Aim. To investigate renal hemodynamics features and their interactions with cardiovascular system structure and function in patients with essential arterial hypertension (EAH), aged 40–60 years.
Material and methods. In total, 102 EAH patients (35 men, 67 women) aged 40–60 years were examined. Myocardial morphology and function was assessed by echocardiography. Renal hemodynamics and total glomerular filtration rate (TGFR) was assessed by dynamic angionephroscintigraphy.
Results. In women, renal blood flow and TGFR were significantly lower than in men. Gender difference was observed for left ventricular myocardial mass (LVMM) index and total peripheral vascular resistance (TPVR): 141,3 g/cm2 vs 111,2 g/cm2 (р=0,000), and 1109±321 dyn/s/cm5 vs 1343±507 dyn/s/cm5 (р=0,012) in men and women, respectively. In men, moderate positive correlation was registered between TGFR and TPVR (r=0,54; p<0,05); in women – moderate negative correlation between TGFR and LVMM index (r= 0,335; p<0,05), TGFR and body mass index, BMI (r= 0,414; p<0,05).
Conclusion. In EAH women aged 40–60 years, renal hemodynamics and TGFR parameters were significantly lower than in men. Men demonstrated moderate positive correlation between TGFR and TPVR, women – moderate negative correlation between TGFR and LVMM index, TGFR and BMI.

Aim. To study intravascular auto-rosette formation (ARF) in peripheral blood of patients with essential arterial hypertension (EAH) during antihypertensive treatment (AHT).
Material and methods. In total, 160 EAH patients were examined, including 30 with first-diagnosed EAH, 100 treated occasionally, and 30 receiving regular AHT for several years. Total white blood cell and auto-rosette count, red blood cell mean size, deformation characteristics, osmotic resistance (RBC OR), blood hemoglobin (Hb) level were measured.
Results. In EAH patients, increased number of AH medications taken was associated with increase in total number of auto-rosettes and RBC lysis auto-rosettes, together with reduced RBC OR. In Stage III EAH patients, regularly receiving AHT, a clinically insignificant decrease in RBC count was observed.
Conclusion. In treated EAH patients, peripheral blood auto-rosette count is higher than in healthy individuals. Increased ARF is typical for regular AHT, being maximal in individuals receiving AHT for several years, and is associated with reduced RBC count.

Aim. To study smoking effects on renal damage progression in young men with early stages of essential arterial hypertension (AH).
Material and methods. The study included 118 AH men aged 18–35 years (mean age 22,1±4,54 years). AH duration varied from 1 to 8 years (mean duration 4,14±2,1 years). Self-reported smoking prevalence (>1 cigarette per day) was 52 % (n=61). Smokers and non-smokers were comparable by age, AH duration, body mass index, and other cardiovascular risk factors. All participants underwent dynamic renal angioscintigraphy, with intravenous Tc99m DTPA administration and glomerular filtration rate (GFR) assessment.
Results. According to dynamic renal angioscintigraphy data, GFR levels differed significantly in smokers and non-smokers with Stage I AH. In Stage II and III AH, the difference was not statistically significant.
Conclusion. Smoking facilitated hyperfiltration progression in Stage I AH young men, comparing to non-smoking patients.

Aim. To assess ramipril effects on microcirculation (MC) and cerebral blood flow (CBF) in patients with Stage II-III arterial hypertension (AH).
Material and methods. In total, 37 patients with Stage II-III AH were examined. Thirty patients completed the study, receiving ramipril (2,5-20 mg/d) and hydrochlorothiazide (12,5 mg/d) for 6 months. At baseline, after one and six months, clinical examination, Doppler ultrasound of extracranial vessels, and MC assessment by conjunctival biomicroscopy were performed.
Results. By the end of the study, target blood pressure level was achieved in 86% of the participants. Main parameters of MC and CBF correlated with each other. Ramipril therapy was associated with normalization of CBF and MC, primary due to the beneficial effects on capillary and intravascular MC.
Conclusion. Inter-correlation between MC and CBF parameters support the interrelation between pathological processes in patients with AH and target organ damage, and also facilitate the assessment of ramipril protective effects on CBF. Long-term ramipril and hypothiazide therapy improved both MC and CBF in patients with Stage II-III AH.

