Aim. To study dynamics of blood pressure (BP) and spiroergometric parameters in young males with arterial hyper8 tension (AH) during treadmill stress test. Material and methods. In total, 78 men aged 18830 years (mean age 20,4±3,9 years) were examined. According to WHO/ISH criteria (1999), essential AH was diagnosed in 42 individuals: Stage I in 35, and Stage II – in 7. Control group included 36 healthy men. All participants underwent treadmill stress test (Bruce protocol, gradually increas8 ing workload), with reaching submaximal heart rate (HR). During the test, ECG was registered, BP level and gas content of the exhaled air were measured. Results. In AH patients, no significant difference in systolic or diastolic BP (SBP, DBP) dynamics during stress test was registered, comparing to controls, despite significantly higher BP levels at rest and during the stress test. AH patients demonstrated significant increase in O2 pulse parameters, respiratory coefficient, peak CO2 production, and earlier anaerobic threshold time. Physical stress tolerance in AH patients under 30, comparing to controls, was the same. In most AH individuals (n=36, 86,7%), BP reaction type was hypertensive, with gradual BP reaction in 6 participants (14,3%). Conclusion. Stable SBP and DBP increase at all treadmill test stages, with prolonged post8test recovery, might be an important AH diagnostic sign in individuals under 30.

Aim. To study physical training (PT) antihypertensive effects and influence on left ventricular (ГУ) structure and function, cerebral blood flow, and endothelial vasokinetic function in patients with arterial hypertension (AH). Material and methods. In total, 74 AH patients were examined at baseline, while receiving two-week indifferent therapy, and then after one-month PT course. PT effectiveness was assessed by 24-hour blood pressure monitoring (BPM). Target organ influence was assessed by echocardiography, transcranial duplex sonography of cerebral vessels, with functional metabolic and myogenic tests, as well as with ultrasound endothelial function assessment. Results. One-month PT was effective as a method of antihypertensive therapy in 47% of the patients. For systolic and diastolic BP, mean daily figures and BP load indices were reduced. PT did not affect TV structure. In patients with antihypertensive PT effect, TV early diastolic filling velocity increased, as well as peripheral resistance indices for intracranial cerebral arteries. Positive dynamics of cerebral blood flow auto-regulation was observed. Fndothelium-dependent vasodilatation improvement was observed in all AH patients, regardless of PT effect, but more significantly in BP reducers. Conclusion. PT effectiveness for systemic BP reduction in Stage I-II AH patients reached 47%. Beneficial PT effects on target organs were more manifested in individuals with greater BP reduction.

Aim. To study effectiveness and safety of long-term monotherapy with АСГ inhibitor moexipril, as well as its combination with diuretic hydrochlorthiazide (HCT), in postmenopausal women with arterial hypertension (AH). Material and methods. In total, 38 women with postmenopause duration of 5 years and longer, aged 58-89 years, with untreated or treated ineffectively Stage I-II AH, and postmenopausal femoral osteoporosis, were followed up for 3 three years. Intervention group (n = 19) received moexipril (7,5-15 mg/d), plus CHT (12,5-25 mg/d) if target blood pressure, BP (<140/90 mm Hg), was not achieved. Control group (n = 19) received any antihypertensive agents chosen by the physician, excluding moexipril and thiazide diuretics. Results. By Week 16 of the treatment, the whole intervention group achieved target BP levels, including 52,6% for moexipril monotherapy; target BP levels were maintained for at least 3 years of follow-up. In control group, by Week 16, target BP was achieved in all participants, including 56,2% for monotherapy; nevertheless, 3 years later, target BP was maintained in 12 out of 19 women. By Week 8, moexipril monotherapy in intervention group was associated with significant reduction in systolic and diastolic BP (SBP, DBP) levels in daytime, nighttime and 24 hours. Daytime SBP and DBP variability significantly reduced, morning SBP and DBP surge significantly decreased. Three years later, according to densitometry data, minimal femoral bone density decreased by 4,3% in intervention group, and by 9,9% in control group (p<0,05). Moexipril demonstrated very good (n = 14) and good (n = 5) tolerability Conclusion. Moexipril, as monotherapy and in combination with HCT, is a highly effective and safe agent for long-term AH treatment in postmenopausal women with osteoporosis.

