The paradigm of the parathyroid hypertensive factor (PHF) and its role in the development of systemic hypertension (HTN) in relation to dietary calcium deficiency was analyzed on the basis of available epidemiological, clinical and physiological data. Modern conceptions of molecular and cellular mechanisms of HTN were considered. Molecular-genetic mechanisms of HTN in humans and in animals are similar. The PHF presence was found in blood plasma in hypertensive patients, as well as in blood of spontaneously hypertensive rats (SHR) kept on low calcium diet. The experimental results show that under the conditions of low Ca2+ intake the blood pressure increases only six weeks after birth preceded by the elevation of Са2+ level in vascular smooth muscle cells and cardiomyocytes, as well as metabolic changes in neuroregulatory proteins in the central nervous system. The NAP-22 fraction of neurospecific brain peptides appears to be an informative biomarker of calcium dependent HTN. With the use of polymerase chain reaction with reverse transcription (considering the presence of PHF in human blood), a reliable method is proposed to identify the genes encoding PHF-dependent HTN. This method would help to detect the proneness to the disease, and will enable and early primary HTN prevention in certain population groups.

Article presents the latest data on the role of the immune, endocrine and sympathetic nervous system in the pathogenesis of hypertension. The authors pay attention to the interaction of regulatory systems in the mechanisms of disease development and stabilization.

Metabolic syndrome (MS) is one of the most significant problems of modern society. Rapidly growing prevalence of MS results in high morbidity and mortality due to its vascular complications. Experimental studies can help us to understand the underlying mechanisms of MS development and progression, as well as to develop potential therapeutic interventions. MS represents a multifactorial complex of pathological changes and the selection of an appropriate experimental model is crucial in investigation of this condition. In this review, we will discuss the most common genetic animal models of MS, along with the models in which MS is caused by exogenous factors.

Obesity is one of the most important public health challenges of the XXI century. Currently, the adipose tissue is considered as an active endocrine organ producing hormones — adipokines. Adipokines are the regulators of insulin sensitivity, oxidative stress, energy metabolism, coagulation and inflammatory reactions. That’s why adipokines may be retailers of mechanism of negative actions of obesity on the cardiovascular system. The study of their pathophysiological role will unveil the potential of adipokines as a therapeutic target in the treatment of obesity and associated conditions. 

The article reviews the relationship between the quality and duration of sleep and cardiovascular diseases (CVD). Chronic sleep deprivation and sleep disorders are common in modern society, however, many people underestimate their effects on health. Experimental data, population-based epidemiologic and interventional studies have shown that both short and long sleep duration are associated with CVD and their major risk factors. Thus, sleep duration could be considered an additional modified risk factor. Social factors, irregular sleep-wake cycle, some somatic and mental diseases, and sleep disorders themselves may decrease quality and duration of sleep. Normal sleep is a complex and dynamic process that significantly affects homeostasis of the cardiovascular system. The main pathophysiological mechanisms involved in CVD development and progression in subjects with the insufficient sleep considered to be the following: increased activity of the sympathetic nervous system, blunted circadian rhythm of blood pressure, impaired lipid metabolism, glucose intolerance and changes in the secretion of hormones that affect appetite. Thus, the novel goals of the cardiovascular prevention should include timely diagnosis and treatment of sleep disorders and sufficient sleep quality and duration.

Review of the literature shows modern approaches to prescription of oral anticoagulants in patients with atrial fibrillation in the development of acute coronary syndrome. This clinical situation requires a comb of two antiplatelet drugs in combination with an anticoagulant, dramatically increasing the risk of bleeding. In accordance with the accumulated scientific data and international guidelines the basic approaches to the treatment of patients at different stages of the disease are generalized.

The review assesses the current guidelines of hypertension treatment in different age groups and pathophysiology of hypertension according to age. Specific questions concerning prevention of cognitive decline in the elderly are also discussed as well as target blood pressure levels and side effects of the drugs.

