Aim. To analyze the association between tumor necrosis factor-alpha gene –308 G/A polymorphism and essential arterial hypertension (EAH).
Material and methods. The study included 354 EAH patients and 295 age-matched healthy subjects. DNA was extracted from venous blood. Genotyping was performed using polymerase chain reaction followed by restriction amplicon analysis.
Results. TNFA -308*G/*G genotype frequency was significantly lower among EAH patients with stroke than in control group (60,98% vs 78,98%; p=0,015). EAH patients with TNFA -308 *G/*G genotype had lower stroke risk (OR=0,38; 95% CI: 0,21-0,83).
Conclusion. The results obtained suggest that TNFA gene -308G/A polymorphism is involved in stroke pathogenesis among EAH patients.

Aim. To compare clinical effectiveness and tolerability of original (Cozaar®) and generic (Lozap®) losartan in high and very high-risk patients with Stage I-II arterial hypertension (AH).
Material and methods. This blind, randomized (envelope method), parallel study included 40 patients, 20 subjects in each group. After 14-day wash-out period, the participants were administered Cozaar® or Lozap® (50 mg/d; 1 tablet in the morning) for 3 months.
Results. Cozaar® and Lozap® reduced systolic blood pressure (SBP) by 11,6% and 12,0% (р<0,05), respectively, diastolic BP (DBP) – by 8,3% and 8,2% (р<0,05), respectively (office measurement data). According to 24-hour BP monitoring data, T/P for SBP was 67,1% and 66,3% in Cozaar® and Lozap® groups, respectively (p<0,05). Both agents similarly reduced left ventricular posterior wall thickness, carotid-femoral and carotid-radial pulse wave rates – by 16,6%, 9,9%, 12,8% vs 16,6%, 10,1%, and 12,2%, respectively.
Conclusion. Original and generic losartan medications were similar by antihypertensive activity and effects on surrogate end-points.

Aim. To study clinical equivalence of two bisoprolol medications (Concor ® and Bisogamma®) in patients with mild to moderate arterial hypertension (AH).
Material and methods. The study included 32 AH patients (15 men, 17 women): 66 % with Stage I, and 34 % with Stage II AH; mean age 60 years; mean AH duration 17,9 years. Most participants had intermediate or high-risk AH. After two-week wash-out period, without any antihypertensive therapy, the patients were administered bisoprolol or its generic (5 mg/d), with medication consequence randomly selected. In case of inadequate antihypertensive effect, the dose was doubled in two weeks, up to 10 mg/d, or, when appropriate, hydrochlorothiazide (HCT) was added (12,5–25 mg/d). After Phase 1 completion and two-week wash-out period, Phase 2 started.
Results. Two-week therapy with original bisoprolol or its generic significantly reduced systolic, diastolic blood pressure and heart rate (SBP, DBP, HR). Target SBP was achieved in 62,5 % and 43,7 % for Concor® and Bisogamma® groups, DBP – in 71,9 % and 62,5 %, respectively. Combined treatment with increased bisoprolol dose ± HCT was associated with target SBP achievement in 90,1 % and 75 % of the patients receiving original bisoprolol or its generic, respectively. Concor® and Bisogamma® monotherapy was effective in 84,4 % and 62 % of the cases (for inter-group difference, p<0,05). After 6 weeks of the treatment, target SBP and DBP levels were achieved in 96,9 % of the patients from each group. Similar antihypertensive effect was achieved with higher bisoprolol dose and HCT administration in Bisogamma® group.
Conclusion. Therefore, in AH patients, original bisoprolol was more effective than its generic, with similar tolerability.

Aim. To study gender-specific pre-hospital lethality structure in acute coronary syndrome (ACS); to identify prognostic factors.
Material and methods. The study included 531 patients with acute myocardial ischemia and various pre-hospital outcomes. Statistical analysis of clinical data was performed, using c_2 correlation and regression methods.
Results. Pre-hospital death risk was higher in males over 60 years, females over 80 years, in patients with atypical ACS clinics, with symptom onset and ambulance call time from 21.00 to 09.00, in individuals not receiving specialist care or with no previous ambulatory follow-up.
Conclusion. Pre-hospital death risk in ACS could be affected by biological, chrono-biological, organizational factors, individual clinical features, patient’s contact with healthcare providers. Some signs of gender dimorphism were observed.

Aim. The study was aimed at verifying a hypothesis: in myocardial infarction (MI) patients with occluded MI‑related coronary artery (IMCA), routine percutaneous coronary intervention is more effective than conservative, pharmacological treatment, for reducing cumulative total mortality risk, risk of recurrent non‑fatal MI, or severe heart failure (HF).
Material and methods. The study included 2166 MI patients, with stable clinical course and IMCA occlusion remaining at Day 3‑28, verified by coronary angiography. The participants were randomized into two groups: pharmaceutical treatment group (n=1084) and invasive treatment group (n=1082). Combined primary end‑point included death due to all causes; non‑fatal MI; severe HF with hospitalization. Secondary end‑points were separate components of primary end‑point.
Results. By the end of follow‑up Year 4, primary end‑point rates were 17,2% and 15,6% in invasive and pharmaceutical treatment groups, respectively (р=0,2). No benefits for any strategy were observed in various subgroups by age, gender, ethnicity, coronary occlusion localization, left ventricular contractility, diabetes mellitus, severity and duration of the disease. Total mortality was identical in both groups. Recurrent MI rates were higher in invasive therapy group, compared to pharmaceutical therapy group.
Conclusion. Therefore, late opening of occluded IMCA in stable patients did not reduce the risk of death, recurrent IM, or severe HF during four‑year follow‑up.

