The article reviews the evidence on the angiotensin-converting enzyme inhibitor vs. angiotensin receptor blocker in patients with cardiovascular diseases. Some negative effects of angiotensin receptor blocker regarding prognosis are demonstrated, including cardiovascular and total deaths, myocardial infarction and stroke.

The elastic arterial walls undergo structural and functional changes by age. Nevertheless, there is no close correspondence between the patient age and arterial aging. Arterial aging rather than patient age should be considered as a cardiovascular risk factor. The review is focused on the major constituents of the age of the arterial wall, and the main criteria for its calculation are determined.

The articles reviews the main approaches to the hypertension management in young and elderly patients, in males and females with the emphasis on the management of hypertension in pregnancy based on the data from the worldwide guidelines by the Joint National Committee of the USA, European Society of Cardiology/European Society of Hypertension, American Society of Hypertension/International Society of Hypertension.

Objective. To determine relationship between metabolic syndrome (MS), its components and cognitive dysfunction among older adults.

Design and methods. Altogether 196 subjects who did not have a history of cerebrovascular events (53 males, 143 females aged 64–86) — survivors of Leningrad Siege — were examined. IDF и АНА/NHLBI (2009) criteria for MS were used. Cognitive function was assessed applying Mini-Mental State Examination scale (MMSE).

Results. MS was identifi ed in 48 % subjects. The prevailing components were hypertension, central obesity, hyperglycemia. According to MMSE results there were no participants with signs of dementia, but in 40 % cognitive dysfunction of different degree was found. Memory and attention were most impaired. Total MMSE score was associated with decreased verbal auditory working memory in women of the age group ≤ 70 years old (p < 0,05). Individual components of MS were associated with cognitive dysfunction, but only in women under or 70 years old. In this group participants with cardiometabolic disorders had the lowest scores at “Repetition” and “Sequence of actions” subscales. Hypertriglyceridemia was the component of MS most tightly associated with cognitive dysfunctions.

 Conclusions. Women with MS (especially with hyper-triglyceridemia) are a risk group of cognitive dysfunctions.

Objective. To investigate the incidence, clinical and hemodynamic characteristics of orthostatic hypotension (OH) in young and middle-aged hypertensive (HTN) patients by the head-up tilt test in relation to target organ damage.

Design and methods. Eighty-fi ve patients with HTN aged 47,0 (39,0–52,0) years and 40 healthy people aged 46,5 (33,0–51,0) years were examined. Head-up tilt test by Westminster protocol was performed. Hemodynamic parameters during the head-up tilt test and prevalence of OH were determined. We evaluated the target organ damage and antihypertensive therapy regimen in HTN patients with OH.

Objective. To determine the effect of vital exhaustion (VE) on the relative risk of hypertension in female population of 25–64 years old during 16 years in a metropolis of Western Siberia (Novosibirsk).

 Design and methods. Within the framework of the third screening of the WHO «MONICA-psychosocial» program random representative sample of women aged 25–64 (n = 870), who were residents of one district in Novosibirsk, were surveyed. VE was measured by means of MOPSY scale. From 1995 to 2010 the women were followed for 16 years for the hypertension incidence. Cox proportional regression model was used for the relative risk estimation.

Results. During the fi  rst 5 years of follow-up the relative risk of developing hypertension was 2,38 times higher in women with VE (95 % confi  dence interval = 1,03–3,87; p < 0,05); during 10 years of follow up there was a 2,32-fold and 2,34-fold risk of hypertension (for age group 35–44 and 45–54 years, respectively; p ≤0,05 for all estimations). The rate of hypertension incidence was higher in married women with VE, having high school education in «manual work» category and in those with higher education in class «executive offi  cer».

 Conclusion. VE signifi  cantly increases relative risk of hypertension incidence in population of women aged 25–64 years. Incidence of hypertension is infl  uenced by occupation class, marital status, educational level.

Objective. To assess the features of coping behavior smoking male hypertensives. Design and methods. Seventy men with hypertension of I–III degree and without associated clinical conditions with high and very high clinical risk were included. There were 35 smoking and 35 non-smoking men (mean age 46,0 ± 1,2 years).

Results. We identifi ed the differences in the attitude to the disease and the severity of coping strategies in smoking and non-smoking hypertensive men. According to the correlation analysis there is an association between the attitude to the disease and the severity of coping strategies.

Conclusions. The features of coping behavior play a role for the attitude to the disease, and their correction could improve the treatment of smokers.

Objective. To determine the prevalence and impact of social support on the relative risk (RR) of systemic hypertension in the open population of 25–64 years old women for 16 years.

Design and methods. In 1994, within the framework of the third screening of the WHO «MONICA-psychosocial» program random representative sample of women aged 25–64 (n = 870), who were residents of one district in Novosibirsk, were surveyed. Social support was studied by the method of Berkman-Sim test. During the 16-year period (1994–2010) all cases of new-onset hypertension were investigated.

