The review presents data on regular and irregular waves of blood pressure (BP) recorded during its invasive (intra-arterial) and non-invasive registration. Regular pulse waves, Traube-Hering waves (second-order waves) and Mayer waves (third-order waves) are described. The characteristic of circadian and ultradian super slow waves is given. The role of the sympathetic nervous system in the origin of regular waves of BP and their relationship with the magnitude of the baroreceptor reflex are shown. Attention is drawn to the role of changes in the minute volume of blood circulation and peripheral resistance to blood flow in the occurrence of fluctuations in BP. We also review the methods and features of BP registration, which enable identification and analysis of irregular high-frequency fluctuations in BP, the relationship of these fluctuations with the magnitude of the baroreceptor reflex and the activity of the sympathetic nervous system. The data on the amplitude of high-frequency irregular fluctuations in BP in animals with simulated hypertension are presented. The review draws attention to the possibility of recording regular fluctuations in BP during its constant non-invasive registration.

We reviewed the composition of gut microbiota (GM) in the presence of essential hypertension by analyzing Russian and foreign research publications from the database PubMed and Electronic Research eLibrary over the last 5 years from the position of evidence-based medicine. An analytical method has been used. A literature review indicated correlations between bacteria numbers and blood pressure level. Streptococcus spp., Klebsiella spp. and also such short-chain fatty acid producers as Bifidobacterium spp., Roseburia spp. and Faecalibacterium prausnitzii were shown to have inverse and direct links with blood pressure level in patients with essential hypertension. Lactobacillus spp. take part in blood pressure regulation in case of excessive salt consumption. The recent studies confirm the role of GM in the development of essential hypertension. Certain bacterial genus and species of GM producing short-chain fatty acids require further studies.

The incidence of cardiovascular complications in non-cardiac surgery is about 3 %. The review presents the data on the assessment of cardiovascular risk (CVR) in non-cardiac surgery. The algorithm of decisionmaking considers the functional state of the patient and the category of CVR of the upcoming surgery. Functional testing is not indicated for patients with low CVR. Stress tests should be considered in high-risk patients if the test results may change the perioperative drug therapy, the method of anesthesia, or the surgical approach. Routine coronary revascularization does not reduce perioperative risks and is used for special indications. Percutaneous coronary intervention and associated dual antiplatelet therapy may delay the timing of non-cardiac operations. Perioperative drug therapy (beta-blockers, aspirin, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and statins) should be prescribed taking into account the individual risk of the patient.

Background. Familial hypercholesterolemia (FH) is the genetic disease characterized by an increase in the levels of total cholesterol and low density lipoproteins since childhood.
The aim of the study was to assess arterial stiffness in children with heterozygous FH by measuring pulse wave velocity (PWV) in the aorta.
Design and methods. The study involved 118 children. Of these, 60 healthy children were in the control group and 58 children with the diagnosis of heterozygous FH were included in the main group. Both groups were divided into 3 age subgroups: from 5 to 7 years old, from 8 to 12 years old and from 13 to 17 years old. The diagnosis of FH was made according to the British criteria by Simon Broome. The lipid profile was determined for all children, blood pressure was monitored daily with the estimate of the minimum, average and maximum PWV (PWVmin, PWVav, PWVmax) in aorta using oscillometric method.
Results. In the younger age subgroup (5–7 years), there were no significant differences in PWV between main and control groups. In children aged 8–12 years, the main group was characterized by significantly higher values of maximum PWV compared to healthy peers — 5,1 [4,7–5,8] and 4,6 [4,45–5,05] m/s, respectively (p = 0,041). In group of children with FH aged 13–17 years, compared to the control group, a significant increase in the minimum PWV was observed — 4,7 [4,1–5,1] and 3,9 [3,5–4,1] m/s, respectively (p = 0,009), average PWV — 5,5 [4,8–6,4] and 4,5 [4,2–4,9] m/s, respectively (p = 0,009), and maximum PWV — 6,2 [5,7–7,55] and 5,4 [5,05–5,6] m/s, respectively (p = 0,007). Correlation analysis in patients with FH showed direct correlation between PWVmin, PWVav and PWVmax with total cholesterol (r = 0,46, r = 0,46 and r = 0,464, respectively, p < 0,001).
Conclusions. Our study demonstrates an increase in the PWV in the aorta in children with FH compared with healthy peers from 8–12 years of age. There is a further progression of arterial stiffness with an increase in the minimum, average and maximum PWV most significant in the group of 13–17 years.

