A number of studies have demonstrated a high incidence of sleep disturbances in patients with stroke. The paper reviews the variants of wakefulness disorders observed in ischemic stroke, taking into account the current terminology, as well as methods for their diagnosis. Currently, the origin of post-stroke hypersomnolence and its pathophysiology remain debatable. Various mechanisms including orexin ligand deficiency, degeneration of orexin neurons, as well as disruption of the links between the histaminergic and orexinergic systems are considered as links in the pathogenesis of hypersomnolence caused by ischemic stroke. The paper discusses the pathophysiology of hypersomnia and excessive daytime sleepiness in patients with ischemic stroke, demonstrates various points of view on the relationship of these pathological phenomena with ischemic stroke. A hypothesis on the compensatory nature of hypersomnia and excessive daytime sleepiness in acute ischemic stroke and their possible neuroprotective effect on the brain in patients with stroke is presented.

This article is an analysis of modern data on the morphological, functional and neurochemical organization of the central mechanisms of blood circulation regulation, the violation of which can cause the development of essential hypertension. The data indicating the validity of the hypothesis of G.F. Lang that prolonged emotional stress leads to a violation of the neuronal activity of the hypothalamus structures are presented. The article describes the morphological connections of the hypothalamus with the neurons of the ventrolateral region of the medulla oblongata and the structures of the spinal cord that provide neurogenic vascular tone. The evidence of convergence of axons of neurons of the paraventricular nucleus of the hypothalamus on the preganglionic neurons of the spinal cord is presented. Neurochemical processes in the vasomotor center of the medulla oblongata are considered, morphological changes of preganglionic sympathetic neurons in experimental arterial hypertension are indicated.

Diagnostics and treatment of the neurogenic cardiovascular disorders in α-synucleinopathies are difficult due to the early-onset of autonomic deficiency and masking under other diseases. The paper discusses the development and progression mechanisms of manifestations of neurogenic cardiovascular pathology. The main forms include neurogenic orthostatic hypotension, neurogenic hypertension in supine position (recumbent neurogenic hypertension) and its nocturnal variant. The existing and promising diagnostic approaches and related difficulties are presented. The possible relationship of cardiovascular disorders in α-synucleinopathies and their manifestations is shown. A possible diagnostic algorithm and possible non-drug and drug treatment and prevention approaches in neurogenic cardiovascular deficiency in α-synucleinopathies are presented. The importance of a multidisciplinary approach is emphasized.

Objective. To assess the influence of periodic limb movements in sleep on the incidence of acute cardiovascular events. 
Design and methods. Fifty-six participants aged 60–75 years were included in the study. Eligibility criteria included no history of acute cardiovascular events and the presence of 1 or more risk factors for cardiovascular diseases. Nocturnal actigraphy and cardiorespiratory monitoring were performed. Patients with apnea/hypopnea index > 5/h were excluded (n = 6). Based on periodic limb movements index (PLMI) two groups were formed: main (PLMI ≥ 15/h, n = 26) and controls (PLMI < 15/h, n = 24). The groups were prospectively observed during 1 year. The endpoints of the study were cases of acute cardiovascular events. 
Results. Despite the similar prevalence of common risk factors for cardiovascular diseases in two groups, the patients with PLMI ≥ 15/h have a higher incidence of ischemic stroke within 1 year (odds ratio 1,07). 
Conclusions. Elevated PLMI might be regarded as a potential predictor for higher risk for ischemic stroke. Nevertheless, further investigations in the field are needed.

