Objective. To investigate the associations of polymorphic variants rs3025058 of the ММР‑3 gene with ischemic stroke occurrence in patients with cardiovascular pathology in a case-control study. Design and methods. The main group included 255 patients admitted to the hospital due to ischemic stroke. The control group included ageand sex-matched 272 patients without ischemic stroke. The age in the main group varied from 32 to 69 years [57,0; 51,0–62,0], the age of patients without ischemic stroke (control group) varied from 37 to 68 years [55,0; 51,0–62,0]. The main group included 157 men [56,5; 51,0–62,0 years] and 103 women [57,0; 51,0–62,0 years]. The control group included 170 men [55,0; 51,0–62,0 years] and 102 women [55,0; 51,0–62,0 years]. Hospitalized patients with ischemic stroke underwent clinical examination, computed tomography scans of the brain, electrocardiography, echocardiography, ultrasound duplex scanning of extracranial brachiocephalic arteries, daily monitoring of blood pressure and heart rate, analysis of the blood coagulation parameters. A molecular genetic analysis was performed (polymorphic variants rs3025058 of the ММР‑3 gene). The recruitment lasted for three years. Results. We found statistically significant associations between the 5a/5a genotype, the 5a allele of the ММР‑3 gene and ischemic stroke. In the subgroup of patients with cardiac arrhythmias, the associations were significant only for the 5a allele, while there were no significant associations between ischemic stroke occurrence and rs3025058 (5a/6a) of the ММР‑3 gene in the subgroup of women with ischemic stroke, subgroups of patients with arterial hypertension and hypercoagulation. Genotype 5a/5a and allele 5a were associated with the ischemic stroke in the whole group, as well as in males, and in subgroups with atherosclerosis of brachiocephalic arteries and dyslipidemia. In the subgroup of patients with cardiac arrhythmias, only 5a allele of the ММР‑3 gene was associated with ischemic stroke, while no associations were found between the rs3025058 (5a/6a) allele of the ММР‑3 gene and ischemic stroke in females, and in subgroups with arterial hypertension and hypercoagulation. Conclusion. The homozygous genotype 5a/5a and the 5a allele of the ММР‑3 gene might be genetic predictors of ischemic stroke. The study of the genetic risk factors for ischemic stroke is important for the personalized approach to the management of both outpatients and inpatients with cardiovascular diseases.

Background. Pregnancy is characterized by adaptive changes in the heart, blood vessels and kidneys, which are necessary to meet the increased hemodynamic needs of the fetus, while ensuring mother’s homeostasis. Currently, there is no information about adaptive changes in the cardiovascular system and kidneys in pregnant women with white coat hypertension. Objective. To compare the frequency of cardiometabolic risk factors, changes in the heart, kidney, and blood vessels in pregnant women with white coat hypertension and in pregnant women with normal blood pressure (BP). Design and methods. The study included 88 pregnant women divided into two groups: group 1 (main group) — 44 women with white coat hypertension (aged 32,5 ± 5,7 years) and group 2 (comparison group) — 44 women with normal blood pressure (aged 28,1 ± 5,9 years), p = 0,001. The assessment of clinical factors, 24-hour BP monitoring parameters, structural and functional assessment of the heart, kidneys and blood vessels was carried out. Results. Pregnant women with white coat hypertension had a higher incidence of abdominal obesity and preeclampsia in the previous pregnancy; based on the 24-hour BP monitoring they had higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) during the day and at night, higher SBP variability during the day, higher SBP time index during the day, higher DBP time index during the day and night, higher average heart rate during the day, higher rate of non-dipper profile. They also demonstrated early signs of heart and vessel remodeling accompanied by the initial functional changes in the kidneys compared with pregnant women with normal BP. Conclusion. Pregnant women with white coat hypertension require careful monitoring and assessment of cardiometabolic risk factors, daily BP monitoring till 20 weeks of pregnancy, and a comprehensive assessment of the structural and functional state of target organs in order to make a differential diagnosis with chronic arterial hypertension and predict the risk of its development.

