Telehealth is one of the promising methods to reduce the burden of uncontrolled hypertension. However, its wide implementation is limited by a few unknowns. In this review we discuss three key questions that ought to be answered in planned or ongoing trials. These relate to target patient populations, to the most appropriate technical features, and to the duration of follow-up.

We present a literature review on short-/long-term management of women with postpartum hypertension (HTN). Future health risks for women with a history of hypertensive disorders of pregnancy (preeclampsia and gestational HTN) are listed. Nonpharmacological therapy and medications for cardiovascular risk management in women with adverse pregnancy outcomes are considered. Inter-pregnancy care details for women with HTN are given.Hypertension-related reasons to discontinue breastfeeding are listed. Medical, ethical and legal issues of a decision-making process in hypertension management during lactation are considered. Sources of reliable information on compatibility of medications and breastfeeding, as well as the information about the use of antihypertensive medications during lactation from LactMed database and package leaflets are given. Dyslipidaemia in women with postpartum HTN is considered and approaches to lipid-lowering medication during breastfeeding (statins, ezetimibe and PCSK9 inhibitors) are discussed. Both known (aspirin, calcium) and investigated (metformin, statins, hydroxychloroquine) prevention modalities in preeclampsia are presented. The implementation of multidisciplinary maternal health clinics for women with a history of HTN pregnancy is reported.

The combination of hypertension (HTN) and breast cancer (BC) is one of the most frequent clinical variants of comorbidity of cardiovascular and oncological diseases. Each of these pathologies is associated with risk factors, which are cross-cutting. The review presents an analysis of pathophysiological processes characterizing the nonrandomness of the co-existence of HTN and BC (chronic systemic inflammation, oxidative stress, endothelial and mitochondrial dysfunction, accelerated cellular aging, and other). Antitumor therapy of BC is often associated with vasculotoxic effects that provoke a transient or sustained increase in blood pressure. Adverse cardiovascular events may interfere with the implementation of antitumor therapy of BC. Interdisciplinary cooperation of cardiologists and oncologists in HTN and BC comorbidity will allow personifying algorithms for the prevention, diagnosis and treatment of these pathologies.

Background. Pathological vascular calcification in hypertension (HTN) is studied worldwide. The relationship between endothelial dysfunction (ED) and vascular wall calcification in HTN has been demonstrated, and an increase in the level of fibroblast growth factor (FGF23) is considered one of the contributing factors. The aim of the study was to assess the incidence and severity of thoracic aortic calcification, and its relationship with fibroblast growth factor and ED in patients with resistant HTN.

Design and methods. Ninety-two patients with resistant HTN were included. All of them underwent: 24-hour blood pressure monitoring (ABPM), the assessment ofendothelial function, the thoracic aortic calcium (TAC) index using multispiral computed tomography, and the level of FGF23.

Results. According to the results of ABPM, patients were divided into group 1 with controlled HTN (n = 44) and group 2 with uncontrolled (n = 48) resistant HTN. In the 2nd group, there was an increase in TAC and ED, in both groups, changes in the blood flow velocity were recorded. There were no significant differences in FGF23 levels between the groups. We found a positive relationship between TAC and pulse pressure according to the results of ABPM (r = 0,49, p = 0,007), HTN duration (r = 0,68, p = 0,04) and a negative relationship with the duration of regular antihypertensive therapy (r = –0,33, p = 0,02). In addition, participants with higher FGF23 levels were older (r = 0,663, p = 0,006) and had a longer history of HTN (r = 0,57, p = 0,03).

Conclusions. In patients with resistant HTN, ED and calcification of the thoracic aorta are more pronounced when the target blood pressure level is not achieved. The level of FGF23 is associated with an increase in the resistance indices assessed by dopplerography of the brachial artery and the severity of calcification of the thoracic aorta.

Objective. To investigate factors associated with arterial hypertension (HTN), evaluate their interrelationship in rotational shift workers in the Arctic.

