Background. Colchicine, traditionally used for gout treatment, has recently emerged as a promising therapeutic option for coronary artery disease (CAD) due to its anti-inflammatory properties. However, its use is accompanied by conflicting clinical data and potential risks.
Objective. To systematize current evidence on the efficacy and safety of colchicine in cardiovascular diseases, identifying key areas of certainty and uncertainty.
Design and methods. We analyzed 35 clinical studies (2021-2025), including randomized controlled trials (LoDoCo2, COLCOT, CLEAR), meta-analyses and cohort studies. The study was supported by the Russian Science Foundation (Agreement No. 25-15-20110).
Results. Proven benefits: 28 % reduction in cardiovascular events in chronic CAD; atherosclerotic plaque stabilization (+ 34,2 μm fibrous cap thickness); 33 % reduction in postoperative atrial fibrillation. Controversial data: no benefit in acute coronary syndrome (odds ratio (OR) 0,99); increased dementia risk with long-term use (OR 1,45). Safety concerns: gastrointestinal complications (+ 3,6 %); trend toward increased non-cardiac mortality (+ 38 %); dose-dependent increase in dementia risk (+ 45 %).
Conclusion. Colchicine represents a promising tool for secondary prevention of atherothrombosis, combining centuries of clinical experience with modern understanding of inflammatory mechanisms. Its niche included patients with chronic CAD and persistent inflammatory activity, where it complements standard therapy without increasing bleeding risk, unlike more aggressive antithrombotic strategies. Further research should clarify its role in acute settings and optimize dosing regimens considering individual safety profiles.

Background. One of the most important regulators of blood pressure is angiotensin-converting enzyme (ACE). High levels of ACE cause an increased risk of arterial hypertension (HTN) and other diseases. GWAS data on genetic determinants of ACE were obtained, but only some of them are located in the gene (near the gene) ACE, and a significant part is located in other regions of the genome. Understanding the mechanisms underlying the association of GWAS-significant polymorphisms with the level/activity of ACE will significantly expand the use of these loci, both in scientific research in the study of genetic determinants of pathological conditions associated with elevated blood pressure, and will create the prerequisites for their introduction into practical medicine as genetic markers of the risk of HTN and other diseases.
Objective. To study the functional effects of single nucleotide polymorphisms (SNPs) associated with the level/activity of ACE according to GWAS data.
Design and methods. We assessed the functional effects of GWAS-significant polymorphisms associated with ACE level/activity based on the analysis of their epigenetic effects (HaploReg v.4.2 database), association with expression (eQTL), alternative gene splicing (sQTL) (GTEx Portal database, — V10 was used), alternative mRNA polyadenylation (aQTL) (3'aQTL-atlas database was used), biological pathways and protein interactions (STRING, V12.0).
Results. Among 14 GWAS-significant for ACE level/activity polymorphic loci, some SNPs (n = 8, rs116112765, rs4968782, rs3730025, rs4308, rs4343, rs4353, rs4362, rs4363) are localized in the ACE gene region, they are functionally associated with 16 genes (ACE, TANC2, FTSJ3, PSMC5, KCNH6, DCAF7, CSH2, ACE3P, TCAM1P, SMARCD2, CYB561, PPIAP55, STRADA, EEF1DP7, TEX2, LIMD2) and can have direct epigenetic, eQTL, sQTL, aQTL influence on the ACE gene. Another part of GWAS-significant for ACE level/activity SNPs (n = 6, rs7626301, rs8176746, rs507666, rs115478735, rs495828, rs11603123) is located outside the ACE gene region and exhibits its functional effects in relation to other 16 genes (HRG-AS1, HRG, LCN1P1, Y_RNA, ABO, ST3GAL4, KIRREL3, OBP2B, SURF6, SURF1, REXO4, DBH-AS1, MED22, DBH, MYMK, SLC2A6). Apparently, these loci modulate the level/activity of ACE through protein products encoded by these genes, which participate in biological pathways significant for the level/activity of ACE as following: the formation of ACE in endothelial cells of the lungs and blood cells (through the activating effect of thyroid hormones and calcium); the formation of endothelial cells in which ACE is synthesized, in the process of angiogenesis and endothelial regeneration; maintaining the viability of ACE-producing cells, due to the regulation of their mitotic cycle; ensuring the stability of ACE, through sialylation of circulating ACE in plasma; deactivation of ACE, due to the regulation of the level of albumin, which inactivates ACE.
Conclusion. The putative medical and biological basis determining the associations of GWAS-significant polymorphic loci for the level/activity of ACE may be both their direct epigenetic, eQTL, sQTL, aQTL influence on this gene (for SNPs located in the ACE gene region), and biological pathways involving protein products functionally associated with these loci (for SNPs located outside the ACE gene region).

