Observational results suggest that environment has a great impact on physiology but these phenomena cannot be explained by genetic mechanisms alone. The epigenetic studies broadens our knowledge about development and physiology. Currently, the topical issues are transgenerational effects which imply transmission through generations both genetic and phenotypic adaptive mechanisms. The accumulated data indicate that the influence of environmental factors (bad habits, stress, excessive or insufficient nutrition, microbiota and others) at early stages of development can contribute to the epigenetic transgenerational inheritance of phenotypic variability. Epigenetic processes can alter gene expression, which in turn can either increase vulnerability or contribute to the development of disease tolerance in future generations. Epigenetic biomarker signatures can be considered as a future diagnostic tool for assessing person’s specific susceptibility to disease or exposure to environmental toxicants. The current review discusses the molecular genetic mechanisms of transgenerational inheritance and the influence of various risk factors.

The review summarizes the data of past two decades on the effect of hypertension on vascular aging and considers the effect of chronic inflammation and oxidative stress patterns on the remodeling of cardiovascular system. Clinical studies on the effect of various classes of antihypertensive drugs on age-associated parameters of vascular aging are discussed. These include endothelial dysfunction and arterial assessed by endothelium-dependent vasodilation, pulse wave velocity, augmentation index, cardiovascular index, thickness of the intima-media complex, and so on.

The paper overviews classification, diagnosis and treatment of hypertensive disorders of pregnancy and early postpartum period (chronic hypertension (HTN), gestational HTN, pre-eclampsia) provided by different societies of cardiology and obstetrics and gynecology. The definition of pre-eclampsia offered by the International Society for the Study of Hypertension in Pregnancy (ISSHP) in 2018 and supported by the International Federation of Gynecology and Obstetrics (FIGO) in 2019, its screening and prevention are considered. All treatment options of moderate and severe HTN in pregnancy are reviewed. A new US Food and Drug Administration (FDA) classification system of drug therapy for pregnancy and lactation Pregnancy and Lactation Labelling Rule (PLLR, 2015) is presented. Treatment goals of HTN and blood pressure (BP) thresholds in pregnancy as well as risk factors, causes, clinical presentation, diagnostic workup and management of hypertensive emergencies in pregnancy are provided. We discuss the evidence of BP ≥ 130/80 mmHg as a factor of high maternal and neonatal risks proposed by the American College of Cardiology/American Heart Association (2017) as the HTN criteria in pregnancy.

Objective. To assess the prevalence of markers of preclinical vascular, kidney and brain damage in the survivors of the Leningrad Siege (SLS) in the long-term period of life, as well as to determine a possible connection with starvation in the prenatal period and early childhood.

Design and methods. A prospective cohort study of 305 SLS was initiated in 2009–2011. In a control sex- and age-matched group we recruited people born in the same time period in other regions of the Soviet Union and permanently residing in Leningrad after the World War II (n = 51). At the second visit in 2013–2014, 252 residents of besieged Leningrad were examined (the response rate was 82,6 %). Blood pressure measurement and anthropometry were performed according to standard methods. The laboratory examination included the assessment of fasting glucose, lipids, and creatinine with the calculation of the glomerular filtration rate (GFR) according to the CKD-EPI formula. The concentration of albumin and creatinine was determined, and the albumin-creatinine ratio was calculated. All patients underwent assessment of the pulse wave velocity by the applanation tonometry (SphygmoCor, AtCor, Australia), cardio-ankle vascular index (CAVI) and ankle-brachial index (VaSera VS 1500, FukudaDenshi, Japan). For cognitive assessment, the Mini-Mental State Examination (MMSE) scale was used.

Results. The analysis included data of 184 residents of besieged Leningrad (52 males (28,3 %) and 132 females (71,7 %), average age 74,7 years old) divided into three groups depending on the age period during the Siege: 132 people in the first group (late childhood and adolescents), 28 people in the early childhood group, 24 people in the third “intrauterine” group. The control group included 44 people: 13 males (29,5 %) and 31 females (70,5 %), average age 75,5 years old. The survivors of the besieged Leningrad showed lower anthropometric characteristics — lower weight (p = 0,005) and body mass index (p = 0,004) compared with the control group. There were no differences in the prevalence of vascular, renal and cerebral lesions. The lowest arterial stiffness according to the CAVI index was detected in the “intrauterine” group compared to early, late childhood and adolescent groups (p = 0,015). Renal dysfunction was detected only in the first group (late childhood and adolescents).

