The review analyzes milestone information about the function and pathogenic significance of human angiotensin-converting enzyme 2 (ACE2). ACE2 is involved in the development of diseases such as hypertension, malabsorption of certain amino acids in the intestine, and a new type of pneumonia COVID-19 caused by the SARSCoV-2 virus. Based on the latest literary sources, an assessment is made of the role of differential expression of receptor and soluble forms of this protein in the functioning of the renin-angiotensin-aldosterone system, as well as the mechanisms of ACE2 participation in the sequential chemical conversion of angiotensin II and its effect on the function of the cardiovascular system. The role of ACE2 in the development of inflammatory processes in the intestine and its effect on the composition of the intestinal microbiota are also discussed. In addition, the review presents most general data on the proteolytic activation of the S-glycoprotein of the SARS-CoV-2 virus and its participation, together with ACE2, in the process of virus introduction into the host cell. In conclusion, the hypothesis about autoimmune complications of COVID-19 associated with the formation of the S-glycoproteinACE2 immune complex and the production of autoantibodies is considered.

Objective. The aim of the systematic review was to find an answer to the question: «does an increased blood pressure affect kidney function at young age?».

Design and methods. The following key words were used to search for relevant publications: “hypertensive nephropathy”, “reduction of glomerular filtration rate in arterial hypertension” in Russian and English. We used “eLIBRARY.RU — SCIENTIFIC ELECTRONIC LIBRARY” and PubMed.gov databases. The inclusion criteria were the young age of the examined patients (from 18 to 44 years), the absence of concomitant pathology. The analysis included only publications of the last 5 years (2015-2020).

Results. A total of 18 articles were selected from Russian and international databases that meet inclusion criteria.

Conclusions. Based on the analysis of the literature of the last 5 years we assume that increase in blood pressure disrupts kidney function in young people. However, the current data a number of limitations. Until now, gender characteristics, risk factors for decreased renal function in hypertension in young people, and most importantly, the pathogenetic basis of renal dysfunction remain unclear.

Objective. To analyze the results of clinical studies on pulmonary artery denervation (PADN) for pulmonary hypertension treatment.

Design and methods. Study search was conducted in PubMed/Medline, Cochrane, Elibrary databases. The analysis included studies of surgical and transcatheter PADN. To assess the effectiveness of the PADN procedure, a mean pulmonary artery pressure (mPAP) and a 6-minute walk test distance (6-MWT) were selected. For each study, the mean change in mPAP and 6-MWT were calculated and included in the analysis.

Results. A total of 8 studies were analyzed: 4 randomized and 4 observational, 320 patients were included in the study, of which 222 patients underwent PADN. The etiology of pulmonary hypertension (PH) was different in each study and included patients with idiopathic PH, PH associated with heart failure, chronic thromboembolic PH. According to the combined data analysis, mPAP decreased in all studies, and the overall change in mPAP was –8,59 [95 % confidence interval (CI) –10,96; –6,23]. The average increase in 6-MWT among studies was 60,00 [95 % CI 35,74; 84,27].

Conclusions. Despite serious limitations (a small number of studies and subjects enrolled, non-randomized design of a half of the studies, high heterogeneity of data), this analysis demonstrated the association of the PADN procedure with a decrease in pulmonary artery pressure and prolongation of the 6-minute walking distance in patients with PH of various etiologies.

Objective. Evaluation of the possibility of a fixed combination of azilsartan medoxomil + chlorthalidone in additional angioprotection in patients with arterial hypertension (HTN) and high pulse wave velocity (PWV) after confirmed severe or extremely severe COVID-19 (bilateral polysegmental viral pneumonia) treated by genetically engineered biological drugs, who had not previously received combined antihypertensive therapy.

Design and methods. An open observational study lasting 12 weeks included 30 patients, 28–31 days after discharge from the hospital after a severe and extremely severe COVID-19, who received or had not previously received antihypertensive therapy. Patients underwent 24-hour blood pressure (BP) monitoring, applanation tonometry (augmentation index and central BP), measurement of PWV, laboratory tests before and after prescription of a fixed combination of azilsartan medoxomil + chlorthalidone.

Results. At baseline, patients showed an increase in office blood pressure to 153,06/92,2 mmHg. After treatment with a fixed combination of azilsartan medoxomil + chlorthalidone, a decrease in systolic BP by 18,47% and diastolic BP by 16,24% was observed. According to ambulatory BP monitoring, the decrease in systolic BP was 19,65% and diastolic BP — 24,68%, PWV decreased by 34,4%, augmentation index — by 9,42%, central systolic BP — by 15,48% (p < 0,05). At baseline, vascular age (VA) was increased to 44,96 years compared to the passport age of 35,03 years. After treatment, there was a significant decrease in VA to 38,74 years (p < 0,01). In addition, the levels of C-reactive protein, fibrinogen, D-dimer, glucose, blood urea nitrogen and uric acid significantly decreased.