 Aim. To assess effectiveness and tolerability of morning / evening-administered rilmenidine in patients with work-place arterial hypertension (WpAH), during combination therapy. Material and methods. This randomized, short-term (8 weeks), pilot study included 20 males (mean age 48,5 years) with Stage I (n = 5) or Stage II (n = 15) AH, risk II (n = 4) or III (n = 16). Rilmenidine was administered in the morning (n = 10) or in the evening (n = 10). If needed, beta-adrenoblockers, ACE inhibitors, diuretics, nitrates, and digoxin were administered. The end-points included: blood pressure (BP) normalization - for mean daily ВР, according to 24-hour BP monitoring (BPM), and office BP (oBP); therapy response; circadian BP profile dynamics; temporary index (TI); circadian rhythm; quality of life (QoL); laboratory and instrumental parameters dynamics. Results. After 8 weeks of rilmenidine-based therapy, systolic oBP (SoBP) was normalized in 95% of the participants, diastolic oBP (DoBP) - in 100%. Mean daily DBP normalization, according to 24-hour BPM, was registered in all patients, and nighttime SBP response to treatment - in 90%. In the morning administration group, DBP was reduced by 22,1%, in the evening one - by 22,7%. For all time periods, pressure load on target organs substantially lowered. In the morning administration group, TI for daily SBP decreased by 53%, in the evening administration group - by 61,5%, TI for DBP - by 44,4% and 66,6%, respectively. Initially disturbed circadian rhythm normalized in 40% of the patients. The combination of rilmenidine with beta-blockers or ACE inhibitors was the most effective for BP reduction. Conclusion. Antihypertensive effect of rilmenidine-based therapy was combined with reduction in pressure load on target organs, as well as circadian BP rhythm improvement, and perfect tolerability

Aim. To study left and right ventricular (LV, RV) diastolic dysfunction in patients with coronary heart disease (CHD) and initial stages of chronic heart failure (CHF). Material and methods. In total, 64 patients with CHD and NYHA Functional Class (FC) I-II CHF (31 men, 33 women; mean age 58,9±2 years) underwent LV and RV myocardial contractility assessment, by balanced radioven-triculography (BRVG), with segmental histogram analysis. Control group included 19 relatively healthy individuals aged 17-48 years. Results. LV and RV ejection fraction was normal in all participants: 63,6+4,6% and 53,4±5,2%, respectively. At the same time, diastolic dysfunction - decreased peak filling velocity - was registered: 259±25%/s and 194±22%/s, as well as decreased 1/3 diastolic filling: 25,9±4,9%/s and 18,3±3,2%/s, respectively. Local dyskinesia was registered for both LVandRV. In LV, 321 segments (62,9%) were normokinetic, 163 (31,8%) - hypokinetic, and 28 (5,4%) - akinetic. Normokinetic zones localized in intraventricular septum (IVS), posterior or lateral LV walls (91%), hypokinetic (85,8%) and akinetic zones (85,7%) - in superior IVS and anterior wall. InRV, prevalence of hypo- or akinetic zones reached 43,5%. Akinetic (70%) and hypokinetic (49%) zones were situated in free RVwall, normokinetic segments (84%) - in anterior-septal RVarea. Conclusion. In CHD patients with initial stages of CHF, LV and RV diastolic dysfunction was observed, manifesting in LV and RV local dysfunction. Maximal segmental contractility abnormalities were registered in LV anterior-septal area and RV free wall.

Aim. To compare long-term results of coronary artery (CA) angioplasty and stenting, according to baseline CA stenosis morphology. To assess clinical course of coronary heart disease (CHD) during long-tem follow-up after endovascular intervention. Material and methods. During 1989-2005, 228 males with angioplasty and 184 males with non-eluted CA stents were recruited. One year later, 358 patients were examined, 5 years later - 273. Results. At five years after endovasular intervention, comparing to baseline and one-year results, the number of patients without angina symptoms substantially decreased, and the number of participants with angina increased. Long-term restenosis incidence was affected by initial CA stenosis morphology. In С Type, comparing to A Type, restenosis developed more often, by 2-2,5 times, regardless of endovascular intervention type. Conclusion. Choosing the therapeutic tactics in CHD, initial CA stenosis morphology should be taken into account. Stenting is more effective than angioplasty, especially in С Type pathology.

