Objective. The paper presents the results of the blood pressure (BP) control by switching from unsuccessful monotherapy and combination therapy to fixed combination «perindopril/amlodipine» in the routine practice. Design and methods. PRORYV (BREAK) program included 589 outpatient general practitioners (GPs) and cardiologists from medical and preventive institutions in 50 Russian cities and 4 115 patients with uncontrolled hypertension (HT). PRORYV is an open, multicentered, observational non-comparative study. Inefficient anti-HT therapy (except for treatment with beta-blockers) was cancelled. Results. With fixed-dose combination therapy perindopril/amlodipine BP level lowered from 167,1/97,6 to 130/80,1 mm Hg (by 37,1/17,5 mm Hg) on average in all patients, and the effect was comparable in both males and females, regardless age, coronary artery disease or diabetes. Target BP was achieved in 80 % patients. Results. Switching to fixed-dose combination perindopril/amlodipine (Prestance, Servier, France) from mono- or combination therapy leads to fast and persistent anti-HT effect in all patients with previously uncontrolled BP.

Objective. To investigate the prevalence, clinical features and markers of resistant isolated systolic hypertension (ISH) in elderly patients. Design and methods. 261 patients with essential arterial hypertension (AH) and mean age of 73,2 ± 7,2 were included into the study. Resistant AH was diagnosed both by the office BP and ABPM criteria. We detected and compared the ABPM parameters, myocardial, vessels and renal damage signs in the resistant ISH group with those of resistant systolic-diastolic hypertension (SDH) and controlled AH groups. Factors reliably associated with resistant ISH development were revealed by logistic regression. Results and conclusion. The resistant ISH was detected by office BP in 11,8 % and by ABPM in 12,2 % of elderly patients. The resistant SDH was diagnosed in 13,6 and 5,4 % respectively. The «white-coat» effect was found in 30,4 %. In patients with resistant ISH the systolic BP variability, Sokolow-Lyon voltage index, left ventricular ejection fraction decrease occurrence and ambulatory arterial stiffness index were greater than in the compared groups. In comparison to controlled AH the aortic pulse wave velocity was higher while ankle-brachial index was lower. We found the markers of resistant ISH to be systolic BP variability, aortic pulse wave velocity and ambulatory arterial stiffness index.

Objective. To improve blood pressure (BP) control in subjects with uncontrolled arterial hypertension treated by monotherapy with high doses of ACE inhibitors (ACEi) or angiotensin II receptor antagonists (ARA) or with the combination of ACEi or ARA with another antihypertensive agent in moderate doses. Design and methods. Forty six non-diabetic hypertensive subjects with clinic BP > 150/90 mmHg on monotherapy and > 140/90 mmHg on combination therapy with daytime ambulatory BP > 135/85 mmHg were switched to fixed-dose combination of perindopril A 10 mg/indapamide 2,5 mg for 12 weeks. Clinic and ambulatory BP measurements and laboratory evaluations were performed. Results. At baseline 39 % subjects received combination therapy, clinic BP was 162,6 ± 4,2/98 ± 3,0 mmHg, 24-h BP 146,1 ± 8,2/88,3 ± 6,0, daytime BP 147,8 ± 8,8/90,2 ± 4,2 mmHg, night-time BP 131,7 ± 5,5/81,6 ± 4,8. After 12 weeks clinic BP was 131,5 ± 4,2/82,4 ± 5,4 mmHg, target BP < 140/90 mmHg was achieved in 89 %, masked uncontrolled hypertension (clinic BP < 140/90 mmHg and daytime ambulatory BP > 135/85 mmHg) was found in 7 %. Treatment with perindopril A 10 mg/indapamide 2,5 mg was associated with significant decrease in 24-h, day- and night-time ambulatory BP, daytime systolic BP variability and morning surge, improvement of night-peaker diurnal BP pattern. No hypotensive episodes with daytime BP < 90/60 mmHg, or night-time BP < 80/50 mmHg, neither significant changes in glomerular filtration rate, hypokaliemia (< 3,5 mmol/l or < 3,2 mmol/l) or hyperkaliemia >5,1 mmol/l were observed. Conclusion. In uncontrolled arterial hypertension change from monotherapy with nearly to high doses of ACEi or ARA or from combination of ACEI or ARA with another antihypertensive agent to fixed dose combination of perindopril A 10 mg/indapamide 2,5 mg results in a well-tolerated significant reduction in clinic and ambulatory BP with low rate of masked uncontrolled hypertension.