Aim. To study the prognosis of heart failure (HF) development in male and female patients with arterial hypertension (AH) and various heart remodeling variants.
Material and methods. The study included 48 men and 41 women of comparable age, with Stage II AH, at baseline free of HF or other diseases resulting in heart remodeling. All participants underwent Doppler echocardiography. The incidence of clinical HF cases during 5-year follow-up was analyzed by Kaplan-Meier method.
Results. During 5-year follow-up, HF symptoms were registered in 50 % men with left ventricular myocardial hypertrophy (LVH) and 9 % men without LVH, as well as in 22 % women with LVH and 14 % LVH-free women. Cumulative rate of AH men with normal LV geometry and manifested LV diastolic dysfunction (DD; Е/А<1,0), who demonstrated HF symptoms in 5 years, was 40 %; in AH men without LV DD, no HF symptoms were registered in the same period. In all AH men with Е/А>1,5, HF symptoms manifested during 5-year follow-up.
Conclusion. LV myocardial mass and manifested DD are independent predictors of HF development in AH patients. Prognostic value of manifested LV DD is higher than that for LVH.

Aim. To study the effects of work conditions on coronary heart disease (CHD) and its risk factor (RF) prevalence in automobile transport drivers (AD), to assess AD work capacity and to define CHD prevention vectors.
Material and methods. Standard epidemiologic methods were used in 1196 urban AD and 1075 rural AD (main group), as well as 864 urban and 687 rural non-drivers – males of the same age (control group). To assess CHD and its RF prevalence according to automobile transport type, three subgroups were formed: lorry AD (n=408), autobus AD (n=421), and taxi AD (n=416). Professional work capacity was assessed by psycho-physiological testing (PPT).
Results. CHD and/or its RF prevalence was higher among urban and rural AD than in controls; in general, this prevalence correlated with age and professional service length. Higher rates of CHD and myocardial infarction (MI), as well as smoking, low physical activity, arterial hypertension (AH), dyslipoproteinemia, left ventricular hypertrophy, were observed in AD, comparing to non-drivers (p<0,05). This could be a manifestation of professionally explained adverse epidemiologic situation regarding CHD and RF in drivers. Maximal rates of CHD, MI, and RF (13,2 %, 4,6 %, 24,1–91,1 %, respectively), registered in lorry drivers, were higher than those for autobus and taxi drivers (p<0,01). According to PPT results, active reaction system function was reduced in AD with CHD, MI, and stage I"II AH, comparing to healthy AD (p<0,01).
Conclusion. CHD, MI, and RF prevalence in drivers was high, especially in lorry drivers; professional work capacity was decreased. Preventive measures at automobile transport units should include not only medical, but also psycho-correcting methods, as well as health education activities.

Aim. To assess the effects of various antianginal nitrate therapy variants on quality of life (QoL) in patients with chronic coronary heart disease (CHD).
Material and methods. In total, 259 patients were examined: 153 males (59,1 %) and 106 females (40,9 %); mean age 62,6±3,4 years. All participants had Functional Class II-IV effort angina and received antianginal therapy, QoL was assessed with Health-Related QoL scale.
Results. In patients receiving retarded isosorbide-5-mononitrate forms (Group I), total QoL score increased from 3,5±0,3 to 7,4±0,25 during three-month follow-up; in participants receiving isosorbide-5-mononitrate and moderately prolonged isosorbide dinitrate (Group II), it increased from 3,3±0,3 to 6,1±0,2.
Conclusion. During three-month follow-up, QoL improved significantly in Group I, and to a lesser extent in Group II.