The article reviews the main approaches to the hypertension management in metabolic disorders, including diabetes, dyslipidemia, hyperuricemia and gout, as well as in sleep apnea. The data are based on the guidelines by the Joint National Committee of theUSA, European Society of Cardiology/European Society of Hypertension, American Society of Hypertension/International Society of Hypertension, considering the important issues mentioned in national guidelines by Russian Society of Cardiology.

Background. Cardiovascular diseases, in particular coronary heart disease (CHD) associated with hypertension, are an important medical and social problem.

Objective. To study the effects of hypertension on primary disability in patients with CHD after percutaneous coronary intervention — coronary angioplasty and stenting.

Design and methods. The study was conducted in the office of medical and social examination (St Petersburg). The main group consisted of 65 hypertensive (III grade) patients with CHD after coronary stenting. The comparison group included 49 patients with CHD without known hypertension.

Results. There was a higher occurrence of left ventricular hypertrophy (LVH) (92,3 and 69,4 %, p < 0,01), more severe impairment of LV systolic function (ejection fraction — 56,3 ± 1,1 and 48,1 ± 1,0 %, p < 0,001), lower tolerance to physical load, more severe chronic heart failure in hypertensive patients with CHD compared to non-hypertensive subjects. Evaluation of clinical outcomes of coronary stenting showed higher re-occurrence rate of CHD symptoms in hypertensive patients than in the comparison group (27,7 and 12,2 % respectively, p < 0,05). The rate of disability was higher in hypertensive patients with CHD compared to subjects with normal blood pressure.

Conclusion. Hypertensive patients with CHD and high blood pressure have poorer outcomes of percutaneous coronary intervention procedures, higher rate of disability and require more rehabilitation procedures.

Objective. The aim of the research was to study the influence of diet with different contents of NaCl on

the level of arterial blood pressure (BP), processes of myocardial remodeling in response to changes in nuclear transcription factor кB (NFкB) expression in the myocardium in rats.

 Design and methods. Two groups of male Wistar rats have received a diet with normal (0,34 %; n = 8) and high (8,0 %; n = 8) content of NaCl for 2 months. BP was measured; urea, creatinine and sodium levels in blood serum and creatinine, protein and sodium levels in the urine were determined. The cardiac left ventricular mass index (LVMI) was calculated, morphological study of myocardium (lightoptical microscopy), including quantitative morphometry was carried out. The relative expression level of the NfкB gene was assessed in heart.

Results. The high-salt diet resulted in a significant increase of diuresis and sodium concentration in the urine. High diet levels of NaCl did not affect significantly BP and LVMI. However, there were changes in the myocardium structure in the high-salt diet group, including myocardium hypertrophy and hyperplasia of cardiomyocytes, perivascular fibrosis, angiospasm, increased thickness of the artery walls due to smooth muscle cells hypertrophy, their vacuolization, and vascular sclerosis. There was a 3,4-fold increase in NFкB gene expression level in myocardium in the high-salt group compared to the low-salt group.

Conclusions. Our findings suggest that the high consumption of sodium chloride can cause myocardial remodeling regardless of changes in BP.

Objective. To monitor blood pressure (BP) and mineral metabolism in adolescents drinking water with low content of mineral salts (St Petersburg municipal tap water) in relation to the constitutional and individual characteristics.

Design and methods. The study included 155 school students aged 11–13 years, both males and females. Table water for the first (experimental) group (64 students) was enriched with Ca2+ and Mg2+ up to 50–60 and 25–30 mg/l, respectively. The second (control) group consisted of 91 adolescents receiving the ordinary Saint-Petersburg tap water with extremely low content of essential macroelements (7–8 mg/l of calcium; 3–4 mg/l of magnesium). By antropometric measurements, all adolescents were divided into 3 constitutional types and into 2 types of different rates of individual development. The study lasted 5 years. During the follow-up BP was monitored periodically in all participants, and the mineral composition of tissues such as nails and hair was studied using atomic absorption analysis (AAS-3, Germany). Results. The initial data on average systolic BP