Aim. To study prevalence and dynamics of depressive disorders in aged and elderly patients with chronic heart failure (CHF).
Material and methods. In 105 hospitalized patients with Functional Class I‑III CHF (NYHA), mean age 77,5±4,7 years, depressive disorder severity (CES‑D scale), quality of life, QoL (Minnesota Questionnaire), physical functioning (6‑minute walk test) were assessed at admission and after 3 weeks of CHD treatment, without antidepressant therapy.
Results. Depression was diagnosed in 32,4% of aged and elderly CHF patients, depressive disorders – in 56,2%. Higher CHF FC were associated with increased depression prevalence (р<0,05). Depressed participants had the lowest QoL and 6‑minute walk test results (p<0,05). Compared to other patients, depressed individuals demonstrated no dynamics in emotional QoL cluster and minimal positive changes in 6‑minute walk test results (p<0,05).
Conclusion. More than 30% of aged and elderly CHF patients suffered from depression. During hospital treatment, only physical QoL parameters improved, with minimal positive dynamics in 6‑minute walk test results.

Aim. To identify character and prevalence of apolipoprotein (apo) B-100 gene mutation in patients with clinical diagnosis of heterozygote familial hypercholesterolemia (FH); to describe its phenotypical features in mutation carriers.
Material and methods. In 111 patients with clinical diagnosis of heterozygote FH, screening for exon 26 apo B-100 gene mutations was performed. For DNA analysis, allele-specific PCR, restriction analysis, analysis of DNA single-strand conformation polymorphism (SSCP), and sequestering of DNA fragments with anomaly electrophoretic activity were used.
Results. In patients with clinics of heterozygote FH, 4,5% had apo B-100 gene mutation. R3500Q mutation was the only apo B-100 gene structure anomaly observed in these individuals. Compared to patients with low-density lipoprotein (LDL) receptor mutation, subjects with apo B-100 defect had less manifested HCH.
Conclusion. R3500Q mutation of apo B-100 gene, together with LDL receptor mutations, partially explain high CH levels in Russian patients. Other mutations of this protein’s exon 26 could be very rare.

Aim. To study simvastatin effects on lipid profile and cognitive function in patients with various cerebral ischemia variants.
Material and methods. In total, 210 patients with cerebrovascular disease and dyslipidemia (DLP) were divided into three groups. Group A (n=108; primary carotid ischemic stroke) and Group B (n=68; Stage I-II dyscirculatory encephalopathy, DCE), took simvastatin for 24 months. Group C (n=34; Stage I-II DCE) did not take simvastatin. Lipid profile (LP) assessment, extracranial Doppler ultrasound, rheoencephalography, neurovisualization, neuro-psychological and statistical analyses were performed. LP was measured at baseline, 6, 12, 24 months later; cerebral hemodynamics and cognitive status parameters – at baseline and 24 months later.
Results. Two-year follow-up and simvastatin treatment (10-20 mg/d) of cerebrovascular insufficiency patients demonstrated positive results. There was a statistically significant decrease in total cholesterol (CH), low-density lipoprotein CH, and triglycerides levels, as well as in atherogenic index, combined with increase in high-density lipoprotein CH concentration. Simvastatin demonstrated pleiotropic effects. Speech function improvement was also observed (р<0,05).
Conclusion. Simvastatin had stable lipid-lowering and cognitive status-improving effects. The medication was highly effective and well-tolerated.

Arterial hypertension (AH) in pregnancy is associated with systemic endothelial damage, vasoconstriction, and blood rheology disturbances, that results in microcirculation disorders, tissue and organ ischemia. Antihypertensive therapy effects on endothelium and blood cells in hypertensive pregnant women should be taken into account. Recent experimental and clinical studies show that nifedipine has good antihypertensive effect in pregnancy, is safe, and beneficial for endothelium, platelets and red blood cells. Nifedipine non-hemodynamic effects support its use as a first-line medication in pregnancy-associated hypertensive states.

Large-scale epidemiological studies have demonstrated that heart rate (HR) is an independent risk factor, increasing total, sudden and cardiovascular mortality risk. Ivabradine specifically binds to sinus node (SN) f-channels and reduces HR. Due to its specific SN action and selective If current inhibition, ivabradine dose-responsively reduces HR at rest and maximal physical exertion, without changes in mean blood pressure. It has been shown that ivabradine is not only well-tolerated, but also possesses anti-anginal and anti-ischemic effects, as potent as those for modern angina treatment agents: beta-blockers and calcium antagonists.