Results. The prevalence of low levels of the index of close contacts (ICC) and the social network index (SNI) was 57,1 and 77,7 %, respectively. The risk of developing hypertension in those with low ICC was 2,01; 1,93 and 1,42 times higher for 5, 10 and 16 years from the date of screening, respectively (p < 0,05). In women with low SNI risk of hypertension for 5 years was not signifi cant. After 10 years, the risk of hypertension was 1,88 (p < 0,05), after 16 years it was 1,58 times higher compared to the subgroup with higher social support (p < 0,01).

Conclusion. The results show a high prevalence of low ICC and SNI, which signifi cantly increase the risk of developing hypertension in the population of women aged 25–64.

Objective. To evaluate the role of risk factors, such as dyslipidemia, carbohydrate metabolism, overweight for the development and progression of hypertension in men depending on the manifestation age.

 Design and methods. The sample consists of 90 male hypertensive patients (aged 18–75 years old). The patients were divided considering their age and the time hypertension manifestation. The control group consists of 50 men (aged 28 to 45 years) with normal blood pressure (BP) level. All hypertensive and normotensive subjects underwent routine clinical and laboratory examination.

Conclusion. The occurrence of hypertension in different age groups depends on the combination of various factors, which determine the specifi c features of its clinical course in combination with the cardiovascular system aging and metabolic status.

Objective. To assess the dynamics of cardiac remodeling after childbirth in various forms of hypertension (HT) during pregnancy.

 Design and methods. Altogether 130 pregnant women with hypertension aged 20 to 40 years (mean age 26,1 ± 1,7 years) at the 28–32 week of gestation pregnancy were examined. The control group consisted of 30 pregnant women with normal values of blood pressure (BP). Two-fold offi ce BP measurement, ambulatory BP monitoring (ABPM), heart ultrasound were performed in all women. After 12 weeks of delivery the examination was repeated.

Results. Chronic hypertension (CAH) was diagnosed in 43 % of surveyed pregnant women with hypertension. This group of patients had higher BP at ABPM and offi ce BP as compared to gestational hypertension (GAH). The frequency of myocardial changes was also higher in this group: left ventricular hypertrophy (LVH) was found in 26 %, LV concentric remodeling (LVCR) — in 42 %, and these changes remained 12 weeks post-delivery. In patients with GAH there were only LVCR signs (29 %) that reversed after childbirth. Cardiac remodeling of different severity and stability was found in all groups studied. CAH was characterized by higher values of office BP and ABPM parameters as compared with GAH and was accompanied by marked and persistent heart changes (through 12 weeks postpartum). There was slight increase in myocardial mass and LV volume in the group of pregnant women without hypertension, but these changes did not go beyond the normal range.

Conclusion. Timely and complete examination of pregnant women with hypertension, including ABPM and heart ultrasound, will improve early diagnosis of essential hypertension and timely management, as well as complication prevention.

Objective. To assess the prevalence of self-reported sleep disorders and their association with emotional complaints in a representative sample of St Petersburg citizens.

Design and methods. Altogether 354 subjects were included (134 males, 220 females, age 25–65 years old). The survey included questions on sleep duration, sleep latency, frequency of sleep-associated complaints, daytime sleepiness; sleeping pills intake; anxiety and depression complaints (emotional tension and low mood).

 Results. According to the survey results 13,5 % respondents deny emotional strain, 65,4 % indicate occasional emotional tension, 21,1 % — complain of regular emotional tension. In older people there is a tighter relation between emotional complaints and early awakening and bruxism. In elderly subjects all sleep-related complaints are associated with emotional discomfort, and the most frequent are diffi culties at falling asleep. Both emotional strain (24,8 % women vs. 13,2 % men complain of regular emotional tension; p < 0,05) and depressed mood (13,2 % females vs. 2,4 % males indicate regular low mood; p < 0,001) were more prevalent in women.

Conclusion. Sleep disorders are associated with emotional discomfort (both tension and depressed mood), and fatigue, frequent early awakenings and nightmares are the most signifi cant. In elderly people emotional complaints are associated with a wider variety of sleep disorders that may be due to the common factor for both tension and depression complaints, and the age-related (organic, dyscirculatory) changes may be the underlying mechanism.

Preeclampsia is a major contributor to the maternal and neonatal mortality and morbidity. It is the second largest cause of maternal mortality worldwide. Preeclampsia is generally defi ned as the development of hypertension and proteinuria after 20 weeks of gestation in a previously normotensive woman. It has also been further subdivided into moderate and severe preeclampsia as well as into early- and late-onset preeclampsia, and the latter is a more contemporary concept. It has been suggested that early- (before 34 + 0 weeks) and late- (after 34 + 0 weeks) onset preeclampsia have different etiologies and therefore a different clinical manifestation, but it is still a subject of considerable research. This article focuses on one case of clinical manifestation of severe early preeclampsia.

Objective.  of this study is to review the main aspects of classifi cation, clinical picture, diagnostic methods, possible complications and the treatment options of hypertension during pregnancy on an example of clinical case. Case report. In present study there was a resistant hypertension not amenable to medical treatment in a young patient.

Conclusion. Feature of this clinical case is the description of the diffi culties of antihypertensive therapy selection during pregnancy.