Design and methods. In the polar settlement of Yamburg (68 N), on the basis of Health Service LLC “Gazprom Dobycha Yamburg” medical unit, 183 out of 213 subjects were enrolled in the study: 100 males (M) aged 48,8 ± 8,4 years, 83 females (F) aged 49,7 ± 7,1 years (p = 0,443), comparable in te duration of rotational shift work: 16,5 ± 8,6 and 16,3 ± 8,9 years, respectively. Patients were divided into 2 groups according to the level of blood pressure (BP): Group 1 (Gr. 1) included 86 individuals with HTN1, 2 stages (BP > 140/90 mm Hg); Group 2 (Gr. 2) comprised 97 individuals with BP < 140/90 mm Hg. Ultrasound examination of carotid arteries was performed, and the indicators of local arterial stiffness (Peterson’s elastic modulus (Ep), β-stiffness) were assessed. The following diagnostic procedures were performed: ambulatory BP monitoring; cardio-ankle vascular index (CAVI) and pulse wave velocity (PWV) assessment; echocardiography with the assessment of probability for heart failure with preserved ejection fraction (HFpEF) by the H2FPEF score (Heavy; Hypertensive; Atrial Fibrillation; Pulmonary Hypertension; Elder; Filling Pressure); biochemical blood tests with the evaluation of homocysteine, high-sensitivity C-reactive protein (hs-CRP), pro-brain natriuretic peptide (pro-BNP).

Results. In Gr. 1 vs Gr. 2, elevated levels of left CAVI (p = 0,022) and right CAVI (р = 0,045) were registered; PWV in Gr. 1 was significantly higher than in Gr. 2 [right (p < 0,001) and left (p < 0,001)], and homocysteine (p = 0,025) level was higher in HTN group. Probability of HFpEF by the H2FPEF score was higher in Gr. 1 than in Gr. 2 (р < 0,001). According to logistic regression analysis, there was a relationship between HTN and PWV (odds ratio (OR) = 1,44; 95% confidence interval (CI) 1,22–1,75), 24-hour diastolic BP variability (DBPV24) (OR = 1,16; 95% CI 1,01–1,38), with the probability of HFpEF (OR = 1,67; 95% CI 1,23–2,33). Peterson’s elastic modulus (Ep) correlated with left ventricular myocardial mass (LVMM) (r = 0,39, p < 0,01), left ventricular myocardial mass index (LVMMI) (r = 0,39, p < 0,01), HFpEF probability (r = 0,27, p < 0,01); while β-stiffness index of common carotid arteries correlated with LVMM (r = 0,25, p < 0,01).

Conclusions. According to logistic regression analysis results, relationship between PWV, DBPV24 and signs of HFpEF by the H2FPEF score and HTN was registered in rotational shift workers in the Arctic region. Obtained data defined HTN as a risk factor for HFpEF even in asymptomatic patients and might be taken into account for cardiovascular prevention in terms of rotational shift work. The associations of arterial stiffness with LVMM and LVMMI, signs of HFpEF by the H2FPEF score may indicate simultaneous interconnected processes of arterial and cardiac stiffness formation.

Objective. To study the relationship of abdominal obesity (AO) with the development of fatal and non-fatal cardiovascular events among residents of the Chui region of the Kyrgyz Republic, taking into account gender and ethnicity.

Design and methods. This study was carried out as part of the international epidemiological study “Interepid”. The total follow-up period was 7 years. Life status at the end of the follow-up was monitored in 1096 respondents out of 1341 initial cohorts (response 82,1%). Cases of fatal and non-fatal cardiovascular events were included as endpoints in the analysis. The frequency of events was assessed using methods of analysis of survival (Cox proportional hazard regression model, parametric survival models, Kaplan–Meier survival analysis).

Results. 181 cases of fatal and non-fatal cardiovascular events (16,44%) were registered during the follow-up. A significant effect of AO on the incidence of cardiac complications in the analyzed cohort was demonstrated. Thus, in respondents with AO, the total frequency of cardiovascular events reached 21,31% and was significantly higher than in those without AO (10,69%, p < 0,0001). An increase in the frequency of events in the presence of AO was recorded in all analyzed subgroups (men, women, Russians, Kyrgyz). The construction of a Cox regression model with a logistic regression analysis made it possible to confirm the independent role of AO in the development of fatal and non-fatal cardiovascular events, which was most pronounced in women and respondents of the Kyrgyz ethnic group. At the same time, on average for the cohort, an increase in waist circumference value by 1 cm is accompanied by an increase in cardiovascular risk by 1,9%.