Enalapril is one of the best-studied ACE inhibitors, demonstrating high effectiveness in treating arterial hypertension, chronic heart failure, and left ventricular dysfunction, including that after myocardial infarction. One of the best enalapril generics is Berlipril® – an ACE inhibitor with unique structure, providing 100% bioavailability of the active agent.

The review summarizes modern principles of lipid-lowering therapy aimed at cardiovascular event risk reduction. The author describes main patient groups in need for early, aggressive lipid-lowering therapy – predominantly, statin therapy. New statin treatment tactics is presented, based on the latest results of recent large-scale clinical trials. The article also contains the results of clinical trials on a new generation statin, rosuvastatin, its lipid-lowering and anti-atherosclerotic effects, its pharmacological features and clinical use perspectives.

Effectiveness and good tolerability of angiotensin receptor antagonists (ARA) in arterial hypertension (AH) have been demonstrated in large-scale randomized clinical trials. Substantial pharmacodynamic differences between various ARA, potentially playing important clinical roles, were identified. Candesartan benefits in regard to stage and duration of blood pressure (BP) reduction, as well as cardiovascular event risk reduction, were shown for long-term AH treatment with the agent. Metabolic benefits of candesartan, independent of BP reduction, were observed in diabetic patients. Candesartan is also effective in chronic heart failure, combined with beta-adrenoblocker, or with beta-adrenoblocker and ACE inhibitor.

ASCOT study results influenced the content of the British National guidelines on arterial hypertension (AH) 2006 and the European Hypertension Society guidelines 2007. This study demonstrated that AH treatment with “new” antihypertensives (calcium antagonists, ACE inhibitors) is more effective and more metabolically safe than treatment with “old” agents (diuretics, beta-adrenoblockers). It has been shown that vessel organo-protection includes not only delaying atherosclerosis progression, but also decreasing arterial stiffness. Reducing blood pressure (BP) in aorta is more important than brachial BP decrease; arterial stiffness reduction is one of the crucial characteristics of antihypertensive medications. Despite lower effectiveness of beta-adrenoblockers in AH complication prevention, these agents still remain among main antihypertensive classes.

The authors present literature review on the important clinical issue – arterial hypertension (AH) management in patients with Type 2 diabetes mellitus (DM-2). In DM-2 individuals, AH prevalence triples, and dangerous combination of AH and DM-2 substantially increases target organ damage (TOD) risk. Analyzing various studies on causes of additional TOD risk increase, the authors conclude that blood pressure control is most important in DM-2 treatment. Clinical importance of antihypertensive agents’ metabolic effects in regard to long-term cardiovascular prognosis is discussed.

Arterial hypertension (AH) is one of the most prevalent diseases. Despite impressive progress in studying AH pathogenesis, treatment results should still be improved. It is mostly explained by poor therapy compliance in patients taking antihypertensive agents (AHA). At present, combined treatment is a priority in AH management. Fixed‑dose AHA combination use is a promising approach. The authors analyze the studies on effectiveness of combined AHA, most prevalent in Russia.

Left ventricular hypertrophy (LVH) is regarded as the main predictor of cardiovascular mortality. “Remodeling” term, preceded by “LVH”, includes the whole complex of multi!level changes, from macroscopic to biochemical and genetic, associated with diastolic and systolic myocardial dysfunction, myocardial blood flow and cardiac rhythm disturbances. At the moment, the crucial point in choosing a medication for LVH prevention and treatment is its organo-protective effect, in particular, LVH remodeling facilitation. One of the most promising pharmacological groups includes angiotensin II receptor antagonists (ARA), e.g., irbesartan. This is explained by leading role of renin-angiotensin-aldosterone system in LVH pathogenesis and alternative AT II synthesis path, unaffected by ACE inhibitors. Irbesartan effectiveness in arterial hypertension has been demonstrated in many clinical trials. New data on hypertrophic cardiomyopathy pathogenesis point to possible ARA effectiveness in this disease as well.

The paper deals with contemporary issues of cardiac involvement at various stages of periodic disease (familial Mediterranean fever). It is supposed that inflammation during acute attacks, in between attacks and in case of amyloidosis development is the main pathologic factor leading to functional and organic heart disturbances in this disease. Shifts of some immunological parameters, along with activation of sympatho!adrenal and other systems and organs, are considered as pathogenic factors predisposing to exhaustion of heart functional reserves. Based on the pathomorphological data, it is possible to claim that myocardial dysfunction, due to microvascular pathology and amyloid sedimentation, is a characteristic feature of the disease, though involvement of other heart structures is not excluded. The main directions for cardiac involvement diagnostics are described and comparatively analyzed.

This literature review focuses on terminology, prevalence, diagnostics, clinical course features, and treatment of coronary artery myocardial bridges (MB). Ischemia pathogenetic mechanisms, MB clinical role and non‑invasive diagnostics by intravascular ultrasound are emphasized. The author analyzes principal studies (3.4‑11‑year follow‑up) on life prognosis in patients with angina‑like clinics and MB.