Conclusions. The fixed combination of azilsartan medoxomil + chlorthalidone provides better control of BP. It also helps to improve vascular elasticity (augmentation index, PWV, central systolic BP, decrease in VA) and to reduce post-infectious inflammation in HTN patients after a severe coronavirus infection.

Objective. To determine the presence or absence of the effect of therapy with renin-angiotensin-aldosterone system (RAAS) blockers in patients with COVID-19.

Design and methods. We examined 57 patients who were treated in a medical unit at the FGAU CEC “Patriot” in the period from October to November 2020, with the diagnosis of “New coronavirus infection” and differed in the prescribed antihypertensive therapy. In group 1, drugs that affect the RAAS were used to treat hypertension before COVID-19 onset and during the treatment of COVID-19. In group 2, other drugs were used as the main antihypertensive agents before and during treatment for COVID-19. The severity of pneumonia in patients according to the results of computed tomography was 1–2. The patients were monitored for anthropometric indicators, body temperature, and laboratory data.

Results. Groups 1 and 2 are comparable, differing only by height, but not by body mass index. The duration of treatment in group 2 was 1–2 days shorter than in group 1, but the result is not statistically significant due to the small sample. Thus, the hypothesis that differences between previous and ongoing antihypertensive therapy throughout the COVID-19 treatment period may affect the course and effectiveness of treatment has not been confirmed.

Conclusions. Concomitant antihypertensive therapy with RAAS blockers does not alter the course of COVID-19 infection in patients. The duration of COVID-19 in patients receiving RAAS system blockers may be one day longer than for patients receiving other antihypertensive therapy.

Background. Acute stroke is a highly specific neurological symptom in the acute phase of COVID-19. Hemorrhagic stroke (HS) is an infrequent, but life-threatening complication of COVID-19.

Objective. To analyze etiopathogenetic factors and the course of HS associated with COVID-19.

Design and methods. A retrospective analysis of 27 medical histories of patients with HS associated with COVID-19 (the main group) and 14 medical histories of patients with HS not related to COVID-19 (the control group) was performed. In the main group, COVID-19 was confirmed by the positive polymerase chain reaction method. HS developed before COVID-19 symptoms in 10 (37,04%) patients and after 4–16 days of COVID-19 symptoms onset in 17 (62,96%) patients.

Results. Our study indicates significant differences in blood pressure (BP), respiratory system parameters, laboratory data, neuroimaging data in patients of the main and control groups. Coagulopathy, thrombocytopenia, hypoxia, and the renal and hepatic failure play a significant role in the development of HS associated with COVID-19 compared to the classic HS (without COVID-19), where hypertension seems to be the important. At the same time BP is significantly lower in the main group.

Conclusions. The etiopathogenetic factors and the course of HS associated with COVID-19 require pathogenetically different therapy compared to HS without COVID-19.

Objective. To assess cardiovascular functional adaptation in athletes with different levels of blood pressure (BP) in the Republic of Sakha (Yakutia).

Design and methods. We examined 147 professional athletes of high sportsmanship (average age 22 (18; 26) years), cyclic and speed-weightlifting sports. All athletes underwent anthropometry, measurement of office BP and daily BP monitoring, exercise test (PWC170), with determination of maximum oxygen consumption, assessment of the reserve capacity of the cardiovascular system, echocardiography.

Results. Masked hypertension (MH) was detected in 40,8% of athletes, normal BP in 59,2%. All athletes showed a high tolerance to physical activity; athletes with MH showed high indices of left ventricular (LV) wall thickness and myocardial mass index compared with athletes with normal BP. The athletes with MH achieve a high level of physical performance due to a less efficient hemodynamic mechanism and energy-intense regimen. A positive correlation was found between LV wall thickness and indicators of cardiovascular functional reserves.

Conclusions. MH was detected in 40,8% athletes. In athletes with different BP levels, quantitative and qualitative differences in ensuring physical performance are expressed by the ratio between the “initial” (rest) and “maximum” (test with physical load) indicators of the functional state. Thus, in athletes with MH, inefficient hemodynamic and energy-intensive processes can lead to overstrain of the cardiovascular system. Indicators of functional reserves of the cardiovascular system positively correlate with indicators of LV myocardial wall thickness and myocardial mass index, which may indirectly indicate the relation between cardiovascular overstrain in athletes with MH and target organ damage (LV hypertrophy).