Background. Hypertensive response of blood pressure (BP) to exercise has substantial prognostic impact. Hypertensive response to exercise is shown to be a predictor for development of hypertension and stroke. The data concerning hypertensive response to exercise influence on stress echocardiography results are controversial. Objective.
The aim of the study was to assess the frequency of hypertensive response of BP to exercise and its impact on the result of the stress echocardiography on treadmill in patients with known or suspected ischemic heart disease.
Design and methods. We analyzed 3434 tests performed in out-patient department during 1 month period (21.01–21.02) of every year since 2007 to 2020. We studied the occurrence of hypertensive response to exercise during exercise stress echocardiography on treadmill and its relation to positive results of the test.
Results. The prevalence of hypertensive response to exercise varied from 8,6 % to 41,5 % (average in 14-year period — 23,24%), however, the proportion of tests with hypertensive response to exercise significantly declined in the period from 2015 to 2020 years. Patients with hypertensive response to exercise showed significantly more frequent positive tests in comparison to patients with normotensive BP response: 40,6 % vs 31,0% (r = 12,2, р = 0,0005), though yearly analysis showed no correlation between the number of tests with hypertensive response to exercise and number of positive tests (r = 0,21; р = 0,47).
Conclusions. Significant correlation between BP response and stress echocardiography results means that hypertensive response to exercise has an impact on the test results, therefore antihypertensive treatment optimization is essential before test.

Hypertension (HTN) is often accompanied by folic acid (FA) deficiency and hyperhomocysteinemia (HHcy). Reduced glutathione (GSH) and dependent enzymes determine the state of cellular antioxidant and redox systems in cardiovascular pathology.
The aim of our work is to assess the relationship between the status of FA and the presence of HHcy with enzymes of glutathione metabolism and the redox state of erythrocyte glutathione in HTN.
Design and methods. In blood plasma samples from 43 HTN patients admitted to the clinic of Pavlov University, the concentration of FA and total homocysteine (oHcy) was determined. We also evaluated the level of GSH, the activity of glutathione peroxidase and glutathione reductase (GR) in erythrocytes.
Results. In the whole group, GR activity positively correlated with the concentration of FA (R = 0,415; p = 0,001). A significant decrease in GR activity (U/g Hb) was found in the subgroup with the low level of FA [0,8 (0,5–1,1)] compared with the subgroup without a FA deficiency [1,2 (0,9–2,0)]. The GSH level (μM/g Hb) was also lower (p < 0,018) in the subgroup with FA deficiency [1,3 (0,9–2,1)] compared with the subgroup with normal FA levels [1,8 (1,5–4,6)]. A significant decrease in the level of GSH and GR activity in the subgroup with HHcy was found compared with the corresponding parameters in the subgroup without HHcy. However, even in the absence of HHcy patients with FA deficiency demonstrated a significant decrease in GR activity compared to patients without FA deficiency. In this case, GR positively correlated with FA (R = 0,564; p = 0,03).
Conclusions. The deficiency of FA can increase the deficiency of GR activity, regardless of the level of oHcy. The indicator of GR activity in erythrocytes can be considered as a possible marker of functional deficiency of FA in the absence of HHcy.

