Achievements of modern medicine and a number of other factors have led to an increase in the life expectancy and aging of the population. Together with an unhealthy lifestyle it has contributed to the growth in the number of noncommunicable diseases (NCDs). The priority area is the reduction of the burden of NCDs on a global scale and for each individual country in order to improve the quality of life and the welfare of the population. However, various programs for the prevention and management of NCDs make an unequal contribution to their effectiveness and cost. In 2017, World Нealth Оrganization (WHO) published cost-effective solutions and other recommended interventions for the prevention and control of noncommunicable diseases. For each behavioral risk factor and disease category, measures were listed with an assessment of their cost-effectiveness. In this review, the cost-effective and other measures presented by WHO are analyzed in terms of their application at three out of the six levels identified by the authors: legislation, the media, and the environment. In addition, examples of preventive programs aimed at combating smoking and drinking sugar-sweetened beverages, as well as increasing the physical activity of the population are given.

High blood pressure (BP) is a leading risk factor for premature death and one of the important risk factors for coronary heart disease (CHD). A significant increase in risk is observed starting from the level of systolic BP of about 140 mm Hg. Tactics of antihypertensive therapy in patients with co-existent hypertension (HTN) and CHD are reviewed in the European and Russian recommendations for HTN. In spite of this, some uncertainty remains regarding the optimal target BP level in patients with HTN and clinically manifest CHD mainly due to the lack of convincing evidence arising from large and specially designed randomized clinical trials (RCTs) dedicated to this issue. Some observational studies, meta-analysis, special analysis of subgroups of patients with HTN and CHD from the large RCTs, showed a J-shaped relation between the achieved BP and an increased cardiovascular risk. Our paper reviews up-to-date literature in relation to the target BP level in patients with HTN and CHD, including patients with high cardiovascular risk and patients undergoing revascularization. We review data from large studies and meta-analysis, evaluating the impact of more intensive vs. less intensive control of BP on the risk of major cardiovascular events or mortality. The analysis of the literature confirmed a lack of evidence of benefits of lower target BP values in senile patients with co-existent HTN and CHD, thus indicating the need for well-planned RCTs.

Given the high percentage of disability and mortality resulting from a stroke, search of new ways to improve early diagnosis and optimize therapeutic approaches is highly relevant. The article reviews the studies of NR2 antibodies to glutamate N-methyl-D-aspartate (NMDA) receptors as a biomarker in acute stroke. The review shows that this biomarker is suitable for determining the presence of ischemic process in the brain and the degree of destruction of brain tissue, both in the first hours of stroke and at follow-up. In addition, the analysis of NR2 antibodies can be informative to predict the worsening, the increase in the locus size, which can contribute to the timely correction of treatment and will improve the effectiveness of the therapy. The prognostic potential of NR2 antibodies can be used for personalized therapeutic approach. However, currently the lack of studies of NR2 antibodies in acute stroke requires further study of this biomarker.

Objective. To estimate the prevalence and impact on mortality of arterial hypertension (HTN) and orthostatic hypotension (OH) in centenarians (95 years and older) in Moscow.

Design and methods. The study participants were 82 super-long-livers of Moscow city aged 95 years and older (minimum age of 95 years, maximum 105 years), who underwent a comprehensive geriatric assessment at home by a multidisciplinary team (geriatrician, nurse and social worker). The following prospective observation lasted for three years (36 months).

Results. Past medical history of HTN was noted in 78 %. The mean systolic blood pressure (SBP) in the supine position was 151 ± 27,9 mm Hg (100–216 mm Hg), and the diastolic blood pressure (DBP) 74 ± 12,8 mm Hg (44–197 mm Hg). OH was detected in 31 % of 61 long-livers who was able to perform an orthostatic test. The presence of OH was not associated with the higher intake of antihypertensive drugs. Within three years, 44 study participants died. The level of blood pressure (BP), history of HTN, and the presence of OH did not affect mortality (p > 0,05).

Conclusions. Centenarians have a wide range of SBP and DBP, high prevalence of HTN and OH. BP level, presence of HTN and OH did not affect mortality over 3 year period. Further investigation is needed to understand better the health status of long-livers and factors affecting the prognosis.

Background. The epidemiology of hypertension (HTN) and antihypertensive treatment (AHT) in the Russian Federation was repeatedly estimated in epidemiology trials with various methodology, but situation in Moscow region has not been fully explored.

Objective. To examine the rate, age and gender features of HTN and AHT in unorganized Moscow cohort.

Design and methods. 532 participants older than 16 years old were interviewed in Moscow park after signing informed consent. Information about sex, age, rate of diagnosed HTN, AHT and its effectiveness was collected based on a questionnaire. Arterial blood pressure (BP) was measured consequently three times.