Background. Obstructive sleep apnea (OSA) is frequently associated with hypertension (HTN), and about 50 % hypertensive patients have concomitant OSA. Episodes of transient upper airway obstruction affect the daily blood pressure profile, leading to nocturnal HTN. Although the general relationship between OSA and the daily blood pressure profile is known, the association between the frequency of various daily blood pressure profiles and OSA severity as well as the age-specific differences remain unknown. 
The aim of the study was to determine the daily blood pressure profiles in patients with HTN and OSA, depending on the OSA severity and age. 
Design and methods. The study included 236 HTN patients underwent treatment in the period from 2008 to 2021 years and were diagnosed with OSA by cardiorespiratory monitoring: 84 patients had mild OSA (apnea/hypopnea index (AHI) < 15 episodes/h), 46 patients — moderate OSA (15 ≤ AHI < 30 episodes/h), and 106 patients — severe OSA (AHI ≥ 30 episodes/h). The control group included 140 HTN patients without OSA. Both groups were divided into 3 age subgroups: younger than 45 years, 45–59 years and ≥ 60 years. At baseline, all patients underwent cardiorespiratory monitoring (“Kardiotekhnika‑07–3/12P”, Inkart, St Petersburg, Russia) and 24-hour blood pressure (BP) monitoring (BPLab, Nizhny Novgorod, Russia). 
Results. We found an association between the distribution of daily BP profiles and age, which differs from that in HTN patients without OSA. Non-dipper and night-peaker BP profiles are predominant in young and middle age. Among OSA patients, the severity of OSA was associated with the BP profiles only in the young and middleage groups. Unfavorable BP profiles (non-dipper and night-peaker) were more common in patients with severe OSA, which was not observed in elderly subgroup. In the elderly, compared to younger patients, the overdipper profile was the most common and its frequency was not associated with OSA severity. 
Conclusions. The study shows the relationship between the age of patients with HTN and OSA, the OSA severity and the distribution of daily BP profiles.

Background. Hypertension (HTN) in metabolic syndrome (MS) in the elderly contributes to the formation of cognitive disorders and anxiety-depressive disorders. Objective. 
To study the psychological state of elderly patients with HTN and MS treated by evening versus morning dosing of a fixed combination (FC) of amlodipine, lisinopril and rosuvastatin. 
Design and methods. In a randomized, double-blind, controlled trial 63 patients aged 60–74 years with HTN and MS received a FC of amlodipine, liiznopril and rosuvastatin at a dose of 5/10/10 mg in the evening (after 20:00 hours) (study group) And 58 patients aged 60–74 years with HTN and MS took the drug in the morning (control group). Cognitive dysfunction was assessed by Mini-Mental State Examination (MMSE), anxiety and depressive disorders were assessed by State-Trait Anxiety Inventory adapted by Yu. Khanin and scale of the Center for Epidemiologic Studies-Depression (CES-D). 
Results. In evening dosing group, MMSE result increased from 17,8 ± of 0,3 to 23,5 ± 0,4 points (р = 0,13) vs. 16,9 ± of 0,3 to 20,4 ± 0,4 points (р = 0,148) in morning dosing. Situational anxiety score decreased from 40,0 ± 2,2 to 30,6 ± 1,8 points (р = 0,009) vs. from 40,8 ± of 2,5 to 33,5 ± 1,9 points (р = 0,011), and personal anxiety score from 48,8 ± 2,0 to 26,4 ± of 1,9 points (р = 0,003) and from 44,9 ± of 1,9 to 30,7 ± of 1,7 points (р = 0,008) in evening and morning dosing, respectively. Depressive disorders decreased similarly and slightly in both groups (14,1% versus 7,7% in evening and morning dosing, respectibely, p = 0,214). 
Conclusions. The results indicate that chronotherapy is more effective than the traditional use of a FC of amlodipine, lisinopril and rosuvastatin in HTN associated with MS.

Objective. To assess subjective and objective sleep characteristics and urinary metanephrine levels in patients with insomnia. 
Design and methods. We included patients with insomnia complaints and those without sleep– related complaints (control group) 18–75 years old. Subjective evaluation of the main sleep characteristics during the last month was assessed by the Pittsburgh Sleep Quality questionnaire, daytime sleepiness — by the Epworth Sleepiness Scale. For objective sleep evaluation we performed one-night polysomnography (PSG). Within 1 week after the PSG, daily urine was collected to determine the level of metaepinephrine. 
Results. The groups did not differ by age, mean sleep duration over the past month, number of night awakenings by the Pittsburgh Questionnaire, and level of daytime sleepiness. Sleep latency in insomnia group was 15 minutes longer than in the control group. PSG showed higher apnea-hypopnea and desaturation indices in the control group. There were no differences in daily urinary metanephrine excretion in the main and control groups. Correlation analysis showed no significant association between the metanephrine levels and the severity of somnolence and the index of periodic limb movements. 
Conclusions. Our analysis showed no significant differences in the daily urine metanephrine levels and the main PSG sleep characteristics among subjects with and without insomnia. Further work is required to clarify markers of insomnia and their negative health effects.