Objective. The aim of the study was to determine the combined effect of systolic arterial hypertension (SHTN) and depression as a risk factor for the development of coronary heart disease in men of economically active age (25–64 years) based on a cross-sectional study in an open population.
Design and methods. A cross-sectional study was conducted on a representative sample of men aged 25–64 years with a response rate of 85,0 %. Different forms of coronary heart disease were identified using standard epidemiological methods. SHTN was recorded at systolic blood pressure (SBP) ≥ 140 mmHg. The WHO MONICA-psychosocial questionnaire (Depression Scale, MOPSY test) was used to assess depression.
Results. Using the equation of the linear function and the application of the logit transformation with the calculation of the cutoff point, the probability of determining coronary heart disease was calculated. For each variable included in the model, the odds ratio Exp(B) was estimated. We found that with a 1-point increase in the BallDepr indicator the risk of developing coronary heart disease increases by 31 %. The presence of SHTN is associated with a 2,2-fold increase in the risk of developing coronary heart disease.
Conclusions. The patterns identified during a cross-sectional study of economically active men living in a large city in Western Siberia indicate that the cluster of SHTN and depression presents a risk factor for the development of coronary heart disease.

Background. The cardio-ankle vascular index (CAVI) index is commonly used as an indicator of arterial stiffness independent of blood pressure (BP) at the time of the measurement. Russian developers proposed the START (STiffness of ARTeries) arterial stiffness index that can be calculated online based on pulse wave velocity (PWV) and BP.
Objective. To analyze the relationship of START and CAVI indices with anthropometric data, BP and pulmonary function in patients with chronic obstructive pulmonary disease (COPD).
Design and methods. Seventy-two COPD patients underwent volume sphymography to determine CAVI, cardio-ankle PWV (haPWV) and BP, then cardio-ankle START index (haSTART) was calculated. Spirometry and bodyplethysmography were performed to assess pulmonary function disorders. Statistical data processing was performed by the means of partial and intraclass correlation analysis, regression models were constructed for both indices of arterial stiffness.
Results. Strong correlation was found between CAVI and haSTART indices (r = 0,97, p < 0,001). Intraclass correlation between haSTART and CAVI indices was 0,848 (95 % CI 0,756-0,905). Significant positive partial cor relation of CAVI and haSTART indices with age (r_p = 0,34, p = 0,005 and r_p = 0,32, p = 0,007, respectively) and with mean BP (BPmean) (r_p = 0,46, p < 0,001 and r_p = 0,48, p < 0,001, respectively) was observed. Both CAVI and haSTART were negatively correlated with body mass index (BMI) (r_p = –0,38, p = 0,001 and r_p = −0,31, p = 0,010, respectively). Statistically significant partial correlation was found between both arterial stiffness indices and pulmonary ventilation parameters. The strongest correlation was observed between both CAVI and haSTART indices and residual volume (r_p = 0,48, p < 0,001 and r_p = 0,49, p < 0,001, respectively). Based on the results of regression analysis, the following models were constructed: CAVI = 1,530 + 0,062 × AGE – 0,084 × BMI + 0,041 × BPmean + 0,009 × RV, F = 13,94, p < 0,001, R² = 0,45 and haSTART = –8,122 + 0,135 × AGE – 0,149 × BMI + 0,095 × BPmean + 0,021 × RV, F = 12,57, p < 0,001, R² = 0,43.
Conclusion. Both haSTART and CAVI indices can be used to assess arterial stiffness in patients with COPD. Both indices have similar correlation patterns with age, mean BP, BMI and with the parameters of pulmonary ventilation. Strong correlation between CAVI and haSTART indices and high consistency between both indices indicates the similarity of the results of PWV corrected by BP level.