Results. Median and interquartile range of participants age was 57 (38–66) years, 71,1 % were women. Women were significantly older than men (59 (46–67) and 48 (31–61) years respectively, p = 0,0001). 42,7 % reported previously diagnosed HTN, 62,5 % received AHT. 79,7 % participants receiving AHT (49,8 % HTN patients) considered it effective. Home BP self-monitoring was performed by 43,7 % respondents (sex- and age-adjusted rates). While measured, 29,7 % participants had optimal BP level, 22,6 % — normal and 15,2 % — high normal. BP > 140 and/or 90 mm Hg was measured in 32,6 % of participants (rates are sex and age adjusted). BP > 140 / 90 mm Hg at assessment was found in 48,8 % HTN patients and 16,4 % participants without previously diagnosed HTN (8,7 % in entire studied cohort). There were no significant differences in the rate increased BP level at assessment and in HTN patients who received AHT or not (49,5 and 46,9 %). HTN rate was 39,6 % in participants who considered their AHT effective, and 75,5 % — ineffective, p < 0,0001. 63,4 % participants taking AHT could specify the drugs (65,3 % received monotherapy, 27,1 % — 2 drugs and 7,6 % — 3 drugs; fixed combinations received 17 %). BP levels and HTN did not differ in HTN patients who received one or more drugs.

Conclusions. In unorganized Moscow cohort age and gender adjusted rate of HTN at BP measurement was 32,6 %. In 8,7 % participants high BP was detected at first time. Only 62,5 % patients with previously diagnosed HTN received AHT. 39,6 % participants who considered AHT effective demonstrate high BP at assessment. AHT was not associated with the lower HTN rate or BP level, which may be attributed to excessive use of monotherapy and insufficient application of fixed combinations.

Objective is to study the relationship of hemodynamic, hormonal and metabolic changes with increased blood pressure (BP) in women after the induction of superovulation for extracorporeal fertilization (ECF).

Design and methods. We examined 80 women aged from 25 to 38 years (mean age 32,3 ± 3,6 years). All patients underwent ECF at the Center for Reproductive Technologies of the St Petersburg Mariinsky Hospital. Daily monitoring of BP was carried out twice: before the induction of superovulation for ECF and on the first day after this manipulation.

Results. After induction of superovulation, an increase in average daily BP ≥ 135/85 mm Hg occurred in 52,5 % of women and an increase in average night BP ≥ 120/70 mm Hg was registered in 13,8 %. In women with initially increased average daily BP, the relative risk of its further increase on the first day after induction of superovulation was 1,46 (95 % confidence interval (CI) 0,79–2,68) compared with women who had normal average daily BP. In women with initially elevated average nightly BP, the relative risk of its further increase after induction of superovulation was 1,16 (95 % CI 1,06–1,27). An increase of BP after induction of superovulation may be associated with age, female factor infertility, the presence of chronic diseases of the genitourinary system in past, changes in the metabolic profile (increase in total cholesterol, urea, creatinine, glucose, estradiol; decreased thyroid-stimulating hormone level), heart rhythm disturbances, episodes of apnea/hypopnea during sleep, increase in heart rate, increased sympathetic activity.

Conclusions. Induction of superovulation during in vitro fertilization has an adverse effect on the circadian BP profile. While planning in vitro fertilization, the risk factors for BP increase should be identified and modified. This will help to avoid adverse cardiovascular reactions associated with the procedure. Women with the hypertensive reaction after the induction of superovulation require dynamic BP monitoring.

Objective. To define gender aspects of subclinical atherosclerosis and evaluate interrelation of cardiac and carotid arteries (CA) remodeling with the results of the load test in the watch workers in the Arctic.

Design and methods. Within a periodic health examination during one year, 743 males and 213 females doing watch work in the Arctic were examined selectively. CA ultrasound examinations, echocardiography treadmill test and 24-hour blood pressure (BP) monitoring were performed.

Results. In the northern watch conditions, the rate of random thickening of intima-media complex (IMC) is equal in males and females and is related to age. Atherosclerotic plaques (AP) in CA were found twice more often in males than in females. In males, IMC thickening correlated with age, watch work duration and BP, whereas AP presence was also associated with left ventricular (LV) remodeling type, 24-hour BP profile and poorly with treadmill test results. CA structure alterations in females were influenced by age and LV remodeling only. Normal average BP was found in hypertensive patients (34,9 % males and 42,1 % females) according to 24-hour BP monitoring. Log-linear analysis showed association between AP in CA lumen and average daily BP in males (by 19,5 %) and in females (by 1,1 %).

Conclusions. In the northern watch conditions, subclinical carotid atherosclerosis has significant gender differences and is present twice more often in males than in females. It is associated with age, 24-hour BP profile and mildly with office and average daily BP, significantly with LV concentric hypertrophy and concentric remodeling and poorly with treadmill test results. Further studies are required to find key determinants of the atherosclerosis to decrease cardiovascular risk in the Arctic watch workers.

