The history of psychosomatic research and current studies of psychological influences on cardiometabolic risk are reviewed. Personality, psychopathological, situational and cognitive-behavioural risk factors are considered. Shortages of current studies are pointed out, the necessity of integration of different psychosomatic approaches as well as the need for individually-oriented investigations are stressed.

Objective. To assess spontaneous baroreflex sensitivity (BRS) in patients with resistant hypertension (RH) and changes during acute salt loading according to changes of blood pressure (BP). Design and methods. Thirty four patients with RH were included. Patients were on standard antihypertensive medication: lisinopril 20 mg per day, amlodipine 10 mg per day and hydrochlorothiazide 25 mg per day. Control group consisted of 11 age- and sex-matched healthy subjects. Salt loading test was performed with i.v. saline infusion (100 ml during 1 hour). Beat-to-beat BP was registered by Finometer Pro device and BRS was assessed by slope method. Results. BRS is reduced in RH patients both at baseline and after salt loading. The level of BP elevation during salt loading is related to BRS reduction, and both parameters are related to salt-sensitivity.

Objective. To determine the effect of personal anxiety on the relative risk of arterial hypertension (AH) in female population 25-64 years during 16 years. Design and methods. Within the framework of the third screening of the WHO «MONICA-psychosocial» program random representative sample of women aged 25-64 years (n = 870), who were residents of one district in Novosibirsk, were surveyed. Personal anxiety was measured by Spilberger’s test. From 1995 to 2010 women were followed up for 16 years for the incidence of AH. Cox proportional regression model was used for the estimation of relative risk. Results. During the first 5 years the relative risk of AH development was 2,38 times higher (95 % CI = 1,137-4,993; p < 0,05); for 10 years — 1,85 times higher (95 % CI = 1,075-3,194; p < 0,05); for 16 years — 1,46 times higher (95 % CI = 0,992-2,040; p < 0,05) in women with high levels of anxiety. The rate of AH incidence was higher in married women, managers, physical labour employees and in those with low level of education. Conclusion. Risk of AH incidence in population of women aged 25-64 years with high level of personal anxiety was the highest during the first 5 years of follow-up. Incidence of AH is affected by occupation and marital status, educational level.

Objective. To assess the quality of life (QOL) in hypertensive patients and to study the interrelation between the QOL indicators and the metabolic syndrome (MS) components. Design and methods. We examined 46 patients with stage II hypertension and 18 healthy subjects. Standard full clinical, laboratory and instrumental examination as well as QOL by MOS SF-36® questionnaire were performed in all subjects. Results and conclusions. Hypertensive patients and healthy subjects differed by the scale of general health (GH), physical functioning (PF), pain intensity (BP) and vitality (VT). We detected reverse correlation between the QOL indicators and all the components of MS, such as abdominal obesity, hyperglycemia, dislipoproteinemia, degree of arterial hypertension, as well as with fibrinogen level.

Objective. To study quality of life in patients with coronary artery disease (CAD) and comorbid anxiety-depressive disorders. Design and methods. 163 patients with CAD were surveyed. The diagnosis of anxiety-depressive disorders was confirmed according ICD-10. Quality of life was studied with Seattle Angina Questionnaire. Results. Patients with CAD and affective disorders perceive angina, as an illness, more negatively. Patients with CAD and prevalent depressive component are characterized by poorer quality of life. In males quality of life is lower. Conclusion. Among patients with CAD and comorbid anxiety-depressive disorders those with prevalent depressive component and males have the poorest quality of life.

Objective. To assess attitudes toward disease in patients following cardiac emergencies at early stages of rehabilitation. Design and methods. The study sample consisted of 70 patients (23 females, 47 males) aged 35-67 years (54,5 ± 6,4 years old) hospitalized with myocardial infarction (MI; 55,7 %), unstable angina (18,6 %) or for planned cardiac surgery (25,7 %). The following methods were used: interview, medical records analysis, «Method for psychological diagnostics of attitude towards disease» (Wasserman L.I. et al., 2005). Results. Most patients (48,6 %) have «ergopathic» attitude toward disease characterized by aspiration to overcome disease in order to maintain the level of social activity they had had before the hospitalization. Denial of illness itself was found in 22,9 % cases, denial of possible illness consequences — in 51,4 %. Females, patients with recurrent cardiac attack and those, who had emergent (versus planned) hospitalization were more frustrated by the disease. Males and patients, who survived MI for the first time, were more prone to deny the fact of the disease as well as its possible consequences. Denial of the fact of illness was typical only of patients with the most life-threatening states — MI (compared to unstable angina). This may be regarded as an evidence of defensive/protective character of illness denial. Conclusion. Resistance, active overcoming and denial are predominant psychological tendencies in reaction to illness in patients following cardiac emergencies at early stages of rehabilitation. In case of ineffectiveness of these psychological strategies there is an increased risk of psychosocial disturbances. These characteristics of attitude toward illness in cardiac patients should be taken into account in the treatment and rehabilitation process.

