Arterial hypertension (HTN) is associated with significant changes in the structure of cerebral vessels. There is a close relationship between the functional activity of neurons and the intensity of their blood supply. Vascular dementia is a heterogeneous group of diseases resulting from the pathology of neurons, glia and vessels. Cognitive disorders are the most typical manifestations of brain pathology in vascular dementia and include memory impairment, decreased learning ability, lack of personal opinion, violation of emotional control and social behavior. The article overviews the data on the organization of cerebral circulation and the mechanisms of its changes in HTN. The article analyzes the causes leading to brain hypoperfusion in elevated blood pressure. The authors discuss the mechanisms resulting in cognitive disorders in hypertensive subjects. We also address the question arising in relation of HTN and cognitive impairments: “To which extent blood pressure should be lowered in hypertensive patients with cognitive decline?”.

Acute stroke-induced damage of endothelial cells leads to impaired cerebral microcirculation and significant damage of the brain tissue. Despite recent advances in treatment approaches that improve survival after a stroke, diagnostic approaches aimed at early identification of the pathogenetic stroke subtype remain limited. MicroRNAs are promising biomarkers in stroke. The article reviews data on the relationship of stroke with changes in the levels of certain circulating microRNAs and the opportunities for their diagnostic use.

Nowadays, the risk factors, improvement of diagnosis and treatment of cardiovascular diseases are of particular interest. Arterial hypertension (HTN) is known to contribute to cardiovascular disease and to be a risk factor for cerebrovascular diseases. HTN during pregnancy and in the postpartum period draws particular attention. Throughout the world, hypertension during pregnancy remains the leading cause of maternal and child morbidity and mortality. To our knowledge, only a few works studied neurological disorders associated with HTN in pregnant women. In this connection, the purpose of our review was to analyze the role of HTN in the development of cerebrovascular diseases in pregnancy. Pregnant women with HTN show 5,2-fold higher frequency of strokes than normotensive women. The risk of stroke increases from the third trimester of pregnancy to six weeks of the postpartum period. The pregnant women with HTN develop changes in the coagulation system leading to the formation of arterial and venous thromboses in the cerebrovascular circulation. The presence of preeclampsia (PE) is associated with the 7–9-fold increase in the risk of stroke. Endothelial dysfunction is one of the leading links in the pathogenesis of PE. The PE is associated with an increase in anti-angiogenic factors and a decrease in angiogenic factors. Thus, the measures preventing the development of cerebrovascular diseases in pregnant women with HTN, include identification of prehypertension in women of childbearing age, the improvement of HTB management strategies, and an interdisciplinary approach to the diagnostic and treatment process involving the obstetrician, the therapist, the cardiologist and the neurologist.

Objective. Understanding of nerve and ganglia distribution in human renal arteries is essential in effective transcatheter denervation procedures. The purpose of the study was histological characterization of nerves and ganglia in human renal artery. Design and methods. Histological study included 29 proximal renal artery sections obtained from 20 patients with different cardiovascular diseases. Results. We identified 1203 nervous elements, of them fibers — 1148, ganglia — 55 (4 %). The range of distances from intima to nerves was 0,3–8,8 mm [1,4 (1,0; 1,9) mm]; the range of distances from intima to ganglia was 0,6–4,5 mm [2,2 (1,4; 2,7) mm]. The majority among nerve elements (93 %) were located at a depth of 3 mm from artery lumen. Conclusions. The majority of nervous elements of renal arteries is located within 3 mm deep from artery lumen.