Objective. To study the effect of achieving the target level of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL–C) on the parameters of local vascular stiffness and the development of chronic heart failure (CHF) in patients with ST-elevation myocardial infarction (STEMI).

Design and methods. The study included 80 patients with myocardial infarction with ST segment elevation (STEMI) aged 35 to 65 years. On the 7–9th day of STEMI, at the 24th and 48th weeks of treatment with atorvastatin 40–80 mg clinical symptoms of heart failure were analyzed, the lipid profile and brain natriuretic peptide (BNP) were determined. Ultrasound of the common carotid arteries using high-frequency RF signal technology was performed. Depending on the effectiveness of treatment with atorvastatin, patients were retrospectively divided into 2 groups: 40 people who reached the target level of LDL–C (highly effective therapy, HET) and 37 patients who did not reach the target level of LDL–C (relatively effective therapy, RET).

Results. In patients who reached the target LDL–С level, the initial BNP values were 115,2 pg/ml, with the regression by 34,5 % at follow-up (p = 0,03). There was no significant change in the RET group. In the HET group, a decrease in IMT, an improvement in distensibility parameters, a decrease in local PWV and stiffness index of common carotid arteries, were found. Based on the 6-minute walk test, only patients in HET group showed an increase in exercise tolerance after 24th week (p = 0,04). Also, individuals who did not reach the target LDL–С level, showed a decrease in the quality of life 27,4 % (p = 0,03). Patients in the HET group showed no negative dynamics.

Conclusion. We showed that at the long-term follow-up after STEMI, the achievement of the target LDL cholesterol values was accompanied by a significant improvement in the parameters of local rigidity of the main arteries, and a decrease in BNP level, as well as by more favorable course of CHF.

Objective. To investigate the dynamics of renal function in patients with resistant arterial hypertension after renal denervation depending on the degree of central and peripheral blood pressure (BP) reduction and the baseline state of the kidneys.

Design and methods. A total of 22 patients (mean age 56,1 ± 10,2 years, 9 males) with treated resistant hypertension undergoing bilateral renal denervation (RDN) (Symplicity RDN System, Medtronic, USA) were included. Office BP measuring, 24-hour ambulatory BP monitoring (ABPM) (SpaceLabs 90207, USA), applanation tonometry (SphygmoCor, AtCor Medical, Australia) with the calculation of central aortic blood pressure (CAP), Doppler ultrasonography (Vivid 7 dimension) were obtained at baseline and at 1, 3, 6, 12, 18 and 24 months after RDN. Urine levels of NGAL (neutrophil gelatinase-associated lipocalin), KIM-1 (kidney injury molecule 1), L-FABP (Liver-type fatty acid binding protein), albuminuria and serum levels of сystatin C (sCysC) and creatinine (sCr) were measured by quantitative enzyme immunoassay at baseline and at 1, 3, 6, 12, 18 and 24 months after RDN. Glomerular filtration rate was estimated by the level of sCr and sCysC by CKD-EPI formula.

Results. All patients were divided into 3 groups according BP reduction: 1 — BP increase above 0 mm Hg; 2 — BP reduction from 0 to –30 mm Hg; 3 — BP reduction by > 31 mm Hg. An increased sCysС was registered in a group with decreased 24-hour systolic BP (1,06 ± 0,41; 0,93 ± 0,18 and 1,22 ± 0,23 ng/mL; F = 2,882; р = 0,04) and increased urine KIM-1 level — in a group with decreased office diastolic BP (2,18 ± 1,94; 1,53 ± 1,02 and 4,41 ± 0,97 pg/mL; F = 3,663; р = 0,03) at 3-month follow-up. An increased sCr level was registered in a group with decreased 24-hour systolic BP (78,3 ± 3,7; 88,2 ± 6,8 and 142,00 ± 8,8 μmol/L; F = 61,987; p = 0,004) and diastolic CAP (83,4 ± 8,2; 82,0 ± 8,0 and 142,0 ± 9,4 μmol/L; F = 23,476; p = 0,01), also an increased urine L-FABP level — in a group with decreased office diastolic BP (3531,3 ± 1795,0; 997,5 ± 1096,8 and 7351,7 ± 3297,0 pg/mL; F = 12,103; p = 0,002) at 6-month follow up.

Conclusions. Renal function worsening in patients during the period of maximum BP lowering may be associated with an excessive BP reduction. Therefore, we can suggest the occurrence of the J-curve phenomenon in relation to the kidneys.

