Cognitive impairment is a global medical and social problem. Alzheimer’s disease (AD) is the most common disease leading to the development of cognitive impairment and dementia. Arterial hypertension (HTN) is considered to be the strongest risk factor for the development of both vascular dementia and AD. Recent studies have demonstrated the importance of the glymphatic system in removing β-amyloid from the brain through the perivascular Virchow–Robin spaces. The interest is that the adequate functioning of the glymphatic system mainly depends on the level of blood pressure during the day and the quality of sleep. In this article, we will consider the main mechanisms of the HTN influence on the glymphatic system, brain substance-related damage and the development of cognitive impairment.

The paper summarizes data on the use of respiratory training under hypoxia, features of permissive hypercapnia, and the potential mechanisms of neuroprotective effect in the combined use of hypoxia and hypercapnia. The paper provides information about the practical application of this training in various diseases. The technical aspects, the possibility of using individual respiratory simulators, the optimal parameters of exposure and the composition of the gas are discussed. Considering the expected effectiveness we assume that this type of respiratory training can be used in the routine medical rehabilitation practice post-stroke survivors.

The review describes the major mechanisms for the initiation and maintenance of comorbid insomnia and arterial hypertension based on the relevant pathogenetic scenarios of insomnia such as the concept of sympathetic activation, the neurobiological model of insomnia, and stress-diathesis model (or 3-P model). The clinical data are lacking, and available clinical studies indicate the association between blood pressure levels and the hyperactivation of the central nervous system during sleep, characterized by electroencephalographic β-activity, and with sleep latency. However, biologically active substances involved in “neurogenic inflammation” also play a significant role in homeostasis maintenance following the exposure to endogenous and exogenous stress factors. The functions of interleukin-6, gamma-aminobutyric acid, substance P, melatonin, serotonin and orexin in normal and pathological conditions indicate their contribution to the development of comorbid insomnia and hypertension. We emphasize the role of insomnia as a separate nosological unit, comorbid with hypertension, as well as the importance of research of molecular mechanisms underlying the association between insomnia and arterial hypertension aimed at identification of therapeutic targets and prognostic markers.

Background. Vasovagal syncopes (VVS) are relatively often recorded in the population of young people. Objective. To establish the changes in the baroreflex function during the tilt test in healthy young males with the history of VVS. Design and methods. A total of 102 people aged 18–30 years were examined and divided into 4 groups, taking into account the specific features of fainting history and response to the tilt test. Subjects of the group 1 (n = 14) had a history of VVS and a positive response to the tilt test (syncope). Subjects of the group 2 (n = 14) had a history of VVS and a pattern of postural tachycardia without fainting verified during the tilt test. Subjects of the group 3 (n = 42) had a history of VVS and a negative response to the tilt test. Subjects of the group 4 (n = 32) did not have a history of VVS and showed a negative response to the tilt test. During the tilt test, we studied the dynamics of the baroreflex functional parameters (the number of baroreflex reactions (NBR), the baroreflex effectiveness index (BEI), the baroreflex sensitivity (BRS)). Results. In the individuals of each group, in the initial horizontal phase, values of NBR, BEI, BRS were within normal range and did not show significant intergroup differences (p > 0,05). The passive orthostasis was associated with the increase in NBR (in each group beside control group), a decrease in BEI and BRS. The increase in NBR in the vertical phase of the tilt test (relative to the initial horizontal phase) was 87 %, 6 %, 16 % in the groups 1, 2, 3 and 4, respectively. The tilt-induced decrease in NBR comprised 8 % in the group 4. The decrease in the BEI in the vertical phase of the tilt test (relative to the initial horizontal phase) consisted: 22 %, 19 %, 12 %, 10 % in subjects of the 1, 2, 3, 4 groups, respectively. During the passive orthostasis we observed a decrease in BRS: by 65 %, 69 %, 64 %, 57 % in individuals of the groups 1, 2, 3 and 4, respectively. Returning from a vertical to a horizontal position in all groups led to a pronounced decrease in NBR and an increase in the BEI to values lower than in baseline horizontal tilt test phase; to an excessive increase in the BRS exceeding the pre-test values in each study group. Conclusions. In prolonged passive orthostasis, healthy young males, regardless of the fainting history, demonstrate a decrease in the baroreflex regulation. Among those with the history of VVS, tilt-positive subjects are characterized by a more pronounced orthostasis-induced drop in the baroreflex sensitivity and the baroreflex effectiveness index and a slow recovery of the baroreflex regulatory function compared to the tilt-negative subjects and to those who demonstrated postural tachycardia pattern without syncope.