Objective. To determine the peculiarities of the diurnal profile of blood pressure (BP), parameters of the arterial stiffness and central pressure in the aorta in men and women with arterial hypertension (HTN) and prediabetes. Design and methods. A group of 146 patients with uncontrolled HTN and prediabetes was formed for one-stage analysis: 68 men and 78 women. All patients underwent general clinical examination including the assessment of anthropometric parameters, office BP, daily BP monitoring with analysis of the main parameters during day and night, central aortic pressure (CAP) parameters and arterial stiffness. Statistical analysis was performed using StatTech software v. 4.8.0 (StatTech LLC, Russia). Results. At baseline, women were older than men and had more pronounced disorders of carbohydrate metabolism, while diastolic BP and heart rate were higher in men (p < 0,05). According to the results of daily BP monitoring, men had higher daytime and night diastolic BP values and lower pulse BP values compared to women (p < 0,05). Similar differences were registered in the analysis of CAD parameters. Higher values of pulse wave velocity were found in men: 10,98 ± 0,9 versus 10,5 ± 0,7 m/s in women (p < 0,05). Conclusion. In comorbid HTN and prediabetes, higher levels of office, daytime and nighttime, aortic diastolic BP and lower pulse BP were registered in men compared to women. Pulse wave velocity was significantly higher in men than in women. These differences should be taken into account when choosing antihypertensive therapy to ensure effective control of office BP, as well as organoprotection, in particular, vasoprotection.

Background. Arterial hypertension (HTN) is common in patients with descending thoracic aortic aneurysms (TAA) and abdominal aortic aneurysms (AAA). Lack of blood pressure (BP) control is associated with excess morbidity and mortality and high complication rate after endovascular aneurysm repair ([T]EVAR). Objective. To determine the achievement of target BP in patients with TAA/AAA and HTN before and one year after [T]EVAR and to identify the main factors influencing HTN control in the distant postoperative period. Design and methods. Data from a local registry of patients with TAA/AAA and HTN were analysed. Office BP was measured before and 1 year after [T]EVAR. Treatment adherence was assessed using the Morisky–Green questionnaire (4-point). Multivariate logistic regression analysis was performed to find the main determinants influencing the achievement of controlled BP in the distant postoperative period. Results. Overall, 136 patients (92 with AAA, 44 with TAA, mean age 67,5 ± 8,5 years, 112 men) were included. The predominant comorbidity was ischemic heart disease (n = 91). Initial systolic BP (SBP) was 134 ± 19 mmHg and diastolic BP (DBP) was 80 ± 11 mmHg. Satisfactory preoperative BP control was observed in 82 (60 %) patients. At 1 year after [T]EVAR, 81 patients were examined, office SBP was 136 ± 17 and DBP was 78 ± 11 mmHg (p [pre-post [T]EVAR] = 0,059), and controlled HTN was confirmed in 53 (65 %) patients (p [pre-post [T]EVAR] = 0,62). The median number of medications prescribed remained unchanged (Me = 2), but treatment adherence was higher (p = 0,02). The main determinants positively associated with achieving BP control 1 year after surgery were: age (odds ratio (OR) 1,1 [95 % confidence interval (CI) 1,01–1,2]), presence of TAA (OR 10,1 [95 % CI 1,3–12,2]), lack of preoperative BP control (OR 5,6 [95 % CI 3,1–13,4]). Negative predictors of HTN control: high baseline SBP (OR 0,84 [95 % CI 0,75–0,93]), number of antihypertensive drugs prescribed (OR 0,43 [95 % CI 0,21–0,89]). Conclusions. More than half of patients with HTN and TAA/AAA referred to a large federal centre for [T]EVAR have initially adequate BP control. There is no significant improvement at 1 year after operation despite better adherence and stable number of drugs. The likelihood of maintaining sustained BP control is higher in older TAA patients with initially mild and uncontrolled HTN taking fewer than three medications.

Background. Hypertension is one of the leading risk factors for cardiovascular diseases (CVD). Vascular stiffness, reflecting structural and functional changes in the arterial wall, is recognized as an important predictor of adverse cardiovascular events (CVE). Objective. To assess the prognostic significance of the cardio-ankle vascular index (CAVI) concerning cardiovascular outcomes in patients with hypertension in the Russian population. Design and methods. The study included 505 patients with hypertension between the ages of 25 and 64 without established CVD, selected as part of the ESSE-RF project in the Kemerovo region. CAVI was assessed using the VaSera VS-1000 device. The prospective follow-up lasted an average of 10,4 years. The study cohort was divided into two groups: the first with baseline CAVI ≥ 9,0 (n = 85), and the second with baseline CAVI < 9,0 (n = 420). The endpoints were CVE including cardiac death, non-fatal myocardial infarction, and stroke. Results. Participants with elevated CAVI (≥ 9,0) were older, had a longer smoking history, and higher levels of depression. Over 10 years, they experienced more adverse CVE: non-fatal myocardial infarction (5,4 % vs. 1,8 %, p = 0,003), myocardial revascularization (9,4 % vs. 3,6 %, p = 0,018), and the combined endpoint (16,5 % vs. 9,1 %, p = 0,04). The risk of adverse CVEs over 10 years was independently associated with smoking (p < 0,001), blood glucose levels (p = 0,014), and increased CAVI values (p = 0,008). The use of antihypertensive therapy reduced the risk of adverse events (p = 0,04). Conclusion. Long-term follow-up demonstrated that the CAVI is a significant prognostic marker of CVE in patients with hypertension in the Russian population. Its use in clinical practice may facilitate more accurate risk stratification and individualized therapy.