Conclusions. The presence of AO is an independent risk factor for the development of fatal and non-fatal cardiovascular events in the analyzed cohort of residents of the Chui region, mostly among women and respondents of the Kyrgyz ethnic group.

Background. Endothelial dysfunction (ED) involved in the pathogenesis of rheumatoid arthritis (RA) is more associated with the endothelial glycocalyx (EGC) condition. EGC thinning is an independent predictor of cardiovascular complications that is why it is important to determine the risk factors (RF) that most affect EGC in RA.

Objective. To study the relationship between the endothelium condition and RF for an RA unfavourable course and cardiovascular risk (CVR).

Design and methods. The study involved 103 patients aged 18 to 69 years of both sexes with active RA. A dark-field microscope was used to assess the EGC condition. In the microcirculatory bed, it allows you to evaluate the depth of erythrocyte perfusion in the EGC thickness (PBR), micro vessel density (VMD) and the number of erythrocytes in them (RBC Filling). An increase in PBR indicates EGC thinning and is a marker of ED. A decrease in RBC Filling and VMD indicates a decrease in the functioning vessels number. Circulating syndecan1 (Sdc1) was assessed as a laboratory EGC damage marker. As a result of a two-step cluster analysis, based on dark-field microscopy, two clusters were identified in the study cohort. They were compared in terms of RF for an unfavourable course of RA and CVR.

Results. Patients belonging to cluster 1 had thinner EGC (high PBR), low perfusion (low RBC Filling) and density (low VMD) of microvessels, higher levels of Sdc1 than in cluster 2. This indicates a significant impairment of microcirculation in cluster 1. Among the studied RF for an unfavorable course of RA and CVR, cluster 1 differed only in a lower frequency of taking disease-modifying antirheumatic drugs (DMARDs) compared to the other cluster. In the future, it was associated with the 3,6-fold greater need for DMARD therapy modification.

Conclusions. The lack of DMARD therapy, compared with the other RF for the unfavorable course of RA and CVR, makes the greatest contribution to EGC damage and microcirculation disorders in patients with active RA. The revealed changes confirm relationship between endothelial disorders and the pathogenesis of this disease and determine the leading role of DMARD therapy in the RA treatment.

Background. Pulmonary arterial hypertension (PAH) is a group of diseases characterized by the damage to the intra pulmonary vessels and the development of right ventricular insufficiency. The pathogenesis of PAH is not fully understood. Remodeling of the extracellular matrix is one suggested mechanism. However, the wide variety of its structures and proteins, as well as the complexity of the relationships between them represent a large field for research work. The aim of the study was to study the features of expression and distribution of extracellular matrix proteins in patients without and with PAH.

Design and methods. Archival autopsy material of lungs from 16 patients with various types of PAH was used, autopsy material from 7 patients who died from hemoblastosis was selected as a comparison group. In addition to histological examination, immunohistochemical examination was performed with the following markers: matrix metalloproteinase 9 (MMP9), filamin A, fibulin 5, collagen V, surfactant protein A, SI00, Ki67.

Results. All patients with PAH had advanced morphological stages of pulmonary hypertension with the formation of plexiform structures. Immunohistochemical examination of the lungs of patients with PAH showed an increase in MMP9 expression and a tendency to increase the number of nerve fibers compared to the group of patients without PAH, while the expression of filamin A, fibulin 5, collagen V, surfactant protein A in the pulmonary arteries and parenchyma was reduced. It should be noted that despite the heterogeneity of the patient’s sample, a similar change in the expression profile of extracellular matrix proteins in the pulmonary arteries and lung parenchyma was shown, which requires further in-depth study in a larger sample of patients.

Conclusions. The study of extracellular matrix markers and features of lung innervation in PAH in humans will contribute to the search for targeted drugs and the involvement of interventional technologies for the treatment of PAH.

Hypertension (HTN) is one of the most important risk factors for the development of chronic heart failure (CHF). The presented clinical case demonstrates the peculiarities of diagnosis and treatment of the patient with CHF with reduced ejection fraction, resulted from uncontrolled HTN. Lifestyle modification and adequate antihypertensive treatment during 5 years led to blood pressure control and improved myocardial contractility, resulting in the reduction of CHF manifestations.