ejection fraction, end-systolic or end-diastolic LV volumes. Endothelial dysfunction was observed in 72% of RA patients. After 12-week APT course, significant improvement of endothelium-dependent vasodilatation (EDVD) was registered. In patients with initial endothelial dysfunction, EDVD increased by 83% (p<0,05), in patients with normal endothelial function – by 5% (p>0,05).
Conclusion. Regular physical training in RA is essential for effective endothelium-dependent regulation of vascular tonus. Physical training does not affect central hemodynamics.

Aim. To study risk factors (RF) of cardiovascular disease (CVD) in climacteric women with hyperuricemia.
Material and methods. This cross-sectional study included 672 women, divided into quartiles (n=168 each) by uric acid (UA) levels. Patients from 1st and 4th quartiles were compared. Anthropometry, lipid and carbohydrate metabolism parameters were assessed, arterial hypertension (AH), coronary heart disease, and chronic heart failure were diagnosed. Stroke, transient ischemic attack, and myocardial infarction in anamnesis were also registered.
Results. Hyperuricemia was observed in 190 women. In 4th quartile, obesity and overweight prevalence was significantly higher than in 1st quartile: 62 (36,9%), 69 (41,1%) and 43 (25,6%), 63 (37,5%), respectively. More than 50% of the 4th quartile patients had waist circumference >88 cm. In hyperuremic women, hypertriglyceridemia, low levels of high-density lipoprotein cholesterol (HDL-CH), plus increased levels of very low-density lipoprotein cholesterol (VLDL-CH) and atherogenicity index (AI) were significantly more prevalent.
Conclusion. In climacteric women with hyperuricemia, abdominal obesity and hypertriglyceridemia prevalence, VLDL-CH and AI levels are increased, and HDL-CH levels are decreased.

Aim. To assess dynamics, stability, and prognostic value of overweight (OW) in adolescent boys.
Material and methods. This prospective study included 376 adolescent boys. During 10-year follow-up, five clinical examinations were performed (at the age of 12, 13, 15, 17, and 22 years). Examination program included measuring body weight and height, body mass index (BMI), subscapular, abdominal, and triceps skin fold thickness, pubescence assessment.
Results. In pubescence period, anthropometry dynamics demonstrated formation of adult obesity type, with central subcutaneous adiposity. OW and obesity prevalence increased as early as in late pubertal period (after 15 years). More than in 50% of the adolescent boys, OW was registered in early adulthood period. Among 22-year-olds, 54,5% suffered from OW or obesity in early adolescence. BMI increase in adolescence was associated with its later stabilization (tracking) and increased risk of OW and obesity in early adulthood. OW and obesity in early adulthood were observed in adolescent boys with OW or high-normal BMI.
Conclusion. The observed age dynamics of anthropometric parameters points to the need for early preventive measures in risk groups and general population, starting in pre-pubertal or early pubertal periods.

Aim. To study tobacco smoking prevalence and intensity in working-age Tumen City men with diagnosed cardiovascular disease (CVD).
Material and methods. A representative sample of 25-64-year-old men to undergo cardiac screening was randomly selected from Tumen City voting lists. The examination included two blood pressure (BP) measurements and registration electrocardiogram, with Minnesota coding. Smoking survey was performed according to the WHO protocol.
Results. The prevalence of coronary heart disease (CHD) was 11,7%, arterial hypertension (AH) – 50,4%. In CHD men, the percentage of occasional smokers was reduced, and the percentage of ex-smokers was increased. In AH men, regular smoking rates and higher smoking intensity were observed. Increased smoking intensity was associated with significantly elevated systolic BP (SBP), and in higher smoking intensity group – also with increased diastolic BP, mostly among AH patients. In all population, smoking intensity directly correlated with mean SBP level, in 35-44-year-olds.
Conclusion. The results obtained should be used for complex CVD prevention in open Tumen City population, with prevention programs based on behavioral risk factor control by both population and high-risk strategies.

The article presents randomized trials comparing effectiveness of beta-adrenoblockers (BB) and other antihypertensive agents in patients with arterial hypertension (AH). BB position in modern AH management is discussed.

The article is focused on the importance of adequate blood pressure (BP) control in arterial hypertension, as well as on pleiotropic treatment effects. The latter are especially important in combined therapy, that, as a rule, is needed to achieve target BP levels. The principal pleiotropic effects include metabolic action and vasoprotection via endothelial function improvement. Tarka medication includes two well-known agents - verapamil SR (180 mg) and trandolapril (2 mg). Tarka therapy facilitates not only prolonged BP control, but also vasoprotection and organ protection, without adverse metabolic effects.

Refractory angina is a relatively rare state that nevertheless remains an important problem in modern cardiology. The article contains its definitions, diagnostics and management algorithms. The emphasis is put on myocardial metabolism modulation as pathogenetic method of refractory angina pharmacotherapy.

Vertigo is a problem faced by doctors of all specialties. Vertigo is diagnosed in 30% of people over 65 years and 50% of individuals aged over 80 years. This symptom affects quality of life, may cause falls and traumas, lead to impaired functioning and even disability. There are three main vertigo types: "true", or systemic; lipothymic states and syncope of various origin; vertigo of combined origin (trait and stature disorders), plus the fourth variant, psychogenic vertigo. Vertigo type identification is based on detailed complaint analysis. Therapeutic strategy should be aimed at eliminating vertigo causes, symptom alleviation, and patient's rehabilitation. Therapeutic agents act on the levels of vestibular receptors or central vestibular structures. One of effective agents for symptomatic therapy is betahistine hydrochloride.

In Russia, high cardiovascular mortality and absence of national epidemiological data on acute coronary syndrome (ACS) prevalence, lethality, and prognosis justify the development of the National ACS Registry, containing information on ACS incidence, lethality, mortality, healthcare quality, and facilitating further healthcare system improvement. This united national database will include the following information: in-hospital and out-patient treatment of ACS individuals; extra-healthcare service ACS mortality registration (“extra-service cases”); primary diagnostics of Q-wave as a sign of non-registered Q-wave myocardial infarction in anamnesis.