Background. Even a moderate decrease in glomerular filtration rate leads to an increased risk of cardiovascular diseases (CVD), which is the leading cause of mortality in patients with chronic kidney disease (CKD). Left ventricular hypertrophy (LVH) underlies CVD development in renal dysfunction. The prevalence of LVH in patients with CKD stages 2–4 is 50–70 % and reaches 95 % at the beginning of dialysis, which significantly exceeds the number of cases in general population (15–21 %). Common hemodynamic factors associated with chronic kidney damage —hypertension (HTN), activation of the renin-angiotensin system, anemia, fluid and sodium retention, and others largely explain the high prevalence of LVH among patients with CKD. Nevertheless, the existence of additional non-hemodynamic mechanisms of myocardial remodeling (MR) is evident.

Objective. To investigate the associations between the MR physiological/histological characteristics and laboratory parameters of calcium-phosphate metabolism in the initial stages of experimental CKD. Design and methods. Four groups of spontaneously hypertensive rats (SHR) were studied (n = 35): 3/4 nephrectomized rats (Nx) one month exposed after surgery (Nx(1), n = 9), 5/6 Nx two months after surgery (Nx(2), n = 8), sham operated rats one month after surgery (SO(1), n = 9) and two months after surgery (SO(2), n = 9). Myocardial mass index (MMI), systolic blood pressure (BP), proteinuria, creatinine (Cr) concentration, total calcium (Ca) and inorganic phosphate (Pi), 25-OH vitamin D (25OHD) and parathyroid hormone (PTH) in serum, myocardial morphology were studied in all experimental animals.

Results. The models corresponded to the 1–3 stages CKD. There were no significant changes in serum total Ca (p = 0,066), Pi (p = 0,051) and PTH (p = 0,015) concentrations, the level of 25OHD was significantly lower in Nx(2) rats vs control (p = 0,015). MMI increased in all nephrectomized rats (p = 0,008). The cardiomyocytes (CM) thickness increased in Nx(1) and Nx(2) animals compared to the corresponding controls (p = 0,010, p = 0,002). A significant increase in interstitial (IF) and perivascular (PF) fibrosis occurred in Nx(2) rats with more damaging influence (p = 0,017, p = 0,004). CM thickness, IF and PF increased with the elevation of BP (r = 0,39, p = 0,038, r = 0,47, p = 0,026, r = 0,49, p = 0,031) and serum Cr (r = 0,68, p = 0,001, r = 0,61, p = 0,003, r = 0,69, p = 0,001), and the decrease in serum 25OHD concentration (r = –0,045, p = 0,047, r = –0,50, p = 0,020, r = –0,52, p = 0,012). Multiple linear regression analysis showed, that 25OHD is an independent predictor of myocardial fibrosis (IF: β = –0,38 ± 0,18, p = 0,047, PF: β = –0,34 ± 0,15, p = 0,032).

Conclusions. The initial stages of CKD accompanied with HTN are associated with serum 25OHD concentration decrease CM hypertrophy and myocardial fibrosis. The CM growth is an earlier event in relation to the interstitial fibrosis. The obtained data suggest a possible role of vitamin D deficiency in the development of myocardial fibrotic lesions.

Background. The data evidence that in patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) nocturnal hypoxemia is associated with poor prognosis. Although, data regarding sleep-related breathing disorders (SRBD) prevalence and their association with pulmonary hypertension (PH) severity are scarce.

Objective. To evaluate the prevalence and the structure of SRBD in patients with PAH and CTEPH and the relationship of SRBD with PH severity. Design and methods. In a prospective, single-center study we examined 31 patients (45 % male (n = 14)) with a verified diagnosis of precapillary PH: 22,6 % with IPAH; 9,7 % with PAH associated with congenital heart disease; 64,5 % with CTEPH; 3,2 % with PAH associated with connective tissue disease. Patients underwent a general clinical examination, questionnaires, respiratory tests, full videopolysomnography, electrocardiogram, and heart ultrasound (ECHO) examination, clinical and biochemical blood tests, including the assessment of ADMA and NT-proBNP levels.

Results. No differences in SRBD pattern in patients with PAH and CTEPH were observed as well as with the severity of PH. A positive correlation was found between the apnea-hypopnea index (AHI) and the end-diastolic left ventricular dimension (ρ = 0,54; p = 0,005); the ventricular diameter ratio (RV/LV) negatively correlated with AHI (ρ = –0,41; p = 0,05). Low peripheral blood oxygen saturation negatively correlated with NT-proBNP level (ρ = –0,40; p = 0.035). ADMA level was increased in all patients, nevertheless no association between ADMA and SRBD severity was found (χ² = 2,97; p = 0,085).

Conclusions. SRBD often occurs among patients with PAH and CTEPH, while the presence of SRBD is not associated with the severity of PH. The severity of SRBD is associated with left heart remodeling. The severity of nocturnal hypoxemia in our group is associated with the increased NT-proBNP level, which is consistent with the idea of a negative prognostic value of nocturnal hypoxemia in patients with PAH and CTEPH.