Conclusions. The residents of the besieged Leningrad demonstrate low prevalence of renal dysfunction and arteriosclerosis of the large arteries and atherosclerosis of the peripheral arteries, as well as preserved cognitive function. The increased arterial stiffness and decreased GFR in SLS who experienced the siege in late childhood and adolescence are most likely due to the older age.

Objective. The aim of the study was to assess the changes in the prevalence of hypertension (HTN) among young men according to two screenings of independent samples of an open urban population.

Design and methods. The study is based on two cross-sectional studies, over a fifteen year range, among males in the Central Administrative District of Tyumen. Representative samples were formed according to a single protocol from electoral lists among men 25–64 years old by the method of “random numbers” — 1000 people each (250 people each in four decades of life), the response was 79,5 % and 85,0 %, respectively, in the first and second screening. As part of cardiac screenings, the prevalence of HTN, mean values and percentile distribution for systolic and diastolic blood pressure (SBP, DBP) were determined in two groups of young age 25–34 and 35–44 years.

Results. Young men of an open population of a moderately urbanized city of Western Siberia have high blood pressure (BP) levels with a significant increase in average levels and percentile distribution of SBP and DBP in the age range from the third to the fourth decade of life. According to the results of two cross-sectional studies in the range of fifteen years, we found a tendency towards a decrease in SBP and the prevalence of HTN in men in the third decade of life in an open population of a moderately urbanized city of Western Siberia. At the same time, the levels of SBP, DBP and the prevalence of HTN in the fourth decade of life remain stable.

Conclusions. We found high levels of BP and the prevalence of HTN among young men in a medium-urbanized city of Western Siberia and a positive fifteen-year dynamics in reduced prevalence of HTN in young people. The latter is a favorable factor and opens up opportunities for targeted impact on other conventional and non-conventional cardiovascular risk factors in this age group.

Objective. To assess the occurrence of various vascular aging phenotypes among young people, depending on the level of blood pressure (BP) and in relation to risk factors (RF) and the presence of connective tissue dysplasia (CTD).

Design and methods. In total, 250 young people (88 boys and 162 girls) aged from 18 to 25 years old were examined at the University Health Center. All the subjects were divided into tercile groups based on cardio-ankle vascular index (CAVI), determined by the VaSera-1500 (Fucuda Denshia, Japan). According to the latest expert recommendations the third tercile group corresponds to early vascular aging or EVA syndrome. The first tercile group corresponds to favorable vascular aging. We have analyzed the representation of various vascular phenotypes in individuals with elevated and normal BP, as well as the main RF and external signs of CTD in each of CAVI-tercile group. Data processing was performed using the software package “Statistica 10.0” (StatSoft Inc., USA).

Results. Among young people with office hypertension and high normal BP, the EVA phenotype and phenotypes of normal and favorable vascular aging are equally distributed. In persons with office normal and elevated BP, vascular stiffness correlates with weight, body mass index and waist circumference (with the increase in arterial rigidity these indicators decrease). CTD is registered among subjects with severe vascular remodeling both in boys and girls.

Conclusions. Our data indicate the feasibility of angiology screening for identification of vascular aging phenotypes as a part of preventive measures among young people, regardless of the level of initial office BP. This strategy strategy will contribute to a more differentiated identification of risk groups and more individualized preventive interventions based on vascular aging phenotypes.

Objective. The aim of the study was to assess the possible association of visit-to-visit blood pressure (BP) variability and the risk of adverse outcomes in hypertensive (HTN) patients after acute coronary syndrome.

Design and methods. We analyzed data of 1,456 patients (mean age 65,6 ± 12,2 years, 875 (60,1 %) men) discharged from the hospital after acute coronary syndrome and followed up for 1 year in 4 vascular centers in Moscow, Astrakhan, Kazan and Krasnodar in 2014–2017. BP, heart rate, and adverse events were recorded on the day of discharge and on days 25, 90, 180 and 360 after discharge. The visit-to-visit BP variability was assessed by the VIM coefficient (variation independent of mean).