Aim. To study local myocardial contractility (LMC) in patients with coronary heart disease (CHD) and Type 2 diabetes mellitus (DM-2).
Material and methods. The study included 144 patients: 70 with CHD and DM-2 (Group I), 74 with CHD only (Group II). To study LMC disturbances, all participants underwent balanced radioventriculography (BRVG).
Results. In patients with CHD and DM-2, LMC abnormalities varied from hypokinesia to akinesia and dyskinesia. In this group, comparing to participants with CHD only, the number of disturbed LMC zones was significantly greater in both left and right ventriculi.
Conclusion. In CHD and DM-2 patients, who demonstrate the presence of myocardial zones hypokinetic due to chronic ischemia and diabetic cardiopathy, LMC abnormalities of both ventriculi should be timely diagnosed. LM dysfunction reversibility should be assessed in acute nitroglycerin test.

Aim. To study sinus arrhythmia (SA) effects on quantitative parameters of time myocardial repolarization dispersion (dQTt) in healthy people and coronary heart disease (CHD) patients, as well to assess the potential of this predictor in CHD diagnostics.
Material and methods. In total, 94 healthy people aged 19–60 years, and 54 CHD patients aged 39–57 years, were examined. All participants underwent morning registration of rest electrocardiogram (ECG) in SII for 5 minutes, to measure heart rate variability (HRV), QT duration and dispersion.
Results. The difference between mean QTtc dispersions in diapasons of sinus isometry, moderate and manifested SA was observed, irrespective of age. A new diagnostic parameter, dQTtc/RRVR, was proposed for normalizing dQTtc according to SA severity and HR. The predictive value of this parameter was substantially greater than that of HRV characteristics, QT and QTc duration and dispersion.
Conclusion. SA and HR-normalized dQTt could be regarded as a diagnostic CHD index, independent of HRV characteristics. Sensitivity and specificity of normalized dQTt in CHD diagnostics is increasing when combined with other parameters.

Aim. To investigate low-energy laser radiation (LELR) effects on parameters of nitroxidergic system and free radical peroxidation (FRP), as well as on physical stress tolerability (PST), in patients with unstable angina (UA) and various cardiovascular disease (CVD) status.
Material and methods. The study included 100 men with UA (mean age 53±1,0 years). The patients were randomized into two groups, comparable by age, gender, cardiovascular anamnesis, and treatment received. The intervention group (n=49) was administered LELR, the comparison group (n=51) – placebo intervention. The control group included 28 healthy men of the same age. LELR course started at Day 2 after hospitalization, and included 7 sessions. FRP and nitroxidergic system parameters, together with lipid profile, were assessed at Days 2 and 9. PST was assessed in 6-minute walk test (WT) at Day 9 and 3 months later.
Results. In UA patients, LELR was associated with significant decrease in atherogenic lipid profile parameters, TBA product level normalization, and increase in nitrite levels. Laser therapy was also associated with significant improvement of PST, regardless of CVD status in anamnesis.
Conclusion. Adding laser therapy to complex treatment of UA patients could be recommended as an effective, safe, and UA treatment-optimizing intervention.

Aim. To investigate clinical role of serum apolipoprotein B (apo B) levels in coronary heart disease (CHD).
Material and methods. The study included 122 patients (mean age 49,7±7,1 years) with possible CHD diagnosis, who underwent clinical and instrumental examination. The diagnosis was confirmed by anamnesis data, stress tests and coronary angiography results. Apo B concentration was measured by immune-enzyme method.
Results. In women, sensitivity of elevated apo B levels was lower than that of hypercholesterolemia (HCH); nevertheless, specificity of both parameters was similar. In men, HCH was more sensitive and specific than increased apo B levels.
Conclusion. Substantial differences in sensitivity and specificity of increased apo B levels were observed in women and men with possible CHD, as well as in various groups of men.