Objective. The article presents the survey data of 80 patients in the acute period of cerebral stroke who were treated in the department of the primary vascular center. Design and methods. Upon recommendations of the motor activity, the patients with acute stroke were screened for the presence of neglect. The choice of motor activity was based on the Performance Oriented Mobility Assessment test in the modification of M. Tinetti (1986) and the results of functional stress tests. Results. There were no complications or falls at the hospital when adequate vegetative support and a high score at Performance Oriented Mobility Assessment in the modification of M. Tinetti (1986) were present, as well as in the absence of visual-spatial inability. The patients with the significant visual-spatial neglect showed higher risk of falls, even with adequate vegetative support and postural stability. Results. We demonstrated the possibility, as well as the prognostic value of the Performance Oriented Mobility Assessment in the modification of M. Tinetti (1986) and functional stress tests along with the assessment of visual-spatial neglect in planning the early motor rehabilitation of patients with cerebral stroke. In addition, we developed an algorithm for the motor rehabilitation planning.

The aim of the study is to assess the relation between hemodynamic parameters and coping behavior and sleep in order to maintain health of students of the northern university. Design and methods. We examined 96 students of the northern medical university (61 females). During academic days, we performed ambulatory monitoring of blood pressure (ABPM) 24 h + 10–120 minutes. We analyzed following parameters: mezors of heart rate (HR), systolic (SBP), diastolic (DBP), and pulse blood pressure (BP), mean BP, Kerdo autonomic index (KI), functional change index (FCI); hypertension time indices of SBP (TI SBP) and DBD (TI DBP) (%), variability of SBP (Var. SBD) and DBD (Var. DBP); night dipping of SBP and DBP (%). We assessed coping behavior. The sleep was assessed using the subjective characteristics of sleep questionnaire and the Epworth sleepiness scale. Statistical analysis was performed using Statistica 10.0 and Excel 2013 software. Results. We found optimal/normal values of mean BP and intersexual differences among students. Female students in all periods showed higher rates of HR and sympathetic influences; males had higher SBD, higher TI SBP during day and night, higher SBP variability at night, and tended to develop isolated systolic hypertension. Parameters and dynamics of the vascular component of BP are in normal ranges. We did not find significant intersexual differences in mechanisms of the vascular regulation. Cardiovascular system regulation in males depended on the sleep and coping, and it was more autonomous from behavior in girls. Conclusions. One of the most effective and affordable ways to prevent cardiovascular diseases during the university education is the consistent training of students in adaptive behavior in a situation of psycho-emotional stress and recommendations on sleep hygiene. Greater efficiency of the learning adaptive coping behavior can be expected in males, and male gender is one of the non-modifiable risk factors for cardiovascular pathology.

Background and objective. Currently, the role of miRNA‑21 in the development of heart and kidney damage and their interaction remains unclear. Therefore, the aim of this work is to assess the impact of changes in the expression of microRNA‑21 in myocardial tissue in the development of cardiac remodeling with chronic reduction in the mass of active nephrons in the experiment. Design and methods. Wistar drain rats were divided into two groups. The first (control) group included nine falsely operated animals. The second (n = 9) group included rats with step-by-step resection of 5/6 renal tissue. After 4 months after surgery, blood pressure (BP) was measured, heart ultrasound (echocardiography, EchoCG) was performed and the level of relative expression of microRNA‑21 in myocardial tissue was determined. Results. The rats with an experimental decrease in the mass of functioning nephrons, showed significantly higher levels of BP, microRNA‑21 expression in the myocardium and the thickness of the interventricular septum (according to EchoCG). They also demonstrated smaller end-systolic dimension of the left ventricle and systolic motion of the mitral valve ring. Conclusions. Our data indicate the potential role of miRNA‑21 in the development of concentric left ventricular remodeling while reducing the number of functioning nephrons. This remodeling is characterized by the prevalence of myocardial hypertrophy over fibrosis. However, the specific mechanisms linking microRNA in the pathogenesis of heart remodeling require further research.

Background. Hypertension (HTN) is often combined with other diseases, that significantly complicate its course, worsen the prognosis, interfere with the therapeutic and preventive measures. Therefore, assessing the development and structure of polymorbidity (PM) in hypertension is a relevant issue. Objective. To study the structure and degree of PM in hypertensive patients depending on age and gender. Design and methods. We conducted an analysis of 20 560 case histories of patients with HTN and without HTN (men and women), inhabitants of West Siberia-Novosibirsk region, who underwent examination and treatment at the clinic of the Federal Research Center of Fundamental and Translational Medicine in Novosibirsk. All identified diagnoses (nosological forms and classes according to the International Classification of Diseases of the 10th revision, ICD‑10) were considered. Transnosological PM was assessed by the average number of nosologies corresponding to the three-digit ICD‑10 rubric. Results. An increase in the PM index by 16,8 % was found in HTN patients compared to patients without HTN. Among HTN patients, there was an increase in the incidence of comorbid diseases of the circulatory system (in the 16–39 age group in men — by 46 %, in women — by 42,8 %), the endocrine system, eating disorders and metabolism (in the age group 16–39 years for men — by 19,3 %, for women — by 45,2 %), the musculoskeletal system, urinary system (for men) and neoplasms (for women) compared with patients without HTN. Conclusions. We found a high rate of transnosological PM in HTN patients was found and defined its structure.