Objective. To assess age and sex differences in sleep disorders as risk factors and markers of hypertension (HTN) in 18–39-year old people with normal body weight. 
Design and methods. We performed a cross-sectional study based on the internet survey of 18–39-year-old people with body mass index of 18–25 kg/m2  (n = 2094). The unvalidated questionnaire included 42 questions about various types of sleep disorders and sleep-associated symptoms (0 — never, 1 — rarely, 2 — from time to time, 3 — quite often, 4 — almost all the time). 
Results. The probability of detecting HTN in young men with normal body weight is higher than in women with similar characteristics (p < 0,001). In women, the probability of detecting HTN decreases, starting with the youngest category (18–24 years old), reaching a minimum in the age group 30–34 years old and then starts to increase. By the age of 40, the indicators for men and women become similar. Based on a multivariate analysis, the risk of HTN in young people with normal body weight is associated with both gender and age (p = 0,022). The contribution of gender to age-related changes in sleep complaints was found for snoring (p < 0,001), sleep apnea (p < 0,001), early awakenings (p = 0,002). The contribution of gender was also noted for various symptoms — daytime sleepiness, some symptoms of restless legs syndrome (RLS), anxiety, depression, leg cramps (p < 0,001) and nocturnal heartburn (p < 0,001). The contribution of age was noted for snoring (p < 0,001), sleep apnea (p < 0,001), early awakenings (p < 0,001) and for a variety of symptoms — daytime sleepiness, some symptoms of RLS, anxiety, nocturnal cough, and nocturnal choking. 
Conclusions. Our data can be considered when developing measures for HTN prevention, can be recommended for clinical use, as well as in subsequent clinical studies using validated questionnaires.

Background. Hypertensive intracranial hemorrhage is an extremely serious complication of hypertension, which accounts for 10 % to 20 % of all cerebral strokes. About 50 % patients die within the next year, and their 5-year survival rate does not exceed 30 %. 
Objective. To study the effectiveness of surgical treatment of hypertensive intracranial hematomas using one-portal mini-access and video endoscopic assistance. 
Design and methods. The study included 23 patients with supratentorial intracerebral hypertensive hematomas aged 26 to 70 years (median age 55 (50; 61) years). All patients underwent one-portal endoscopic surgery. The median volume of intracerebral hematoma, calculated according to the Tada formula, was 50 (40; 60) ml. The comparison group included 28 patients who received conservative treatment. The dynamics of the severity was assessed using the Glasgow Coma Scale (GCS), NIHSS, Rankin, Rivermead scales upon admission to the hospital, on days 3 and 7 of treatment, at discharge for outpatient treatment, and after 6 months.
Results. There were no lethal outcomes in either the main group or the comparison group. The hematoma was removed totally in all patients, which was accompanied by a rapid improvement of general cerebral symptoms and, as a consequence, an increase in GCS values from 13 (12; 14) to 13 (12; 15) points by 3rd day after the disease onset. By the 7th day, there was a slow positive dynamic in both groups, however, all patients still had a pronounced or severe disability according to the Rankin scale. After 6 months, patients who underwent surgical treatment showed faster and more complete recovery. 
Conclusions. The results of the study are consistent with current worldwide data on the effectiveness of modern endoscopic technologies in patients with hypertensive intracerebral hemorrhage in relation to the rate and degree of regression of neurological loss.