Aim. To assess atorvastatin lipid-lowering effect and tolerability at the initial stage of lipid-lowering treatment.
Material and methods. The study included 47 patients (14 women, 33 men; mean age 55,6±11,6 years). Inclusion criteria were: verified coronary heart disease, CHD (stable effort angina, post-infarction cardiosclerosis), total cholesterol (TCH) level >5,0 mmol/l, low-density lipoprotein (LDL) CH level >3,0 mmol/l, triglycerides (TG) level _<3,5 mmol/l. CHD was verified in 31 patients (62%), including 17 with previous myocardial infarction (MI); 38 participants (76%) had arterial hypertension, 30 (60%) were overweight. All patients received atorvastatin (10 mg/d), individuals with CHD also received clopidogrel (75 mg/d). The follow-up period lasted for one month. After 14 days and one month of the therapy, lipid profile and liver function tests (LFT) were performed.
Results. Thirty-day lipid-lowering therapy resulted in decreased TCH level (by 33,2%; p<0,01), reduced LDL-CH concentration (by 33,9%; p<0,05), elevated high-density lipoprotein (HDL) CH level (by 18,5%; p<0,05), and decreased atherogenicity index (by 38,4%; p<0,05). During one-month follow-up, no significant changes in LFT were observed.
Conclusion. As early as during the first month of the treatment, lipid-lowering therapy with atorvastatin resulted in significant reduction in TCH, LDL-CH, and TG concentrations, together with increase in HDL-CH level. No effect on FLT was observed.

Aim. To assess prognostic value of clinical and psychological factors in regard to sudden cardiac death (SCD) risk in patients after myocardial infarction (MI).
Material and methods. In total, 420 patients were examined at Day 10-14 after MI; follow-up period lasted for 1-4 years. General clinical examination, echocardiography, 24-hour electrocardiography (ECG) monitoring, late ventricular potentials (LVP) detection, active orthostatic test (AOT), heart rate variability (HRV) assessment, psychological testing, if necessary – coronary angiography and endocardial electrophysiological examination were performed.
Results. In the first post-MI year, SCD incidence was 6,7%. SCD risk was predicted by anterior MI localization, left ventricular (LV) aneurysm, heart failure, pre-syncope in anamnesis, hypotension during AOT, sinus tachycardia, left bundle block, anxiety and depression symptoms, leukocytosis and monocytosis in acute AMI period, alcohol abuse in anamnesis, treatment features (no beta-adrenoblockers; diuretic therapy). In multivariate analysis, the most important clinical factors included previous MI, hypotension in AOT, LV ejection fraction, ventricular arrhythmias by 24-hour ECG monitoring, HRV and LVP assessment data.
Conclusion. Due to high SCD rates in MI patients, SCD risk should be assessed as early as during hospitalization, using relevant clinical and psychological parameters. If needed, detailed examination and secondary SCD prevention measures should be performed.

Aim. To analyze diagnostic defects and to identify objective and subjective factors causing inadequate emergency cardiac medical care (ECMC).
Material and methods. Two thousand medical histories of patients hospitalized with myocardial infarction (MI) and acute coronary syndrome, were analyzed.
Results. Adverse outcomes were registered in 312 cases (15,6 %), including diagnostic defects in 83,3 %. The causes included inadequate doctor qualification (52,6 %), diagnostics and treatment inaccuracy (48,4 %), haste (44,6 %), or combination of inadequate qualification, inaccuracy, and specialist incompetence (34,6 %). Low doctor qualification resulted in inattentiveness (21,5 %) and uncertainty (19,6 %). Over-self-assurance (11,5 %), associated with underestimation of complaints, anamnesis, or clinical data, caused late MI and unstable angina diagnostics.
Conclusion. Continuous analysis of ECMC defects, their causes and sources could improve ECMC quality and decrease the risk of legal actions initiated by patients and their relatives.