(SBP) and diastolic BP (DBP) were statistically identical in both groups: mean SBP was 117 ± 3,9 and 118 ± 3,8 mmHg, respectively; mean DBP was 80 ± 2,5 and 78 ± 2,4 mmHg in groups 1 and 2, respectively. At the same time, initial BP (both SBP and DBP) was significantly (p < 0,05) higher in adolescents with the ectomorphic cerebral type are characterized by higher neurotism and emotional instability. After 5-year follow-up both SBP and DBP decreased significantly (p < 0,05) in adolescents receiving table water enriched with calcium and magnesium. At the same time, in the control group in different constitutional subgroups receiving low-Ca2+-Mg2+ tap water no significant changes in SBP and DBP were observed throughout the study. The concentrations of Ca2+ and Mg2+ in nail and hair samples increased with time in all 3 constitutional subgroups of the experimental group. By the end of the study the most marked increase was observed in adolescents of the mesomorphic and of the endomorphic type. In the mesomorphic subgroup calcium content in hair increased from 0,78 ± 0,06 up to 1,34 ± 0,13 mg/g (p < 0,05), and magnesium content — from 0,02 ± 0,001 to 0,07 ± 0.008 mg/g (p < 0,05). In the endomorphic adolescents the hair mineral content increased from 0,58 ± 0,04 up to 1,60 ± 0,10 mg/g and from 0,02 ± 0,.001 up to 0,08 ± 0,007 mg/g, respectively (p < 0,05).

Conclusions. After 5-year follow-up the average BP increased significantly in subgroups of adolescents characterized by higher neurotism and emotional instability, as well as in accelerants. Compensation of the natural deficiency of mineral salts in drinking water (within physiological norms and hygienic standards) protects from mineral loss and has a positive effect on mineral distribution in tissues.

In kidney of spontaneously hypertensive rats in early postnatal ontogenesis, we studied the changes in the expression of NAP-22 quantitatively predominant protein kinase C substrate mRNA, which served us as an indicator of the severity of disruption in cell apparatus. Exogenous calcium deficiency increased the expression of NAP-22 mRNA. Based on the changes in the expression level of this protein, it can be resumed that disorders of kidney function precede the formation of lasting hypertension in the animals.

Background. Carotid atherosclerosis is closely connected with the development of stroke, cognitive deficits and dementia. The impact of the localization of carotid atherosclerosis on the development of cognitive deficits remains unclear.

Objective. To analyze the relationship between the indicators of cognitive functions and structural changes of the carotid arteries in patients with metabolic syndrome (MS).

 Design and methods. The study included 178 patients divided into 2 groups. The first group included 80 patients (44,94 %) with MS without cognitive impairment. The second group consisted of 98 patients (55,06 %) with MS and cognitive disorders. All patients underwent neuropsychological testing, cognitive evoked potential (EP) for the assessment of cognitive functions, and the thickness of intima-media (TIM) of the carotid arteries was determined.

Results. There was an increase in TIM of the internal carotid artery (p < 0,01) and bifurcations (p < 0,01) in the group of patients with MS and cognitive deficit compared to the group without cognitive disorders. The correlation was established between the TIM of the internal carotid artery and bifurcations and the results of Mini-Mental State Examination test (p < 0,01), as well as responsiveness and concentration (p<0.01), an indicator of memory, storage and display of information (p < 0,01). We also have found a significant relationship between TIM of the internal carotid artery, bifurcation and the cognitive EP latency period (p < 0,01).

Conclusions. According to the neuropsychological testing and cognitive evoked potentials the increase of TIM in the internal carotid artery and bifurcations is associated with the development of cognitive impairment.

Objective. Тo study relationship between left ventricular hypertrophy and peripheral capillary network remodeling in hypertensive patients with metabolic syndrome and without it.