The review discusses the new data about primary aldosteronism and the connection between increase of aldosterone level and resistance to antihypertensive treatment, including patients with obstructive sleep apnea. Also the main pathophysiological mechanisms underlying the progression of end organ damage and leading to resistance to antihypertensive treatment in patients with high aldosterone level are presented.

Objective. To assess the prevalence of prehypertension and its association with cardiovascular risk factors in Kursk citizens. Design and methods. Cross-sectional study was carried out in one of Kursk outpatient departments during 2010, and 170 patients were screened. All subjects were interviewed with special questionnaire about personal data, lifestyle factors, concomitant medical history and therapy. Blood pressure (BP) was measured 3 times at right hand and anthropometrical parameters were assessed. Serum lipids and glucose were measured by Hitachi-902 equipment (Roche reagents). Metabolic syndrome (MS) was diagnosed according to ATP III criteria (2001–2005), IDF 2005 and harmonized criteria JIS 2009. Results. Comparing subjects with optimal BP, prehypertension and arterial hypertension we found that higher BP levels were associated with the higher prevalence of triglyceridemia and higher values of waist circumference, subjects with higher BP were also older. The number of smokers was twice higher among prehypertensive males than in females. Comparing groups of participants with optimal BP, prehypertension and hypertension we found that MS prevalence was higher in subjects with higher BP levels independently of the criteria applied: NCEP-ATP III, IDF, or JIS. The highest MS prevalence was identified when JIS criteria were applied. Males with optimal BP did not have MS. Females had higher MS prevalence independently of MS criteria, and the higher parameters were found in the group of hypertension. The positive statistical correlations were found between following parameters: systolic BP with age and waist (p = 0,001), diastolic BP with waist (p = 0,001). BP level correlated with triglycerides level in males. Conclusions. Our study showed high prevalence of prehypertension and its association with metabolic disturbances. The early diagnosis of prehypertension and cardiovascular risk factors correction should be performed. The prevalence in our population group was similar with world data, the gender and age particularities were detected.

Background. Risk factors of cardiovascular diseases play an important role in the cognitive dysfunction (CD) progression. Objective. To determine allelic variants frequencies caused by ACE I/D ( rs4646994 ) polymorphism as well as the SLC6A4 L/S ( rs4795541 ) and A/G ( rs25531 ) polymorphisms in patients with different intensity of metabolic syndrome and CD. Design and methods. Fifty five participants underwent anthropometric measurements, blood tests (glucose, lipids), molecular genetic analysis (polymerase chain reaction, restriction fragments length polymorphism) and neuropsychological tests. Results. Allelic variant D of ACE gene as well as allelic variants S and L_G of SLC6A4 gene are associated with metabolic syndrome progression. CD progression is associated with allelic variants S and L_G of SLC6A4 gene, but not with allelic variants of ACE gene.

Background. Ischemic postconditioning (IPostC) - a phenomenon of cerebral infarct volume reduction after a series of short ischemic stimuli in the early reperfusion period after prolonged ischemia. The mechanisms of IPostC remain poorly studied; in addition, the effects of combined application of pharmacological neuroprotection and IPostC are not investigated that precludes the translation of IPostC to the clinical practice. Objective. To assess the neuroprotective effect of IPostC and neuroprotective agent citicoline, and the effect of their combined application in the experimental model of global cerebral ischemia-reperfusion. Materials and methods. Transient global cerebral ischemia was induced by bilateral occlusion of the common carotid arteries in Mongolian gerbils for 7 minutes. IPostC was induced by three 15-s episodes of reperfusion/reocclusion. Citicoline was administered intraperitoneally at a dose of 500 mg/kg 2 min after the start of ischemia. In a separate series of experiments, the combined application of IPostC and citicoline was used. The number of viable neurons in the CA1 hippocampus was used as an and-point of neuroprotection. Results. In the experimental groups using IPostC, citicoline administration at a dose of 500 mg/kg, as well as their combined use a significant (p < 0,05) increase in the number of viable pyramidal neurons in the CA1 hippocampus was observed when compared with control group. The combined use of citicoline and IPostC did not provide an additional increase in the number of viable neurons. Conclusions. The combined use of citicoline and IPostC resulted in the expression of a significant neuroprotective phenotype, but its magnitude was not different from that in the groups of isolated citicoline and IPostC use.