Objective. The purpose of this study was to establish the features of body composition and their association with functional activity in patients with arterial hypertension (HTN) and metabolic dysfunction-associated steatotic liver disease (MASLD).
Design and methods. The study included 133 patients of both sexes with HTN grade I-II and MAFLD. The average age of the study participants was 48,0 ± 7,99 years, including 58 women (46,6 %). All patients underwent anthropometric measurements, evaluation of muscle strength and function, as well as instrumental examinations. Quantitative determination of body composition (fat, fat-free, and bone mass) was performed using dual-energy X-ray absorptiometry. The short form of the International Physical Activity Questionnaire (IPAQ) was used to assess physical activity. Statistical analysis of the data was performed using the SPSS 27.0 statistical software package (IBM, USA). The differences between the indicators were considered significant at p < 0,05.
Results. Patients with HTN and MASLD had modified body composition with excessive fat tissue accumulation together with decreased muscle mass. Significant correlations were established between the increased fat mass, decreased muscle mass, muscle strength and disturbed muscle function, indicating a higher probability of the sarcopenic obesity in this category of patients.
Conclusion. Assessment of body composition, as well as early interventions aimed at increasing muscle mass and improving its structure and function, are key aspects in planning a set of medical prevention measures for patients with HTN and MASLD.

Objective. The aim of the study was to assess the dynamics of office blood pressure (BP) levels and to analyse factors associated with the individual variability in BP changes under different measurement conditions in patients with hypertension (HTN).
Design and methods. The study enrolled 200 outpatients with confirmed HTN, including 80 men. The median age was 68,0 (58–73) years. BP was measured using an automated oscillometric device according to the standard protocol (the reference BP), followed by a series of single measurements conducted under conditions simulating common protocol violations: the absence of back support, crossed legs, a mismatch between BP cuff size and arm circumference, the patient talking during the procedure, and preceding physical activity. The frequency of uncontrolled HTN (defined as systolic BP (SBP) ≥ 140 mmHg and/or diastolic BP (DBP) ≥ 90 mmHg) was assessed. For each participant, the absolute and percentage (PV) deviations from the reference BP were calculated, along with the individual BP variability (SDPV), defined as the standard deviation of PV across the different measurement conditions. Patients in the upper quartile of SDPV were classified as having high intra-visit BP variability. Predictors of high BP variability were identified using logistic regression and receiver operating characteristic (ROC) analysis.
Results. All non-standard measurement conditions, except for the use of an oversized BP cuff, resulted in a significant increase in BP compared with the reference values. The greatest increase was observed in the seated position with crossed legs, with an average rise of 13,5 mmHg in SBP and 3,0 mmHg in DBP. The proportion of patients classified as having uncontrolled HTN rose from 19 % (based on the reference BP) to 58,5 % under the crossed-legs condition. After adjustment of the regression model for sex, age, and body weight, high SBP changes variability (SDPV ≥ 9,0 %) was independently associated with a reference SBP < 122 mmHg (odds ratio [OR] 4,01; 95 % confidence interval [CI] 2,02–7,93) and a history of an acute cerebrovascular event (OR 2,55; 95 % CI 1,14–5,72). High DBP changes variability (SDPV ≥ 7,1 %) was independently associated with a reference DBP < 73 mmHg (OR 2,86; 95 % CI 1,49–5,50).
Conclusions. Non-adherence to the recommended BP measurement protocol predominantly leads to increased BP readings and contributes to the overdiagnosis of uncontrolled HTN. High intra-visit BP variability in response to altered measurement conditions is associated with a history of acute cerebrovascular events and lower reference BP levels. These findings underscore the critical importance of strict adherence to the established BP measurement protocol.