Background. Long-term activation of adrenergic receptors in patients with hypertension (HTN) has detrimental long-term effects leading to left ventricular hypertrophy (LVH) and subsequent development of heart failure. In case of sympathetic overactivation, the representation and sensitivity of beta1-adrenergic receptors (β1-AR) decreases, and the main β-adrenergic regulation is mediated via β2-AR. However, their sensitivity can also change, which affects the possibility of adequate inotropic support of the contractile function of the heart. It remains relevant to clarify the inotropic function of cardiomyocytes in HTN patients, to assess the mechanisms of the development and severity of heart remodeling and neurohumoral regulation. Objective is to study the inotropic potential of β-AR stimulation in isolated trabeculae of the right atrium in patients with resistant HTN and obstructive coronary atherosclerosis. Design and methods. The study included 17 people with resistant HTN combined with coronary artery disease (CAD) referred for coronary artery bypass grafting due to multivessel atherosclerotic coronary lesions. The exclusion criteria were: symptomatic hypertension, chronic kidney disease stage C3-C4, absence of CAD. Myocardial contractility was studied ex vivo on isolated muscle preparations (trabeculae of the right atrial appendage) obtained during the intravenous cannulation in patients connected to a cardiopulmonary bypass machine during coronary artery bypass grafting. The inotropic response of trabeculae was assessed in the isometric mode. To influence β1and β2-AR, agonists were used against the background of preceding α-AR blockade. Results. The correlation analysis showed that the inotropic response of trabeculae to β1-AR stimulation in patients with resistant hypertension negatively correlates with the myocardial mass (MM) of the LV (r = –0,52; p = 0,04) and the average daily diastolic blood pressure (BP) (r = –0,64; p = 0,009), and with β2-AR stimulation with the dimensions of the posterior wall of the LV (PWL) (r = –0,50; p = 0,04) and the dimensions of the left atrium (LA) (r = –0,54; p = 0,03). A direct correlation was found in patients with preserved left ventricular (LV) ejection fraction (EF) between the inotropic response of isolated trabeculae to β1-AR stimulation and the LVEF value (r = 0,64; p = 0,02). When dividing patients into groups according to the level of adrenoreactivity, i. e. according to the reaction of the isolated myocardium to β1,2-AR agonists, it was found that in patients with a strong reaction the level of average daily, average daily systolic blood pressure and pulse blood pressure was lower. Conclusion. As a result of the study, a relationship was found for the first time between changes in the inotropic potential of β1and β2-AR stimulation of the right atrial myocardium and BP levels and morpho-functional changes in the heart. This is of significant importance for understanding the mechanisms of formation of hypertensive myocardial pathology and the role of sympathetic hyperactivation in the development of these processes. The obtained results indicate that cardiac remodeling in patients with a combination of coronary heart disease and hypertension is associated with the characteristics of β-AR activity according to inotropic stimulation data.