Objective. The purpose of the work was to assess the application of modified ways of polyhepatography (PHG) and peripheral arterial tonometry (PAT) in the evaluation of regulation of peripheral circulation (capillary blood flow).

Design and methods. We included 150 people, divided into four groups. The first group (n = 40) includes patients with stage II hypertension, moderate and high risk of cardiovascular complications. The second group (n = 40) includes patients with stable forms of coronary heart disease in combination with hypertension. The third group (n = 40) includes patients with chronic liver diseases. The fourth group (n = 30) consisted of subjects without anamnestic and objective data of pathology. All subjects underwent a comprehensive clinical and laboratory examination, an assessment of intrahepatic hemodynamics by the PGG method, an assessment of the endothelial function by the PAT method. A modified method of PAT was used to evaluate the central reaction of the peripheral blood flow regulation system (endothelium-independent vasodilation).

Results. Endothelial dysfunction was found in patients with cardiovascular pathology and in patients with chronic liver diseases. A modified method of PAT showed a multidirectional reaction of peripheral blood flow to the test with local ischemia. A number of features were identified in the study groups when assessing disorders of intrahepatic microcirculation. Patients of group I had multidirectional disorders of arteriovenous inflow (45% cases, confidence interval (CI) from 27 % to 63 %) and outflow (37,5 %, CI from 22 % to 56 %) in the liver, while in patients of group II and group III, disorders of arteriovenous inflow were more common, 85 % (CI from 70 % to 95%) and 90% (82 % to 94%), respectively. Rheographic signs of bile passage disorders were more common in groups II  and III. A significant negative relationship was established between endothelial dysfunction and the severity of intrahepatic microcirculation disorders (r = –0,35, p < 0,001).

Conclusions. Modified methods of peripheral arterial tone and PHG enable assessment of local and central mechanisms of blood flow regulation at the microvascular level in patients with hypertension, coronary heart disease and chronic liver diseases. The relationship between impaired endothelial function and intrahepatic microcirculation allows us to consider the liver as a target organ in cardiovascular pathology.

Objective. To evaluate the impact of fosinopril versus zofenopril on the regulatory adaptive status (RAS) in hypertensive patients with chronic heart failure (CHF) with preserved left ventricular (LV) ejection fraction (EF).

Design and methods. The study inclded 67 hospitalized patients with hypertension (HTN) and CHF I–II NYHA functional classes with LV EF ≥ 50 %, who were randomized into two groups for treatment with fosinopril (13,8 ± 4,1 mg/day, n = 32) or zofenopril (17,9 ± 5,9 mg/day, n = 35). All patients additionally received nebivolol (7,1 ± 1,9 and 6,9 ± 1,8 mg/day), and if needed, atorvastatin and acetylsalicylic acid were prescribed. At baseline and after 24 weeks, we performed quantitative assessment of RAS-regulatory-adaptive capabilities (by cardio-respiratory coupling test), echocardiography, treadmill test, six-minute walking test, assessment of the N-terminal brain natriuretic pro-peptide level in blood plasma, subjective evaluation of quality of life (QL).

Results. Fosinopril versus zofenopril led to a greater improvement of RAS (by 69,0%, p < 0,01 versus 41,1%, p < 0,01) and to a higher increase in tolerance to physical activity: longer distance in a six-minute walk test (by 28,1 %, p < 0,05 versus 25,9 %, p < 0,05), improvement in functional class of CHF (from II to I in 56 % of patients, in 25 % CHF was not registered versus change from II to I in 42 % of patients, and no CHF in 14 %). In both groups, cardiac diastolic function improved (decreased VE/Ve by 39,5%, p < 0,01 and 37,8%, p < 0,01), neurohumoral hyperactivity reduced (NT-proBNP decreased by 40,6 %, p < 0,01 and 39,4 %, p < 0,01), and subjective QL increased (decrease in the amount of negative points by 69,3%, p < 0,01, and 64,9 %, p < 0,01).

 Conclusions. In HTN patients with CHF with preserved LV EF, fosinopril versus zofenopril may be preferable due to a greater impact on regulatory and adaptive capabilities. 

 This article presents a clinical case of an asymptomatic myocardial damage associated with the chemotherapy. Myocardial lipomatosis developed in a 23-year-old patient with cancer of the right breast after 4 AC chemotherapy cycles. The death resulted from the rupture of a 14 cm saccular aneurysm of the internal carotid artery. This article presents both the data of instrumental and laboratory tests and pathomorphological analysis.