Objective. To assess the association of personality type D with stress reactivity and autonomic balance among medical students, depending on gender and nationality.
Design and methods. The study included 188 healthy students aged 18 to 23 years (median 18,0 ± 1,0 years), Russian speakers and residents of India. To determine the type of personality D used questionnaire DS-14. All examined were divided into two groups: with the presence of personality type D (n = 67) and without personality type D (n = 121). Additionally, groups of male students with type D (n = 24) and without type D (n = 63) and female students with type D (n = 43) and without type D (n = 58) were identified. We evaluated the psychophysical stress test “Mathematical Account” and indicators of variational pulsometry at rest.
Results. When examining medical students, personality type D was detected in 27,5 % girls and 42,6 % boys (p = 0,03). When analyzing ethnic differences among Indian students, type D was detected in 42,6 % cases, among Russian-speaking students in 32,8 % (p = 0,21). Among the examined, there was no effect of type D on the test with an oral count, in the whole cohort, as well as in boys and girls. Logistic regression analysis in young men showed a pronounced relationship between Indian nationality and the presence of personality type D (p < 0,001).
Conclusions. The influence of multidirectional factors (gender, nationality) can offset the influence of personality type D on the studied psychophysiological mechanisms and determine the heterogeneity of the influence of personality type D on the course of the disease in the general cohort.

Objective. The aim of the work was to study the features of cerebral blood flow in patients with chronic
obstructive pulmonary disease (COPD) associated with hypertension (HTN).
Design and methods. A crosssectional study was conducted, which included 90 males 40–60 years old. Of these, 30 patients with chronic COPD associated with HTN (COPD + HTN) were included in the study group, 30 individuals with isolated COPD were in the comparison group, 30 healthy volunteers were included in the control group. All participants underwent physical examination, spirography, 24-hour blood pressure monitoring and ultrasound examination of cerebral vessels.
Results. Patients with COPD + HTN in comparison with the control showed an increase in the diameter (p = 0,018) and complex of the intima-media of the common carotid artery (p = 0,003) while the velocities, resistance index (RI) and pulsation index (PI) did not change. In the basin of the internal carotid artery an increase in RI values was noted (p = 0,018). At the intracranial level there was a decrease in the end-diastolic velocity (p = 0,03) and the time-averaged average blood flow velocity (TAV) (p = 0,033) without due changes RI and PI. At the same time no changes in speed indicators and indices were noted in the vertebral artery basin. Among the indicators of cerebral perfusion in patients with COPD + HTN, hydrodynamic resistance (p = 0,0015), intracranial pressure (ICP) (p = 0,0048) significantly increased, and the cerebral blood flow index was comparable with the control. Assessment of venous cerebral blood flow showed an increase in the diameter of the internal jugular vein (p = 0,021) with unchanged TAV together with an increase in ICP indicating the formation of venous dysfunction. It was shown that the body mass index, forced expiratory volume at the first second, systolic and diastolic blood pressure together determine the peak systolic blood flow velocity from the midbrain artery.
Conclusions. The cerebral blood flow in patients with COPD + HTN is characterized by a change in arterial blood flow at the level of both intra- and extracranial vessels, while maintaining a normal cerebral blood flow index, as well as the formation of arteriovenous dyshemia against the background of remodeling of the cerebral vascular bed.