Objective. To evaluate the occurrence of latent hypertension and to analyze the indicators of 24-hour ambulatory blood pressure monitoring (24-h ABPM) in comparison with other phenotypes of increased blood pressure in young women with excessive body mass and obesity. Design and methods. The study included 104 women aged 18 to 35 years. Inclusion criteria: overweight with body mass index (BMI) ≥ 25,0 kg/m2. All subjects underwent 24-h ABPM with an oscillometric sensor using the BPLab Vasotens device (Peter Telegin LLC, Russia). More than 20 indicators were evaluated. The risk factor (RF) profile was also studied, including indicators of the lipid profile, fasting glucose level and HOMA-IR index (“Homeostasis Model Assessment of insulin resistance”). Based on the instrumental examination, four groups were formed: group 1 — persistent normotension (control); group 2 — white coat hypertension (WCH); group 3 — latent hypertension; group 4 — persistent hypertension. Data processing was carried out using the Statistica 10.0 software package (StatSoft Inc., USA). Results. Among young women with overweight and obesity, the frequency of normotension, WCH, latent hypertension and stable hypertension was 28,8 %, 9,6 %, 30,8 % and 30,8 %. In women with persistent hypertension, SBPday and DBPday indicators exceeded the control by 15 % (P1–4 < 0,01) and 17,2 % (P1–4 < 0,01), but with latent hypertension — by 10,3 % (P1–3 < 0,01) and by 7,7 % (P1–3 < 0,01); time index (TI) SBP was 4,9 times higher (P1–4 < 0,01), TI DBP was 7,1 times higher (P1–4 < 0,01), and in latent hypertension it was 3,8 times higher (P1–3 < 0,01) and TI DBP was 2,5 times higher (P1–3 < 0,01). A similar trend was noted in some of the indicators during night sleep. The variability of SBP and DBP in daytime hours was slightly higher with latent hypertension, and at night — with stable hypertension. Women with latent versus persistent hypertension differed significantly by daytime values, while nocturnal data were almost equivalent. The highest value of PBP 24 was found in the group with latent hypertension compared to the control (P1–3 < 0,01). In WCH group, as expected, both daytime and nighttime values did not tend to increase compared to the control group, and some were even significantly lower. In groups with latent and stable hypertension the rates of non-dippers by SBP and DBP were the same. Conclusion. Every second young woman with overweight or obesity has latent hypertension and stable hypertension, which should be taken into account when developing individualized preventive intervention programs among young women, depending on the variant of BP regulation in the presence of excessive body mass and obesity.

Background. Frailty syndrome is a common condition among elderly patients. It is associated with increased risks of hospitalization, falls, and mortality. Despite its clinical significance, the syndrome remains underdiagnosed and underrecognized, particularly in the context of arterial hypertension (HTN) management in older adults. Objective. This study aimed to assess the awareness of practicing physicians in the Russian Federation (RF) and the Kyrgyz Republic (KR) regarding frailty syndrome and its role in managing elderly patients with HTN. Design and methods. An anonymous survey was conducted among 472 physicians (370 from RF and 102 from KR) using online forms in RF and paper questionnaires in KR. The survey included five questions evaluating knowledge of frailty syndrome, diagnostic practices, and treatment approaches to elderly patients with HTN. Statistical analysis involved chi-square tests and Fisher’s exact tests, where appropriate. Results. While 87,5 % of physicians were aware of frailty syndrome, only 37,5 % reported knowledge of its diagnostic criteria, and 23,1 % systematically evaluated it in clinical practice. Physicians from RF were more likely to consider glomerular filtration rate when prescribing antihypertensive drugs. Orthostatic hypotension was routinely assessed by 20 % of respondents, and half performed this evaluation only in symptomatic cases. Physicians expressed caution with beta-blockers, diuretics, and anticoagulants when treating elderly patients. Conclusion. The results underscore the insufficient implementation of frailty syndrome screening in routine care of elderly hypertensive patients. Despite its presence in clinical guidelines, actual use remains low. Educational interventions and the inclusion of frailty assessment in quality indicators are needed to improve elderly care practices.

Objective. This study aims to analyze the characteristics of hypertension among individuals undergoing health examinations at Al-Sader Medical City in Najaf. We seek to determine potential predictors that contribute to the development and progression of hypertension. Design and methods. The study population was selected based on individuals undergoing routine health examinations from Al-Sader Medical City in Kufa city, Najaf, south of Iraq, within the period between April to October 2023. The collected data included information on age, gender, body mass index, blood lipids, blood glucose levels, and hypertension classification indices. Statistical analysis included descriptive statistics, normality testing, t-test, one-way analysis of variance (ANOVA), post hoc analysis, chi-square test. Results. A total of 334 individuals participated in the study (192 males and 142 females). The average age of the participants was 46,04 ± 14,958 years, ranging from 20 to 94 years. Among them, 118 people (35,3 %) had a family history of hypertension, and 59 people (17,7 %) had a history of smoking. Notably, female participants exhibited a higher rate of abnormal cholesterol, triglycerides (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) levels compared to males, particularly in the age group of 50 to 59 years. The mean levels of cholesterol, LDL, and fasting blood glucose were higher in females compared to males (p < 0,05). Furthermore, the levels of cholesterol, fasting glucose, TG, LDL, and other indicators demonstrated a significant increase with the progression of hypertension grades (p < 0,05). Conclusion. The study showed that factors such as age, gender, body mass index, blood glucose levels, blood cholesterol levels (including TG and LDL), and the presence of diabetes are closely associated with hypertension. These factors play a significant role in understanding and addressing the prevalence and management of hypertension within the examined population.