Results. The systolic BP variability was 7,81 ± 0,226 mm Hg, diastolic BP variability was 9,89 ± 0,577 mm Hg during follow-up. In total, 110 deaths from any cause, 63 coronary deaths, 130 repeated non-fatal coronary events, 33 ischemic strokes were recorded. A decrease in BP variability was associated with the dihydropyridine calcium antagonists (10,21 ± 6,45 and 7,99 ± 4,70 mm Hg, p = 0,024) and thiazide diuretics (10,34 ± 6,59 and 7,63 ± 9,63 mm Hg, p = 0,049). Multivariate analysis showed that high long-term variability of BP is a more significant factor associated with the overall mortality rate than the initial severity of HTN and even the fact of achieving target BP. The risk of ischemic stroke in patients with HTN was associated with factors such as atrial fibrillation, heart failure, a history of stroke, and high visit-to-visit BP variability.

Conclusions. Visit-to-visit BP variability is an important characteristic of BP control and is associated with the risk of death from any causes and stroke in patients with coronary heart disease.

Objective. To analyze adverse drug reactions (ADR) occuring in patients taking antihypertensive drugs (AHD).

Design and methods. We have analyzed 459 cases of ADR caused by AHD and recorded in the regional database (register) called ARCADe (Adverse Reactions in Crimea, Autonomic Database) during 2011–2018 years.

Results. Out of all ADR, 304 cases (_3,9 4,4 _4,9 % of the total number of cases) were associated with AHD affecting renin-angiotensin-aldosterone system,101 (_1,2 1,5 _1,8 %) — with calcium channel blockers, and 54 cases (_0,6 0,8 _1,0 %) — with β-blockers. In the majority of cases, the ADRs were attributed to Enalapril (85 cases) and Amlodipine (76 cases). The analysis of the outcomes showed that serious reactions (life-threatening conditions, hospitalization, and disability) occurred in 72 cases. The remaining 387 ADRs were not considered serious. The majority of reported ADRs were unavoidable reactions of mild severity.

In the natural course of postductal aortic coarction, the average life expectancy of the patient is 30 years. The quality of life depends largely on the severity of narrowing, the presence of an open arterial duct and the development of collaterals providing blood flow in the descending aortic basin. Adult patients are characterized by hypertension syndrome symptomatic angina pectoris arrhythmias and heart failure. Pathology is diagnosed by means of two-dimensional echocardiography with color dopplerography and three-dimensional and four-dimensional ultrasonic reconstruction. The obtained data are significantly refined and supplemented by magnetic resonance or contrast multispiral computer tomography. Timely and correct diagnosis can save a patient’s life or significantly improve its quality, preventing the consequences of persistent hypertension and the development of heart failure. The present paper considers a clinical case of pronounced aortic coarctation, first diagnosed in a man aged 30 years, previously observed with a diagnosis of hypertension, despite the signs of hypoxemia of the lower half of the trunk. The algorithm of examination is discussed, which provides timely diagnosis of this defect in order to prevent its complications.

The syndrome of the ectopic production of the adrenocorticotropic hormone (ACTH) presents a version of endogenous hypercorticism which is the most challenging one for diagnostics and treatment. The paper discusses a clinical case of the ACTH-ectopic syndrome diagnosed in an elderly female patient. Advanced age and ongoing long-term treatment may obscure the typical manifestations of a disease. At the same time, it is common for doctors to be less focused on identifying rare diseases when working with elderly patients. A combination of clinical signs (resistance to the antihypertensive therapy; poorly controlled glycemia; increasing weakness; hypokalemia and severe skin pigmentation) allowed for suspecting symptomatic hypertension. Doctors need to be alert and to identify rare diseases among patients of any age group. This case also demonstrates the productivity of a multidisciplinary approach (a team including cardiologists, endocrinologists, radiology specialists and surgeons).

Current data on the prevalence of hypertension and diabetes mellitus (DM) are presented. Concomitant DM complicates the course of cardiac diseases, affecting the effectiveness of antihypertensive therapy. Along with high blood pressure, lipid and carbohydrate metabolism parameters should be corrected. Nephroprotection is also important in these patients. These goals are achievable due to the pleiotropic effects of some drugs. The analytical paper reviews the pleiotropic organoprotective effects of the antihypertensive drug azilsartan medoxomil. The data on its antihypertensive efficacy versus other angiotensin II receptor blockers are presented. In addition, the results of clinical trials in patients with various components of the metabolic syndrome (obesity, dyslipidemia, hyperglycemia) and DM are described.