Design and methods. The study included 33 hypertensive patients (51,4 ± 11,0) with and without metabolic syndrome (n = 12 and n = 21, respectively). The control group included healthy volunteers without cardiovascular pathology (n = 41). Besides routine clinical and laboratory examination all participants underwent vital nail-fold capillaroscopy to define density of capillary network and an assessment of remodeling coefficient (calculated as the ratio of the mean diameters of venous to arterial portions of capillaries). The left ventricular mass and index mass were estimated by echocardiographic technique.

Results. The study indicated change of capillary network: rarefaction and significant remodeling in hypertensive patients in comparison with healthy volunteers. Increased left ventricular index mass was predominant in hypertensive patients with metabolic syndrome (75 %) whereas it was found only in 27,3 % hypertensive patients without metabolic syndrome.

Conclusion. There was a correlation between blood pressure level and capillary network remodeling and between blood pressure level and left ventricular hypertrophy. Left ventricular hypertrophy was more frequent in hypertensive subjects with metabolic syndrome, whereas capillary network remodeling was not associated with presence of metabolic syndrome.

Objective. To assess total and high-molecular weight adiponectin (AN) and (HMWAN) level in women with abdominal obesity (AO) and arterial hypertension (HTN) — citizens of St Petersburg aged 30–55 years old.

 Design and mеthods. We examined 94 women with AO (IDF, 2005), mean age 45,3 ± 0,1 years. Compari-son group included 16 healthy women without АО. The levels of AN, HMWAN and insulin were determined by ELISA method (DRG, USA). Serum lipids were determined by enzymatic method (COBAS INTEGRA 400/700/800, Germany). The homeostasis model was used to assess the insulin resistance HOMA-IR.

 Results. HTN was diagnosed in 48,4 % women with АО (IDF, 2005). The level of total and high-molecular weight adiponectin was lower in subjects with АО compared to the healthy women (р < 0,05). Total AN level did not differ in hypertensive women with АО and in the normotensive subjects (р > 0,05). However, the HMWAN level was lower in hypertensive subjects with АО compared to the normotensive women (р < 0,01). The highest insulin level and НОМА-IR were found in hypertensive women with АО and the lowest level of total AN (1st tertil). At the same time women with the lowest HMWAN concentration (1st tertil) had the highest levels of systolic and diastolic blood pressure (BP), waist circumference, insulin, glucose, triglycerides and НОМА-IR. Linear regression analysis confirmed the correlation between the levels of HMWAN and BP (β = –0,21, р = 0,03).

Conclusions. The high-molecular weight adiponectin level is lower in women with AO and HTN compared to the normotensive subjects with AO. Low level of high-molecular weight adiponectin might be considered a factor for HTN development in women with AO.

fibrillation (AF) and to reveal the significance of this marker of fibrosis in MS.

Design and methods. We examined 100 patients with MS (50 with paroxysmal or persistent AF and 50 without arrhythmia) and 50 healthy persons. Serum galectin 3 was measured by ELISA method, all examined subjects underwent echocardiography.

Results. Galectin 3 was higher in patients with MS and AF compared to patients with MS without arrhythmia and much higher than in healthy persons [0,72 (0,44; 1,36); 0,44 (0,42; 1,22 and 0,32 (0,28; 0,42) ng/ml, р < 0,05; р < 0,001 and р < 0,001, respectively]. Galectin 3 in patients with 5 components of MS was higher, than in patients with 4 and 3 components of MS [2,01 (0,52; 4,59); 0,54 (0,44; 1,37) and 0,42 (0,32; 0,42) ng/ml, р < 0,05; р < 0/001 and р < 0,001, respectively]. Correlations between galectin 3 and waist circumference, blood pressure, left and right atrium volume, triglyceride level were found (r = 0,57; r = 0,51; r = 0,45; r = 0,40; r = 0,41; р < 0,001).

Conclusion. Galectin 3, a marker of fibrosis in patients with MS and atrial fibrillation was higher than in patients with MS without arrhythmia and significantly higher than in healthy persons.