objective. To study the impact of complex treatment (acetylsalicylic acid, hirudotherapy, phytotherapy) on the functional activity of thrombocytes in patients with hypertensive encephalopathy. design and methods. An open prospective study included 25 patients with hypertensive encephalopathy and dysfunction of thrombocytes activity. All patients took acetylsalicylic acid. A simultaneous course of hirudotherapy (10 sessions, 2,5 months; own patent of the Russian Federation № 2327494) and a course of phytotherapy (polycomponent infusion, for 2,5 months; own patent of the Russian Federation № 2542423) were conducted. Functional activity of thrombocytes was studied by the phase contrast microscope at baseline and after the treatment was completed. Results. Initially, 25 patients with hypertensive encephalopathy showed abnormal platelet functional activity in the presence of acetylsalicylic acid: a decrease in the number of intact platelets — discocytes in 9 patients; increased number of activated cells with discoquinocyte sprouts on the surface — in 18 people; active forms in 17 patients; platelet aggregates — in 15 patients; increased number of small aggregates per 100 free thrombocytes — 13 patients; large aggregates — in 2 patients. After hirudotherapy and herbal medicine were applied in addition to acetylsalicylic acid, complete normalization of platelet functional activity was achieved in 11 of 25 patients, and partial normalization — in 12 subjects. conclusions. The complex approach, including both drug treatment (acetylsalicylic acid) and the course of hirudotherapy and phytotherapy showed a positive impact on the intravascular platelet activity in patients with hypertensive encephalopathy and initial disturbances of the platelet functional activity. As a result, the number of intact forms of platelets increased, the number of early and late active forms (discoquinocytes, spheroechinocytes and bipolar cells) decreased. Also the number of platelet aggregates and small aggregates reduced. Such a multimodal approach can be implemented in aspirin resistance, a high risk of primary and recurrent vascular events. The method is safe and well tolerated by patients. 

Objective. To analyze the changes in the structural and functional characteristics of the heart, clinical severity of heart failure (HF) and the levels of N-terminal fragment of the brain natriuretic peptide (NT-proBNP) in patients with arterial hypertension (HTN) and various forms of the thyroid dysfunction (TD). Design and methods. The total of 101 HTN patients were included in the study: 40 with hypothyroidism; 39 — with hyperthyroidism, 22 — without any TD. Control group consisted of 20 persons without any cardiovascular pathology and TD. Basic structural and functional parameters of the heart, serum levels of NT-proBNP were studied. Results. In patients with TD, HF was revealed significantly more often than in the group of AH without TD. There with patients with hypothyroidism had higher, HF functional class compared to the group of hyperthyroidism. In the group of HTN with hypothyroidism left ventricular (LV) hypertrophy and decrease of E/A ratio were observed, whereas patients with HTN and hyperthyroidism were characterized by LV dilatation and by a significant increase of serum NTproBNP level. Conclusions. In HTN patients with hyperthyroidism cardiac remodeling is characterized by the prevalence of LV dilatation, whereas in hypothyroidism LV hypertrophy with LV diastolic dysfunction dominate. Hyperthyroidism is also associated with increased NT-proBNP serum levels.

Objective. To determine the role of elevated blood pressure (BP) as a risk factor in the formation of subclinical atherosclerosis of carotid arteries (CA) in males in the Northern watch. Design and methods. We divided 424 males into 2 groups: group 1 included 294 people with arterial hypertension (HTN) of I, II stages and group 2 which consisted of 130 normotensive people. They were examined at the branch “Health Service” LLC “Gazprom Вobycha Yamburg” (Yamburg settlement, 68°N). Control group consisted of 144 Tyumen males with HTN of I, II stages (group 3) (Tyumen settlement, 57°N). The groups matched by age (49,6 ± 6,9 years), duration of living in the North (16,5 ± 6,8 years) in groups 1 and 2, the length of watch service (11,2 ± 3,8 years), office BP in groups 1 and 3. Patients had undergone ultrasound examination of carotid arteries (CA), echocardiography, 24-hour BP monitoring, lipids assessment. Results. Showing equal office BP the northern group of patients (group 1) demonstrated high atherogenic lipid fractions (р = 0,0001), lower high-density lipoprotein cholesterol (HDL–C) (р = 0,0001), increased atherogenicity index (р = 0,0001) in comparison with group 3. HTN patients showed higher plasma levels of total cholesterol, low-density lipoprotein cholesterol (LDL–C) and lower HDL–C than in healthy patients. In group 3 atherosclerotic plaques (AP) in common CA were registered in 7,8 % HTN patients and in 56,1 % northern HTN patients (р = 0,0001); intima-media complex was 0,93 ± 0,34 mm which was higher than in HTN patients of group 3 (р = 0,0113). In the northern normotensive patients AP in CA were determined in 25 % cases despite more rare dyslipidemia in the group 1. Patients and normotensive people in the Northern watch showed greater frequency of the main risk factors, low physical activity (p = 0,0001), higher body mass index (p = 0,0002) and smoking rate (p = 0,0001) in comparison with the control group. Conclusions. There is a need for further investigation of atherosclerosis in the northern regions. High frequency of the main risk factors, dyslipidemia, increased BP and coronary artery disease draw close attention in order to preserve health of able to work population in the Far North.