Objective. To assess and compare efficacy of perindopril, eprosartan and amlodipine according to their effects on cognitive function in patients with arterial hypertension and obesity. Design and methods. This open clinical trial included 78 patients (mean age — 46,8 ± 5,5 years), 26 of them received perindopril, 26 — eprosartan, and 26 — amlodipine. Monotherapy has lasted for 12 months. At baseline and 12 months later, all participants underwent 24-hour blood pressure monitoring, neuropsychological testing and cognitive evoked potential (P300) to assess cognitive function. Results. Twelve-month monotherapy with eprosartan and amlodipine significantly improved cognitive function (neuropsychological testing and P300) in patients with obesity and arterial hypertension.

Background. Nowadays coronary artery bypass graft (CABG) surgery is the most widely used treatment option in patients with multivessel coronary artery disease (CAD) including left main artery lesion. The long-term prognosis of these patients is determined by the properties of the grafts. Objective. To investigate antihypertensive and antiproliferative activity of the angiotesin-converting enzyme inhibitor Valsartan (Valz, Actavis Group, Iceland). Design and methods. Sixty CAD patients who underwent CABG surgery, were enrolled. Antihypertensive effects of Valsartan were assessed by 24-hour blood pressure monitoring. Venous specimens were taken during CABG surgery. Morphological changes in saphenous veins were studied by microscopy, histochemistry and immunological methods. Results. Antihypertensive effects of valsartan and perindopril were comparable. The mean systolic and diastolic blood pressure did not differ in valsartan and perindopril groups. No changes between groups were found by morphological methods. Proliferative activity of endothelial cells was significantly lower in valsartan group. Conclusion. Valsartan in CAD patients after CABG surgery is an effective therapeutic approach regarding the prevention of the intimal hyperplasia of venous grafts.

Background. Cardiovascular diseases are the most common cause of mortality and morbidity in Russia. Objective. To detect the main features of myocardial infarction pathogenesis in patients following experience of an extreme state. Design and methods. We included 140 patients with myocardial infarction and 151 liquidators of the Chernobyl accident with myocardial infarction; we used clinical and psychological methods of examination. Results. We found certain clinical and psychological patterns and mechanisms of apprehensive and extramental psychosomatic models of self destructive behavior in patients who took part in liquidating the Chernobyl accident. Conclusions. Experience of an extreme state distorts both clinical and psychological mechanisms of disease response that leads to the pathological change of the existence meaning including the existence in a disease. The participants who have had an experience of an extreme state demonstrate mechanisms of self destructive behaviour both at organic and psychological levels.

Onjective. To assess the efficacy of vibroacoustic impact and transcranial electrostimulation in the treatment of neuroautonomic regulatory disorders in Chernobyl clean-up workers with polymorbid cardiovascular pathology in the remote period. Design and methods. One hundred and seven males (the Chernobyl clean-up workers with polymorbid cardiovascular pathology) were divided into 2 groups: 1^st group included (n = 62) subjects with polymorbid cardiovascular pathology who got vibroacoustic treatment and transcranial stimulation besides standard therapy; 2^nd group (n = 45) got only standard antiischemic and antihypertensive therapy; 48 patients without radiation accident in past, formed the control group. Mean age was 51,6 ± 9,3 years. All subjects underwent the assessment of autonomic regulation (Poly-Spectrum, «Neurosoft», Ivanovo, Russia) at rest and 2000 Hz discretization frequency and Holter ECG monitoring («Cardiotechnika 4000 BP», «Inkart», St Petersburg, Russia). Results. The Chernobyl clean-up workers develop a phenomenon of additional mutual burden that is characterized by the neurological (stable depression, anxiety and stress-mediated reactions), autonomic (sympathetic activation) disorders and cardiovascular diseases (prolonged ischemic episodes, stable arterial hypertension). The majority of the parameters of heart rate variability are impaired, both at rest and during orthostatic test. The parameters were significantly improved after the therapy. Conclusion. The complex therapy with the use of vibroacoustic treatment and transcranial electrostumulation is highly effective in the treatment of autonomic disorders in Chernobyl clean-up workers with polymorbid cardiovascular pathology.

The review provides evidence that in the early twentieth century the research on the mechanisms of «metabolic cardiovascular syndrome» was started at the Department of Faculty Therapy in Pavlov St Petersburg State Medical University (that was called St Petersburg Women’s Medical University at that time). The investigations were initiated by G.F. Lang, and extended by A.L. Myasnikov, D.M. Grotel, B.V. Ilyinskiy, V.M. Dilman, V.A. Almazov and others, and based on the results they proposed the concept of a cascade of metabolic syndrome and its main components — obesity, insulin resistance and hyperinsulinemia. Nowadays, as the continuation of those studies, the first epidemiological Russian study NICA (National Investigation of Cardiovascular Complications in mеtАbolic syndrome) is conducted by the employees of the Department of Faculty Therapy and Almazov Federal Heart, Blood and Endocrinology Centre.