Objective. To assess the characteristics of antihypertensive therapy (AHT) in outpatient patients in relation to comorbidities and multimorbidity level.
Design and methods. A cross-sectional study included 140 patients with diagnosed hypertension (HTN). We performed a standardized complaints and medical history registration, questionnaire survey, anthropometry, office blood pressure (BP) assessment. Based on Charlson index the patients were divided into 2 groups: group 1 with moderate multimorbidity (≤ 4 points), group 2 with high multimorbidity level (≥ 5 points). The data are presented as median and proportions with bi-directional 95 % confidence interval.
Results. In the sampling of 100 (_64,3 71,4 _78,6 %) women and 40 (_21,4 28,6 _35,7 %) men median age was ₆₅ 68 ₇₀, median Charlson index was ₄ 5 ₅. Group with moderate multimorbidity included 63 patients. High multimorbidity group included 77 subjects. HTN degree did not differ between the groups. Subjects from group 2 had higher level of cardiovascular risk (χ² = 17,2, df = 2, p = 0,00018) and were more likely to have a history of HTN-associated clinical conditions (χ² = 27,1, df = 2, p = 0,00000). By the time of examination, AHT was started in 137 (_95,097,9 _100,0%) patients. Monotherapy was ongoing in 20 cases (8,814,3 20,4%), combined AHT was prescribed to 117 (_79,6 85,4 _91,2 %) persons: 50 (_21,2 36,5 _43,8 %) patients received 2 drugs, 67 (_40,9 48,9 _56,9 %) patients received ≥ drugs. Number of antihypertensive drugs was higher in patients of group 2 than in group 1 (χ² = 6,7, df = 2, p = 0,036). Drug number was not associated with HTN degree (χ² = 3,8, df = 4, p = 0,44). Patients from group 2 were more likely to take β₁-blockers (p = 0,027) and moxonidine (p = 0,042). Non-steroid anti-inflammatory drugs (NSAIDs) reduced the frequency of achieving the target BP level in patients treated by angiotensin converting enzyme inhibitors (p = 0,002). The frequency of achieving target BP was _42,9 50,7 _58,6 %, it was independent of the number of prescribed drugs (p = 0,07) and did not differ in the groups of moderate and high multimorbidity (p = 0,87).
Conclusions. Multimorbid patients require combined antihypertensive drugs to control hypertension. Multimorbidity level, comorbidities and drug-to-drug interactions should be taken into account during individualized HTN management. NSAID significantly affect the effectiveness of antihypertensive therapy.

Objective. To assess the hemodynamic reaction to orthostasis in hypertensive men with chronic venous diseases (CVenD) taking a combination of an angiotensin-converting enzyme inhibitor (ACE inhibitor) and a diuretic.
Design and methods. We enrolled 44 men aged 30–50 years old with uncontrolled hypertension (HTN) who were taking antihypertensive therapy (AHT). We performed a comparative assessment of the changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, femoral peripheral venous pressure (PVP), diameter and area of the lumen, blood flow velocity in the superficial and deep veins of the left lower limb in response to orthostasis. The patients were divided into two groups: 22 patients with HTN without chronic venous insufficiency, 22 patients with HTN and chronic venous disease. We studied the reaction at 3 minutes of orthostasis before and after 14 days of AHT in a hospital using ACE inhibitors (Perindopril) and a diuretic (Indapamide).
Results. Before treatment, the reaction to orthostasis was similar in both groups, we registered a decrease in SBP, PVP, blood flow velocity and an increase in diameter, lumen area of all veins. As a result of treatment, 40 patients reached a level of SBP < 140 mm Hg. Of these, there were 19 patients without CVenD, and 21 patients with CVenD. After treatment, the reaction to orthostasis was similar for the most of the studied parameters. However, there were some differences between the groups. After treatment, patients with HTN and CVenD demonstrated a decrease in SBP, the absence in DBP change, a 4-fold drop in PVP, and orthostatic hypotension was registered in 3 cases. After treatment, in patients with CVenD with orthostasis, SBP and DBP were significantly lower than in patients without CVenD (p = 0,0014 and p = 0,0028, respectively). The difference in SBP between groups after treatment was 12 mm Hg (9%), according to DBP — 6 mm Hg (7%).
Conclusions. At baseline and after a 14–15-day use of the combination of ACE inhibitors and a diuretic, the reaction to orthostasis was similar for most of the studied parameters. In patients with HTN and CVenD, the main features of the reaction to orthostasis included a decrease in SBP, the absence of DBP change, a 4-fold drop in PVP, and orthostatic hypotension registered in 3 cases.