The article reviews available up-to-date knowledge from randomized trials, observational trials and metaanalyses about the problem of risk of cancer as a possible complication of angiotensin II receptor blockers therapy.

Left ventricular hypertrophy (LVH) is the most important element of cardiovascular continuum in patients with essential hypertension (EH). The results of a five-year retrospective analysis of EH patients cohort with initially different types of left ventricular geometry (491 subjects) are presented. It is shown that the overall mortality in patients with concentric and eccentric LVH does not differ significantly (37 and 35 %, respectively) but exceeds that in subjects with normal LV geometry (20 %). Associated and concomitant pathology determine the total and cardiovascular prognosis more in patients with concentric LVH than in subjects with eccentric LVH. The presence of ECG valid quantitative and strain diagnostic LVH criteria (Sokolow-Lyon index and Perugian university sign) determines the worst remote prognosis in patients with both concentric and eccentric LVH. The enlarged size of the left atrium is an universal marker of poor outcome in hypertensive patients regardless the type оf left ventricular geometry.

The paper reviews the role of registries in clinical practice and their difference from randomized clinical trials. The article focuses on the use of registries and databases in the management of patients undergoing revascularization surgery, and on the particular need for the registry of patients who underwent planned bypass surgery.

Изменение водо- и ионовыделительной функции почки и физико-химического состояния одновалентных катионов плазмы крови у больных гипертонической болезнью при психоэмоциональной нагрузке Dynamics of water and ion renal excretion and physicochemical monovalent cations in hypertensive patients under psychoemotional stress I.E. Ganelina, N.A. Kruchinina, M.N. Maslova, A.A. Panov, E.E. Poroshin Object. To study the influence of psychoemotional stress (PES) on renal mechanisms blood pressure regulation and on the activity of plasma Na⁺ and K⁺ in hypertensive patients. Design and methods. Eighteen males with normal blood pressure and 20 males with hypertension (mean age in both groups - 57 ± 3 years) underwent PES [1], and all of them developed the rise in blood pressure, increased diuresis, natriuresis, renal excretion of K⁺, osm, clearance of Na-C_Na and osm–Cosm. We assessed the levels of Na⁺ and K⁺ in the flame photometer Flafo-40 (Germany), we performed osm-cryoscopy on the thermoelectric milliosmometre (MT-1) to assess the activity of Na⁺ and K⁺ in plasma with the use of ion-selective electrodes ISE-M-K and ISE- M-Na. Results. After PES, SAP and DAP reduced in normotensive and hypertensive patients, however, it was about 12 % remaining above the initial level in both groups. After PES, normotensive subjects increased kidney excretion compared to the initial level: diuresis for 15 %, , U _NaV for 15 %, U_КV for 18 %, U _osmV for 14 %, C_Nа for 17 %, C_osm for 15 %, i.e. their reabsorption remained low. After PES diuresis, renal excretion of ions, CNa, Cosm are decreased in comparison to baseline level: diuresis, U _NaV; U _osmV, CNа, C_osm were higher for 1-1,3 %. The baseline levels of Na⁺ and K⁺ activity and their activity coefficients were higher in patients in comparison with healthy subjects for 12 %, and the activity coefficient of K⁺ was decreased at PES for 9 %. Conclusion. After PES reabsorption of water, Na⁺, C_Na, Cosm is decreased in normotensive subjects, while in hypertensive patients it significantly increases, despite high blood pressure. The high activity of Na⁺, and its activity coefficient in patients with hypertension may be associated with a decrease in the proportion of free water in blood plasma.