Objective. To verify latent forms of coronary artery disease (CAD) in young hypertensive patients with psycho-vegetative disorders working at chemically hazardous industries. Design and methods. The study included 105 patients with concomitant cardiovascular disease, stratified into 3 groups (n = 35). Mean age was 35-45 years in groups 1 and 2, and 45-55 years – in group 3. In the second group, all surveyed worked at chemical hazardous industries. All patients underwent 24-hour monitoring of blood pressure and electrocardiogram, and ECG synchronized perfusion SPECT myocardial at rest and at pharmacological load test. The load included sodium adenosine triphosphate (ATP). Results. There were signs of hypertension progression, and a reduction in myocardial perfusion in the second group compared to the control group (group 1). Conclusions. Thus, we confirmed the opportunity to verify latent forms of CAD in young hypertensive subjects with psycho-vegetative disorders working at chemically hazardous industries with SPECT myocardial adenosine stress, and we found that latent forms of CAD manifest by an average of 5-7 years earlier in this group compared to the age-matched controls without occupational exposures.

Objective. Open, comparative, randomized study of efficiency, safety and assessment of influence of paroxetine and hydroxyzine hydrochloride therapy on platelet serotonin level in patients with coronary artery disease (CAD) and comorbid anxiety-depressive disorders were examined. Design and methods. We included 40 patients with chronic CAD and comorbid anxiety-depressive disorders, confirmed according to ICD-10. Patients with score more than 18 by Hamilton’s scale of anxiety and depression were enrolled. Results. We observed significant decrease Hamilton’s scale scores after 4 weeks of treatment, and after 8 weeks of treatment the reduction reached 50 %. Side effects were registered in both groups and quickly passed after the drug withdrawal. Platelet serotonin level decreased significant during paroxetine therapy. Conclusion. Treatment by paroxetine and hydroxyzine hydrochloride was associated with high anti-anxiety and anti-depressive activity. Use of paroxetine was associated with significant reduction of platelet serotonin level.

Objective. To assess autonomic regulation in hypertensive patients with and without obstructive sleep apnea syndrome and in relation to the severity of sleep-disordered breathing. Design and methods. We included 107 subjects, mean age 53,0 ± 8,4 years, 85 males and 22 females. The main group included 77 hypertensive patients who were divided into 2 groups based on the results of sleep study: 37 patients with obstructive sleep apnea syndrome and 40 subjects without sleep=breathing disorders. Control group included 30 normotensive subjects without sleep apnea. All patients underwent clinical examination, 24-hour blood pressure monitoring (SpaceLabs 90207, USA), cardiorespiratory study (Embletta Pds, MedCare Flaga, Iceland), assessment of autonomic regulation of blood circulation by Finometer (FMS, Amsterdam) and vasomotor reactivity by occlusion plethysmography according to Dohn. Results. Sleep apnea patients and hypertensives without sleep-breathing disorders had lower autonomic baroreflex than controls (5,6 ± 2,8; 6,7 ± 1,6 and 9,8 ± 2,4 ms/mmHg, p < 0,005 and p < 0,01, respectively). Subjects with more severe sleep apnea demonstrated lower parameters of spontaneous arterial baroreflex. Valsalva index was reduced in sleep apnea patients (1,45 ± 0,22) compared to hypertensive patients without sleep-breathing disorders (1,71 ± 0,31, p < 0,01) and controls (1,72 ± 0,25, p < 0,01). Forearm cutaneous-muscular blood flow velocity was decreased in patients with obstructive sleep apnea syndrome (3,7 ± 1,7 ml/min×100 cm²) compared to controls (5,8 ± 2,2 ml/min×100 cm², p < 0,05) and subjects without sleep apnea (6,5 ± 2,6 ml/min×100 cm², p < 0,01). Conclusions. Lower control of arterial hypertension in hypertensive patients with sleep apnea is associated with the impairment of baroreflex and non-specific cardiochronotropic heart regulation, increased tone of resistant vessels and non-soecific vasomotor reactivity.

Background. At the present time there are no objective methods that enable definition of the mechanisms of blood pressure elevation in a particular patient. Objective. Based on the results of blood pressure and heart rate measures to find new additional features that could help a differentiated management approach. Design and methods. Literature analysis, model formation and analysis, statistical analysis were performed. Results. The new criteria based on the measurements of blood pressure and heart rate are offered. A new way of reporting the results of blood pressure measurements, and a new computer program for analyses observations with the probability characteristics are offered. Conclusions. The present result can be used for the assessment of blood pressure dynamics, and for check-up of the working hypotheses.