The aim of the study was to identify factors associated with the development of arterial hypertension (HTN) over a ten-year period, in people under 45 years of age.
Design and methods. The study included residents of Novosibirsk, 25–44 years old, examined in 2013–2016 and in 2023–2024 at the Research Institute of Therapy and Preventive Medicine — 174 people (40,2 % men, 59,8 % women). At the time of examination in 2013– 2016, they did not have an increase in blood pressure. Ten years later, at the examination in 2023–2024, in 51 individuals HTN was diagnosed. This article presents a comparison of two groups of individuals based on the 2013–2016 examination — 123 individuals with normal BP and 51 individuals with HTN developed subsequently (after 10 years).
Results. According to the results of multivariate logistic regression analysis, the development of HTN in individuals under 45 years of age during the remote 10-year period was directly associated with systolic blood pressure level (odds ratio (OR) = 1,054, 95 % confidence interval (CI) (1,009–1,101), p = 0,019) and age (OR = 1,124, 95 % CI (1,029–1,228), p = 0,009), independent of sex, alcohol consumption, waist circumference and lipid levels.
Conclusion. In summary, in young adults under 45 years of age, the chance of developing HTN in the distant 10-year period increases by 5,4 % with each 1-mmHg increase in systolic blood pressure and by 2,4 % with each 1-year increase in age.

Background. Evaluation of the effect of antihypertensive drug (AHD) concentrations on blood pressure (BP) in comorbid patients may help optimize the treatment of arterial hypertension (HTN).
The aim of the study was the effect of the AHD (lisinopril, amlodipine, indapamide) concentration assessment on BP in comorbid HTN patients to optimize antihypertensive therapy.
Design and methods. A prospective clinical controlled study was performed. In comorbid patients with essential HTN and regular use of lisinopril, amlodipine and indapamide, fasting blood samples were taken to determine the concentration of AHD using high-performance liquid chromatography with tandem mass spectrometry. Comorbidity was assessed by Charlson index.
Results. In this study 183 patients were enrolled, the mean age was 63,4 ± 11,1 years, 42,6 % were men. The analysis of covariance (ANCOVA) showed that a decrease in the concentration of each of the studied AHD below the therapeutic range (TR) did not affect the magnitude of daytime and nighttime systolic and diastolic blood pressure (SBP and DBP). At the same time, blood pressure in patients whose concentrations of the two drugs amlodipine and indapamide were recorded below TR, the levels of daytime DBP, nighttime SBP and DBP were statistically significantly (p < 0,05) higher than those in patients with concentrations of all AHD within TR. In one patient concentrations of all three drugs were below TR, and SBP day level was 164 mmHg, DBP day — 102 mmHg, SBP night — 157 mmHg, DBP night — 97 mmHg.
Conclusion. Our results indicate that the decrease in the concentration below TR of at least two antihypertensive drugs (amlodipine and indapamide in our study) affects the level of BP. Analysis of the concentration of AHD in HTN patients may be useful and can increase the treatment effectiveness.

The aim of the study was to characterize the attitude of general practitioners towards the cancellation of antihypertensive drug prescription in elderly patients and to identify the subjective main reasons for and barriers to deprescribing.
Design and methods. The cross-sectional study included 104 general practitioners who completed an anonymous face-to-face survey.
Results and discussion. 73,1 % of respondents were internists, 3,8 % specialized in geriatrics, and 23,1 % were doctors of other specialties. Most respondents (73,1 %) had more than 10 years of medical experience. 34,6 % of doctors consider clinical episodes of hypotension to be common during antihypertensive treatment in elderly and senile patients, but only 15,4 % perform survey to identify hypotension, and only 7,7 % conduct an orthostatic test. Most physicians (65,4 %) either do not conduct or rarely conduct a test for the assessment for orthostatic hypotension, and 34,6 % rarely conduct a survey to identify hypotension symptoms. The following were cited as reasons for deprescribing: a decrease in systolic blood pressure to less than 90 mmHg (34,6 %), falls (11,8 %), and less frequently (3,8 % each) — frailty, dizziness, inability to selfcare, and cognitive impairment. More than 40 % of respondents found it difficult to identify reasons for revising antihypertensive therapy. Overall, physicians' lack of awareness about the need for identification of adverse reactions and the causes of deprescribing can be considered barriers to drug deprescribing in elderly patients.