Aim. To compare reverse remodeling process after coronary bypass surgery (CBS) in coronary heart disease (CHD) patients with and without Q-wave myocardial infarction (Q-IM) in anamnesis. Material and methods. The study included 133 CHD patients after CBS; mean age - 56,03±8,90 years. According to Q-IM presence, all participants were divided into two groups: Group I (n = 71) - patients without MI in anamnesis (61,97%; n = 44) or with non-Q-MI (38,03%; n = 27); Group II (n = 62) - patients with Q-MI in anamnesis. All participants underwent echocardiography for three times: before surgery; in early (4,2±1,3 days later) or longterm post-surgery period (2,53±1,31 years later). Results. Positive dynamics in cardiac structure and function among CHD patients after CBS was registered regardless of MI presence in anamnesis. Nevertheless, dynamics intensity differed in patients with non-Q-MI and Q-MI in anamnesis. Early significant increase in ejection fraction (EF) and decrease in abnormal local contractility index were observed in individuals with large infarction zones, due to multiple zones with restored local contractility. In long-term follow-up, volume parameters returned to baseline, but in patients with Q-MI, significant EF improvement persisted. Conclusion. Positive influence of CBS on myocardial contractility in patients with Q-MI in anamnesis persisted in long-term post-surgery period.

Aim. To study dynamics of acute psychosis (АР) incidence and clinical features during reanimation period of acute myocardial infarction (AMI) treatment, according to ten-year data from a large specialized Cardiology Center. Material and methods. The study was based on the case history data of all AMI patients, treated at Reanimation and Emergency Care Department, Yekaterinburg Clinical Center «Cardiology» (YeCCC), in 1995-2004 (in total, 12 048 case histories). From these data, 473 histories were selected, with AP registered during reanimation period of AMI treatment. Results. In 10 years, AP incidence increased from 1.57% to 5.65%. AP was registered significantly more often in AMI patients aged over 60 years. Myocardial damage severity determined AP development in reanimation period of AMI treatment. There was a significant positive correlation between AP in reanimation period of AMI treatment and lethality, regardless of age and AMI size. Conclusion. A non-precedent (by data volume and, therefore, by observed correlations and differences' significance) study of AP development in reanimation period of AMI treatment, based on 10-year data from one of the largest Russian Cardiology Centers, was performed. The results point to the problem's actuality in modern cardiology practice, and to a need for timely AP diagnostics, prevention and therapy during reanimation period of AMI treatment.

Aim. To study intraventricular septum (IVS) role in left and right ventricular (LV, RV) contractility among patients with coronary heart disease (CHD) and chronic heart failure (CHF). Material and methods. In total, 117 CHD patients with NYHA Functional Class (FC) I-IV CHF (mean age 58±4,1 years), underwent IV and RV inotropic function assessment by standard balanced biventricular radioventriculography For local myocardial contractility assessment, a unified 16-segment IV and RV model was used. Results. Local LV and RV segmental contractility was analyzed. Segments with local ejection fraction (EF) >50% were regarded as normokinetic, 25-50% - as hypokinetic, and <25% - as akinetic. Total EF in all patients with FC I-II CHF was normal. At the same time, segmental hypo- and akinesia were registered mostly in anterior-septal area of LV and RV. In FC III CHF, LV EF decrease was associated with local IVS akinesia and LV free wall dyskinesia. RV EF was reduced to 38,4±4,8%, associating with local IVS dyskinesia due to pulmonary hypertension. In FC IV CHF, LV EF reached 15,1±4,1%, and RV EF - 25,9±6,8%, with pronounced segmental dys- and akinesia in septal area and free walls of LV and RV Conclusion. In CHD patients with initial CHF, local contractility disturbances were registered in IVS segments. CHF progression was associated with LV and RV EF decrease, as well as with local hypo-, dys-, and akinesia.