Objective. To analyze the dynamics of blood pressure in the early postoperative period in hypertensive patients with kidney tumor after nephrectomy. Design and methods. We examined 96 patients with cardiovascular diseases and kidney tumors, at the age from 41 up to 75 years (mean age — 57 ± 6,3 years), who were planned for nephrectomy (I group). Group II included 53 patients aged 37-65 years (mean age — 49 ± of 7,2 years) who underwent laparoscopic nephrectomy. Daily monitoring of blood pressure MECG-DS-HC-01 («LCA Advanced technologies», Russia) was performed in all subjects. Results. Young hypertensive patients (from 40 to 48 years, mean age — 43,7 ± 4,6 years) demonstrated blood pressure elevation in the early postoperative period after nephrectomy even when antihypertensive medication was taken. At the same time elderly patients (from 56 to 85 years of age, mean age — 65,3 ± 7,5 years) develop hypotension episodes. Calcium channel blockers appeared to be highly effective in young patients who also demonstrated higher blood pressure levels in the postoperative period after laparoscopic nephrectomy, as compared with patients after open surgery. On the second day after the open nephrectomy 22,9 % (22 of 96) patients required antihypertensive treatment correction, and on the tenth only 1 % (1 patient out of 96) required treatment enhancement, whereas in group II on the second day after the intervention 100 % patients required therapy enhancement, and on the tenth day 60,4 % (32 out of 53) patients needed some correction of the treatment. Conclusions. Hypertensive patients with kidney tumors require precise control of blood pressure before the operation and correction of antihypertensive therapy, as almost one third of the patients develop increase of blood pressure in postoperative period. Calcium channel antagonists should be considered as a drug of choice in the young patietnts (mean age — 44 years) as they allow to achieve target blood pressure, that is necessary to improve renal blood flow and protects the kidney. At the same time 20 % of elderly patients (age 66) develop hypotension episodes requiring lower doses of antihypertensive drugs.

Objective. Тс determine allelic variants frequencies caused by Apo E polymorphism in patients with metabolic syndrome and cognitive dysfunction (CD). Design and methods. 54 participants had undergone anthropometric measurements, blood examination (glucose, cholesterol and triglycerides), molecular genetic analysis (polymerase chain reaction, restriction fragments length polymorphism) and neuropsychological tests. Results. Allelic variant s4 of Apo E is an unfavourable factor contributing to the development of CD, depression, anxiety disorders. Allelic variant s2 of Apo E is protective factor in relation to the development of depression.

Objective. To evaluate the efficacy and safety of transcatheter renal denervation (TRD) in drug-resistant hypertension in a single-institution study (NCT01499810). Design and methods. Subjects with essential hypertension aged 18-80 years with blood pressure (BP) > 160/100 mmHg despite three or more antihypertensive drugs who signed written informed consent were included in the study. Exclusion criteria were: mean 24-h systolic BP < 135 mmHg (a^mbulatory blood pressure ^monitoring), esti^mated glo^merular filtration rate (e^jFR.) < 30 ml/ min/m², severe concomitant diseases. TRD was performed as 4-8 point radiofrequency (RF) ablations in each renal artery using standard EP catheter 5F. Efficacy endpoints: changes in office and ambulatory BP at 6 and 12 months after TRD. Safety endpoints: adverse events, changes in renal blood flow (ultrasound dopplerography) and renal function (proteinuria, serum creatinine, eGFR) at 1^st week, 6 and 12 months after TRD. Results. Interim analysis was done to monitor safety of TRD. The intervention was performed in 45 patients (aged 52,9 ± 12,2 years, 22 male), 29 patients were examined at 6 months and 16 patients — at 12 months after TRD. Intraoperative angiography showed no damage of renal arteries due to RF ablation. There were 5 minor periprocedural complications: small subcapsular kidney hematoma (80 ml by magnet-resonance tomography), contrast nephropathy, 2 access site pseudoaneurysms, allergy to dye. No additional events, significant changes in renal blood flow or renal function were found at 6 and 12 months of follow-up. Office BP fell by -34,8/-17,2 mmHg (p < 0,00001/0,00001) at 6 months and -41,0/-24,1 mmHg (p < 0,0001/0,0001) at 12 months after TRD (systolic/diastolic, respectively). Mean 24-h BP decreased by -11,1/-7,1 (p < 0,001/0,001) and 20,8/-13,1 mmHg (p < 0,0001/0,0001), respectively. Conclusions. TRD is safe in patients with resistant hypertension and causes significant long-term reduction of both office and ambulatory BP.

Objective. To study features of remodeling of the left ventricle myocardium in patients with arterial hypertension and type 2 diabetes mellitus (DM) in comparison with patients with arterial hypertension and without abnormalities of glucose metabolism. Design and methods. We enrolled 180 patients with degree 1 and 2 arterial hypertension matched by age and gender. They were divided into 2 groups: group 1 included 90 patients with type 2 diabetes mellitus, and group 2 included 90 patients with normal glucose tolerance. Laboratory tests and echocardioscopy were performed. Results. The patients of group 1 had obesity, dyslipidemia and non-compensated type 2 diabetes mellitus. The patients with type 2 diabetes mellitus had concentric left ventricular hypertrophy in comparison with patients with normoglycemia (33 vs. 5,5 %, р < 0,001), including non-obese patients (19 vs. 1,8 %, р = 0,025). Patients with type 2 diabetes mellitus more often had disorders of the left ventricular diastolic function (94,4 vs. 58,9 %, р < 0,000). Disorders of the diastolic function were more obvious in association with type 2 diabetes mellitus with concentric variants of heart remodeling.