Objective. To study the quality of life and workability in men with arterial hypertension (HTN) and chronic venous disease (CVenD) of the lower limbs. Design and methods. We examined 60 men with HTN (systolic blood pressure 148 (144–155) mmHg, diastolic blood pressure 101 (92–108) mmHg) aged 30–50 years old. We compared the frequency of decreased work efficiency (CEAP scale) and quality of life (questionnaire CIVIQ-2) in 42 men with CVenD and 18 men without CVenD. Symptoms of CVenD were diagnosed by examination and palpation of the lower limbs according to the CEAP criteria. Results. HTN patients with CVenD show lower quality of life compared to men with HTN without CVenD (χ 2 = 50,6; p = 0,0001). The quality of life is reduced due to the leg pain, which cause disturbances both during the daytime and at night during sleep. Pain is the leading factor that causes movement difficulties in the morning in men with HTN and CVenD (p = 0,034). The work efficiency is more frequently decreased in men with HTN and CVenD (71 %) compared to the control group (0 %; p = 0,001). Conclusions. The co-existence of HTN and CVenD in men 30–50 years is associated with the reduction of the quality of life and the work efficiency. The leading causes of the decline are leg pain and difficulty in moving in the morning.

Objective. Recent studies showed that statin therapy in patients with cardiovascular diseases (CVD) could increase serum 25(OH)D level. However, data remain unclear. the aim of the study was to assess serum 25(OH)D level in patients with abdominal obesity and dyslipidemia before and after atorvastatin therapy. Design and methods. We included 66 women, aged 41 to 57 years, with abdominal obesity and dyslipidemia. The group 1 included 45 women with more than two CVD risk factors and received atorvastatin treatment, and the group 2 (control group) included 21 women. All patients underwent anthropometric measurements (body weight, height, body mass index, waist and hip circumferences), laboratory (serum lipid profile, fasting plasma glucose, C-reactive protein, alaninaminotransferase and aspartataminotransferase, creatine-phosphokinase levels) and instrumental methods (diastolic and systolic blood pressure) at baseline and after six months. Results. Our study showed vitamin D deficiency in 62,1 % participants. Atorvastatin therapy was associated with the decrease in atherogenic lipoproteins and increase in serum 25(OH)D level by 6,0 ng/ml (40,3 %). We did not find correlations between increase in 25(OH)D level with a decrease in total cholesterol, low-density lipoproteins and triglycerides (p > 0,05). Conclusions. Our study shows that 6-month therapy with atorvastatin (40 mg per day) associated with the decrease in atherogenic lipoprotein levels and increase in serum 25(OH)D concentration.

Objective. The aim of the study was to investigate the anthropometric correlates of left ventricular (LV) structural changes in school-age children (10–17 years old) with overweight and obesity in comparison with children of similar age with normal body weight living in St Petersburg. Design and methods. In the study, according to inclusion criteria, 112 children of 10–17 years old (71 boys) were included, the average age was 14,0 ± 2,1 years. Three groups were identified: 60 (54 %) children (41 boys) with obesity, 26 (23 %) children (16 boys) with overweight and 26 (23 %) children (14 boys) in the control group. All children underwent anthropometry (height and weight, head, chest, waist, thighs, wrist, shoulder, shin and hip circumference, lower segment length, umbilical point, leg length, head height) with calculation of body mass index (BMI), overweight percent, waistto-hip ratio and waist-to-height ratio. Echocardiography was performed according to a standard procedure with calculation of LV mass (LVM), LV mass index (LVMI). On the percentile tables grades of LVM and LVMI were allocated. The relative wall thickness was calculated, and the LV geometry phenotypes were determined. Results. Echocardiography LV dimensions (posterior wall thickness, interventricular septal thickness, diastolic and systolic LV diameter), as well as LVM and LVMI were higher in obese children compared to control group children. LV hypertrophy (LVH) developed in 42,3 % overweight children and in 58,3 % obese children. Normal LV geometry was found in 73,1 % children with normal body weight, concentric remodeling — in 19,2 % cases, and 7,7 % children had eccentric LVH. In the overweight children group, normal LV geometry was determined in 34,5 %, concentric remodeling — in 7,7 %, concentric LVH — in 19,2 %, and eccentric LVH — in 38,6 %. In obese children, the distribution of various types of LV remodeling was as follows: 23,3 % / 3,3 % / 15 % / 58,4 %, respectively. We found a stronger correlation between LVM and body surface area, thigh circumference and shoulder circumference, and LVMI with BMI, overweight percent, shoulder circumference and lower segment length. The waist circumference is less associated with LVH in children. Conclusions. Since childhood, overweight and obesity are risk factors for LVH and the development of various LV geometry phenotypes. Anthropometric markers of myocardial remodeling is an affordable way of early cardiovascular risk stratification in overweight and obese children.