Aim. To compare effectiveness of carvedilol as monotherapy and in combination with digoxin for heart rate (HR) control in patients with persistent atrial fibrillation (AF) and chronic heart failure (CHF). Material and methods. In total, 45 men and women, aged 42-77 years, with persistent AF and NYHA Functional Class II-III CHF were randomized into two treatment groups, and sub-divided by baseline ejection fraction, EF (EF>45%; EF<45%) and HR (HRMOO; HR<100 bpm). Clinical and hemodynamic parameters, as well as beta-adrenoreactivity were assessed during the study. Results. The most manifested clinical signs of myocardial contractility improvement were observed in combined therapy group. At the same time, in patients with EF>45%, non-significant benefits of carvedilol monotherapy were registered. Conclusion. In CFH patients with persistent AF and baseline EF>45%, carvedilol monotherapy was more effective; in EF>45%, combined therapy had more clinical benefits. Moreover, combined therapy was more effective in baseline HRMOO, and carvedilol monotherapy - in baseline HR<100.

Aim. To study effects of stress, myorelaxation, and their combination on endothelium-dependent vasodilatation (EDVD) in healthy adolescents. Material and methods. In total, 19 healthy adolescents (8 boys, 11 girls) were examined; mean age 14,4±0,3 years. Central hemodynamics and brachial artery (BA) blood flow were assessed before and during reactive hyperemia test (RHT), with ultrasound system «ACUSON 128XP/10c» - at baseline, during counting aloud test, myorelaxation, or their combination. Results. During counting aloud test, a significant heart rate (HR) increase, with non-significant systolic and diastolic blood pressure (SBP, DBP) surge, was registered, without substantial dynamics of BA blood flow or EDVD parameters. In myorelaxation, significant decrease in HR and BP was associated with substantial increase of BA diameter during RHT-from 7,97±0,68% at baseline to 11,13±1,07% (p=0,0005). For combination of myorelaxation and counting aloud test, HR and BP figures were intermediate, EDVD remained high (11,52±1,23%), and BA blood flow was maximal. Conclusion. The data obtained support a possibility of using stress-limiting influences for improving endothelial stress-reactivity in preventive cardiology programs.

Aim. To investigate regional blood pressure (BP) features in Kabardino-Balkaria Republic (KBR) schoolchildren, as well as to determine the number of children and adolescents with increased BP (IBP), who needs preventive intervention. Material and methods. In 1991-98, more than 6000 schoolchildren aged 7-17 years, from 5 KBR cities and 10 villages, were examined. BP levels, physical and gender maturity, total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol levels were assessed. Data analysis was age, gender, ethnicity, and region-specific. Results. Age, gender, national, and climate-geographical features of BP levels were identified in KBR schoolchildren. Regional tables for systolic and diastolic BP (SBP, DBP) percentile distribution in children and adolescents aged 7-17 years were created. IBP and other cardiovascular risk factor prevalence, together with the need for preventive intervention, were determined. Conclusion. In KBR children, population-level prevention is needed, pediatric service should pay more attention to a serious problem of arterial hypertension.

Every year, sudden cardiac death (SCD) takes lives of 400 000 American citizens, and in 10-20% ofthe cases, fatal outcome is explained by hereditary pathology. Short QT interval syndrome remains rarely diagnosed, and virtually unknown, as it was described just recently. Its clinical course is characterized by syncope or fainting episodes, and SCD in patients with corrected QT interval <320 ms. In patients with short QT syndrome, syncope can be caused by atrial fibrillation (AF) paroxysms or ventricular arrhythmias. AF episodes are typically the first manifestation ofthe disease, being registered more often in children and adolescents; some cases in new-born babies have been described. According to genetic examination results, short QT syndrome is a hereditary pathology, explained by various mutations of potassium channel gene. Genetic polymorphism in short QT syndrome manifests during antiarrhythmic treatment. At present, the single effective therapeutic method for such patients is cardioverter-defibrillator implantation.

The article is focused on modern approaches to heart rate reduction, as a new method for stable angina (SA) management. The algorhithm of SA pharmaceutical treatment, by the European Society of Cardiology (2006), is analyzed.

High prevalence of atrial fibrillation (AF) and low effectiveness of antiarrhythmic therapy are the reasons for searching a new therapeutic strategy focused on this arrhythmia. Recent studies have demonstrated the link between anatomical atrial structure changes and pro-inflammatory cytokine levels, that led to a new direction in AF pathogenesis investigation. Whether AF paroxysm is primary, or on the contrary, inflammation provokes AF, is still unknown. Inflammation might be not the only cause of atrial arrhythmogenicity but it plays an important role in myocardial predisposition for AF paroxysm. Results of multi-center studies have shown that early administration of ACE inhibitors, angiotensin receptor antagonists, and statins in cardiac patients significantly reduces AF risk, and could be a promising therapeutic strategy.