Myxoma of the heart is the most common variant of a primary benign heart tumor, which is complicated in some cases by embolic complications. Myxoma of the heart is often a diagnostic puzzle in young patients due to a low-symptom or masked clinical manifestations. This case report presents a 37-year-old patient with the onset of left atrial myxoma with mitral valve obstruction manifested with syncope, associated traumatic brain injury, rightsided hemihypesthesia, and speech difficulties. The examination showed multiple lacunar ischemic brain lesions in the middle cerebral artery basin. Transthoracic echocardiography (TTE) showed a large left atrial myxoma with prolapse into the left ventricle. Myxoma was successfully removed. The case highlights the complexity of the diagnosis of cardiac myxoma, associated with the variable clinical manifestations from low-symptomatic cases to the development of cardioembolic complications. Considering recurrent embolic complications, a quick identification of the causes of ischemic stroke in patients without cardiovascular risk factors is important. TTE is a highly specific and sensitive method for the diagnosis of cardiac myxoma. Surgery is a priority treatment method, characterized by a good prognosis for sporadic single-chamber isolated myxomas.

The article presents an observation of a rare clinical arrhythmia — REM-associated advanced atrioventricular block 2nd degree. The absence of structural abnormalities of the heart, the young age and the need for additional methods of instrumental examination for diagnosis (polysomnography, test with the active orthostasis test) are important features of the case. Despite the orphan nature of this arrhythmia, the correct diagnosis is important for the choice of the management strategy choice.

Objective. To assess the effect of combined antihypertensive therapy with ramipril and indapamide on the structural and functional state of the heart, blood vessels, kidneys, autonomic nervous system and liver in hypertensive patients with non-alcoholic fatty liver disease (NAFLD). 
Design and methods. We performed a prospective controlled study including 30 patients with hypertension (HTN) stages I–II, 1–2 degrees with NAFLD (fatty liver index (FLI) > 60) aged 45 to 65 years. Five-seven days before the initial examination, patients discontinued antihypertensive drugs, after the washout period one of the fixed combinations of ramipril (2,5/5 mg/day) and indapamide (0,625/1,25 mg) was prescribed depending on the required dosage and recommendations on lifestyle changes and weight loss were given. Clinical examination, measurement of “office” blood pressure (BP), ambulatory BP monitoring (ABPM), central aortic pressure (CAP), pulse wave velocity (PWV), echocardiography and heart rate variability assessment were performed. The functional state of the kidneys and the structural and functional state of the liver were also assessed before and after treatment. 
Results. After 24-week therapy with a fixed combination of ramipril and indapamide (an average dosage 4,04 ± 1,24 and 1,01 ± 0,31 mg, respectively) target BP levels was achieved. According to ABPM, both daytime and nocturnal systolic BP (SBP) and diastolic BP (DBP) decreased. In addition, CAP (SBPao, DBPa) and augmentation index decreased. There was also a decrease in the stiffness of the arterial wall in muscle-type vessels (PWVm) (p = 0,0166) and in the number of patients with paradoxical test (p = 0,0320). There was a significant increase in creatinine clearance (Cockroft–Gault) after treatment (p = 0,0439) with no increase in glomerular filtration rate (CKD-EPI) (p = 0,1617). There was a significant change in the structural and functional indicators of the heart: increased left ventricular (LV) ejection fraction (p = 0,0398), decreased LV posterior wall thickness (p = 0,0457), LV end-systolic diameter (p = 0,0286), relative wall thickness (p = 0,0419) and LV myocardial mass index (p = 0,0002). There was a decrease in SDNN < 50 (p < 0,0001) and increase in RMSSD (p < 0,0001), which indicates a decrease in the sympathetic activity and an increase in parasympathetic regulation. Also the number of patients with normotonic type of autonomic reactivity in the orthostatic test increased after treatment (12 (24,0%) vs 19 (63,3%), p = 0,0456). The liver function and structure also improved showing decrease in total bilirubin (p = 0,0038) and gamma-glutamyltransferase (p = 0,0498), as well as the indices of liver steatosis (p = 0,0278) and fibrosis (p = 0,0166). 
Conclusions. Thus, combined antihypertensive therapy with ramipril and indapamide is well tolerated by patients, highly effective and demonstrates organoprotective properties regarding the heart, blood vessels, kidneys, autonomic nervous system and liver.