Objective. To evaluate the antihypertensive efficacy and safety of a fixed combination of amlodipine/indapamideretard in patients with uncomplicated uncontrolled arterial hypertension (HTN) in the older age group. Design and methods. We included 40 patients (average age — 62 years, men — 20 %, mean HTN duration — 9 years) with uncomplicated uncontrolled HTN in an open, single-center study. Fixed-combination therapy with amlodipine/indapamide-retard (5/1,5 mg) once a day for 4 weeks were prescribed. After 4 weeks, in patients who did not reach the target blood pressure (BP), the dose increased from 5/1,5 to 10/1,5 mg. The follow-up period was 12 weeks. Results. The initial systolic BP (SBP) was 165 [148; 171] mm Hg, diastolic BP (DBP) — 96 [80; 102] mm Hg. After a 12-week therapy with a fixed combination of amlodipine/indapamide-retard, SBP decreased by 31 mm Hg, DBP — by 17 mm Hg. Target clinical BP (< 140/90 mm Hg in patients without diabetes mellitus (DM), < 140/85 mm Hg in patients with diabetes mellitus) was achieved in 93 % patients. Central SBP measured by applanation tonometry decreased by 16 mm Hg, DBP — 10 mmHg, pulse pressure — 6 mmHg. Prior to treatment, the median of carotid-femoral pulse wave velocity (cfPWV) was 11,1 [7,8; 14,5] m/sec. After 12 weeks there was a decrease in cfPWV to 8,9 [6,7; 12,6] m/sec (p < 0,05 in comparison with the baseline). Conclusions. Fixed combination of amlodipine/thiazide-like diuretic in patients with uncomplicated uncontrolled 1–2 degree HTN has a high antihypertensive efficacy, allowing achievement of target BP in 93 % patients after 12-week therapy, with a satisfactory safety profile and metabolic neutrality. We showed the ability of a combination of amlodipine/indapamide-retard to reduce central SBP, pulse pressure in the aorta, and cfPWV.

Objective. To investigate the effects of various necroptosis inhibitors on the morphological and functional characteristics of the myocardium in the model of prolonged cold preservation of the donor rat heart. Design and methods. Thirty eight Wistar rats were divided into the following groups: 1) control (n = 7), 2) dimethylsulfoxide (DMSO) (n = 7), 3) necrostatin-1s (n = 6), 4) necrosulfonamide (n = 6), 5) necrostatin-5 (n = 6), 6) necrostatin-1 (n = 6). Necroptosis inhibitors were administered by intraperitoneal injection 1 hour prior to the start of the experiment, previously dissolved in DMSO. HTK solution cooled to 4 °C was used as a preservative solution. The functional state of the myocardium was assessed by continuous recording of intraventricular pressure, heart rate and coronary flow velocity. Morphological changes in the myocardium were assessed by the size of myocardial necrosis, measured planimetrically after the end of 8-hour ischemia and 2-hour reperfusion. Results. All investigated necroptosis inhibitors significantly improved the morphological and functional state of the myocardium, which manifested itself in a significantly smaller amount of myocardial necrosis in the groups of necroptotic inhibitors in comparison with control groups and DMSO. Thus, in the groups of necrosulfonamide and necrostatin-1s, myocardial necrosis size was 31 ± 8,7 % and 27 ± 8,2 %, respectively; in necrostatin-5 and necrostatin-1 groups — 37 ± 9,2 % and 34 ± 7,8, respectively, which is lower than in control groups and DMSO (58 ± 8,6 % and 60 ± 7,6 %, respectively, p < 0,05). Also, diastolic intraventricular pressure was lower and pulse intraventricular pressure and coronary flow velocity were higher during the reperfusion period in the groups of necroptosis inhibitors compared to control group and DMSO group (p < 0,05). We did not find any significant differences between necroptosis inhibitors regarding cardioprotective activity in the model of prolonged cold preservation of the donor heart. Conclusions. All inhibitors of necroptosis equally improved the morphological and functional state of the myocardium in the model of prolonged static cold storage of the donor heart.