Atherosclerosis is the only human disease genetically "assigned" to everybody. Multiple agents and methods for atherosclerosis treatment have a single target - blood lipids. Decreasing their levels by 10% is associated with cardiovascular disease (CVD) risk reduction by 18%, and cardiovascular death risk reduction by 10%. Diet modification role in atherosclerosis prevention is hard to overestimate. Plant stanols, contained in Finnish Benecol products, reduce plasma total cholesterol (CH) by 10%, and in combination with diet - by 15%. Benecol products decrease CH adsorption by 50-80%. Regular intake of plant stanol products is recommended to patients with dyslipidemia, to individuals with normal CH level but high CBD risk, and to everybody eager to maintain good health and workability for years.

Inflammation and thrombosis play an important role in pathogenesis of various cardiovascular diseases (CVD). The studies on atherosclerosis and acute coronary syndrome (ACS) pathogenesis have demonstrated the interaction of these two systems. One of the mechanisms linking inflammation and thrombosis is activation of signal system CD40/CD40L. CD40 and CD40 ligand (CD40L) are transmembrane glycoproteins, related to tumor necrosis factor (TNF) receptor family and TNF family, respectively. CD40 and CD40F are expressed by various cells, including atherosclerotic plaque cells: В-lymphocytes, macrophages/monocytes, endotheliocytes and smooth myocytes. Recently, it has been discovered that platelets can be a source of soluble CD40L form (sCD40FL. In recent clinical trials, diagnostic and prognostic role of sCD40L had been studied in patients with coronary heart disease (CHD). In individuals with myocardial infarction and unstable angina, sCD40L levels are significantly higher than in healthy persons or patients with stable angina. Prognostic sCD40L value was investigated in healthy women and ACS patients; high sCD40L levels independently predicted increased CVD risk. Raised plasma levels of sCD40L are associated with restenosis after balloon coronary angioplasty. Moreover, sCD40L concentrations are increased in Type 1 and 2 diabetes mellitus, hypercholesterolemia, acute cerebral ischemia, smoking, primary and secondary pulmonary hypertension. Therefore, sCD40L could be regarded as inflammation and thrombosis marker. Its increase is a CVD risk factor, associated with poor prognosis in CHD patients.

The authors analyze the results of principal studies focused on cardiomyocyte (CMC) energy metabolism in normal physiological state and ischemia. Special emphasis is put on mechanisms of regulation and interaction of main energetic substrate oxidation processes, as well as on chemical substances and pharmaceutical agents affecting key stages of energetic metabolism in ischemia. Medications that partially reduce fatty acid (FA) oxidation in ischemic myocardium, demonstrate cytoprotective action. Their clinical safety is explained by preventing CMC accumulation and toxicity prevention of FT and their products.

Atherosclerosis is one of the most urgent problems in modern cardiology. Atherosclerosis instability and coronary heart disease clinical course are based on plaque ulceration, rupture, and atherothrombosis. Atherothrombosis causes 28% of all deaths worldwide. Therefore, usage of medications targeted on atherosclerosis is very important. One of such agents is clopidogrel - thienopyridine, first used in patients with effort angina, stroke (S), or peripheral artery disease, PAD (1997). Clopidogrel demonstrates polyvalent anti-aggregant effects on platelets. Adding clopidogrel to standard therapy improves outcomes in non-ST elevation acute coronary syndrome patients of low, intermediate, and high risk. Relative risk (RR) of death, myocardial infarction (MI), and S decreases by 20%, irrespective of standard treatment. In patients with recent MI, S, or severe PAD, long-term (three-year) clopidogrel treatment reduces RR of MI, S, or cardiovascular death by 8,7%, comparing to aspirin treatment. Clopidogrel prevents ischemic events more effectively (by 26%) than aspirin

The Round Table Discussion «New concept of cardiovascular disease prevention: combined treatment role» was held in Moscow, July 15th 2006, with the support of «Dr Reddy’s» pharmaceutical company (India).