Background. Chronic systemic inflammation is a key factor in the pathogenesis of cardiovascular diseases. The exact mechanisms underlying blood pressure elevation are unclear, but recent findings suggest that inflammatory mediators are involved. The objective of our study was to investigate the influence of gene-gene interactions between IL6, IL1B, IL12B, TNF, LTA and IL10 genes polymorphic markers on susceptibility to essential hypertension. Results. In the ethnic group of Tatars residing in Bashkortostan, Russia, we found an association of IL1B rs16944 and IL10 rs1800872 polymorphic markers with the disease. The analysis of gene-gene interactions showed significant synergy between IL12B rs3212227 and TNF rs1800629 polymorphic markers towards essential hypertension. The final model (logistic regression) included IL10 rs1800872 genetic marker and the combination of IL12B rs3212227 and TNF rs1800629 genetic markers as optimal predictors of essential hypertension. Conclusion. Our data confirm the involvement of cytokine system in the development of essential hypertension.

Myocardial fibrosis plays a key role in the pathogenesis of cardiovascular diseases. Renin-angiotensin-aldosterone system (RAAS) is the key regulator of vascular tone, potassium and water homeostasis, and response to the tissue damage. The effects of angiotesin II are mediated by 1 type angiotensin II receptors, together with angiotensin-converting enzyme, forming the «classical regulation axis» of RAAS. At chronic high cardiac afterload the genes of procollagen and collagen synthesis are overexpressed leading to the increased production of collagen, fibrosis and myocardial hypertrophy. Both hemodynamic and non-hemodynamic factors affect fibrosis development. RAAS blockers are suggested to have antifibrotic activity. There is a strong evidence of losartan efficiency that can be, at least, partly mediated by antifibrotic activity.

Objective. To compare the frequency, causes and characteristics of sleep disorders, the severity of daytime sleepiness in men with arterial hypertension (AH), which have risk factors, evidence of target organ damage or associated clinical conditions. Design and methods. We enrolled 158 hypertensive men (31-73 years) divided into three groups: group 1 (n = 50) with two or more risk factors for AH; group 2 (n = 52) with evidence of target organ damage; group 3 (n = 56) with associated clinical conditions. Testing was performed according to the protocol for patients with sleep disorders, including questionnaire value subjective characteristics of sleep, Russian version of the Epworth Sleepiness Scale, screening test of sleep apnea syndrome (SAS), hospital anxiety and depression scale. Results. Men with AH are characterized by reduction in the subjective sleep evaluation due to the multiple and disturbing dreams, increased sleep time and the number of nighttime awakenings, poor quality of sleep and morning awakening. SAS can be suspected in 54, 71 and 84 % of patients in the 1^st, 2^nd and 3^d group, respectively. Patients in group 3 are more likely to complain of sleep apnea (70 %), daytime sleepiness in a relaxed state (75 %), headache in the morning (77 %), and are also more likely to have excessive and severe daytime sleepiness (20 %), anxiety (48 %) and depression (25 %). Conclusions. Patients with AH and associated clinical conditions, in contrast to patients with risk factors and target organ damage, are likely to have normal characteristics of sleep, often have nocturnal and daytime symptoms of SAS and high risk for anxiety and depressive disorders.

Background. Nowadays, progress has occurred in mitral valve surgery; however, the frequency of performance of mitral valve prosthesis with preservation of subvalvular structures still yields to «standard» mitral valve prosthesis with removal of subvalvular structures. Design and methods. The results of checkup and treatment of 185 patients in whom mitral valve prosthesis was performed are presented. A comparative analysis of two different groups of patients was made: a group of patients with the preserved subvalvular structures (120 patients) and a group of patients with the removed subvalvular structures (65 patients). Results. Echocardiography showed a positive effect of preservation of the subvalvular structures in mitral valve prosthesis surgery, particularly in patients with the dilated left heart chambers, both at early postoperative and remote follow-up periods.