Aim. To study the validity of Nottingham Health Profile (NHP), “Arrhythmia Patient quality of Life” (APL) scale, Duke Activity Status Index (DASI) in patients with drug-resistant atrial fibrillation (AF).
Material and methods. In total, 78 patients with drug-resistant AF were examined. Later on, 54 underwent atrioventricular radio-modification or radio-ablation.
Results. During functional capacity assessment in AF patients, physical stress test results and questionnaire data significantly correlated with each other. There was a positive correlation between NHP “emotional reaction”, “physical abilities”, or “energy level” domains, that might point to constructive validity of this questionnaire in AF patients. APL scale data significantly correlated with all NHP domains, as well as with functional status parameters by DASI method, that also points to sufficient validity of APL instrument in this patient group.
Conclusion. NHP, DASI, and APL scale are sufficiently valid in AF patients; these methods could be used for quality of life assessment in individuals with various AF forms.

Aim. To assess the role of medico-genetic counseling in diagnostics of the insufficiently explored premature ventricular complex (PVC) syndrome.
Material and methods. Medico-genetic counseling and prospective follow-up (1973-present) was performed in the families of 36 patients with Wolf-Parkinson-White (WPW) syndrome (222 relatives examined), and in the families of 40 patients with Clerc-Levy-Cristesco (CLC) syndrome (227 relatives examined).
Results. PVC phenomenon in I-IV line relatives was regarded as a manifestation of hereditary arrhythmia predis-position and an indication for preventive measures, electrocardiographic assessment included. Healthy relatives were examined at least every 6-months, then once per year, including psychotherapeutic counseling on lifestyle modification. During the 30-year follow-up period, PVC patients’ relatives complying with healthy lifestyle recommendations did not have any complaints and regarded themselves as healthy persons.
Conclusion. Therefore, medico-genetic counseling is the most sensitive method for PVC syndrome diagnostics. Widely available psychotherapeutic counseling on healthy lifestyle facilitates the healthy status maintenance in III-IV line relatives.

Elevated blood pressure (BP) is one of the main independent risk factors for cardiovascular complication development. In clinical practice, the combination of coronary heart disease (CHD) and arterial hypertension (AH), increasing adverse outcome risk, is highly prevalent. In June 2007, new guidelines on AH management, were presented by ESH and ESC, providing a new target level of BP for CHD and AH patients: <130.80 mm Hg. The achievement of this new target level, as a part of complex preventive measures, guarantees improved prognosis in CHD and AH individuals.

The article is focused on choosing heart rate-lowering antianginal medications for patients with stable angina. Antianginal therapy algorithm by the European Society of Cardiology (2006) is analyzed.

Early treatment optimization improves clinical outcomes and reduces morbidity and mortality in patients with acute myocardial infarction (AMI). Intravenous beta-adrenoblocker (BAB) therapy, associated with improved survival, is well tolerated by AMI patients. The results of relevant clinical trials are presented. The causes of possible increase in cardiogenic shock risk for metoprolol group, COMMIT trial, are analyzed. Evidence base for early BAB therapy in AMI patients is presented.

Based on СОURAGE study results (Clinical Outcomes Utilizing Percutaneous Coronary Revascularization and Aggressive Guideline-Driven Drug Evaluation), modern tactics for management of patients with coronary heart disease (CHD) and stable angina are discussed (percutaneous coronary intervention, PCI, or aggressive drug therapy with statins, aspirin, ACE inhibitors etc.). The role of secondary drug prevention, according to modern guidelines, is highly appraised. The emphasis is put on the leading role of lipid-lowering therapy with statins and ezetimibe. No significant difference was observed for complication rates in PCI group (n=1149) and optimal drug therapy (n=1138). Cumulative incidence of primary events during 4,6 years of follow-up was 19,0% and 18,5% in PCI and drug therapy groups, respectively (р=0,62). Therefore, in patients with stable CHD, PCI as a first-line strategy does not reduce the risk of death, myocardial infarction, or cardiovascular events, if combined with drug treatment.

High effectiveness and safety of beta-adrenoblockers (BB) in patients with coronary heart disease (CHD) have been proven by manifold clinical trials. BB are effective and safe, provided dose regimen is correct and contraindications are taken into account. BB significantly reduce total mortality and sudden cardiac death risk in CHD patients.