Objective. To determine the diagnostic criteria for asymptomatic hyperuricemia as a cardiovascular risk factor, the need for antihypertensive therapy and urate-reducing therapy in patients with hypertension; to develop an algorithm for the management of hypertensive patients with asymptomatic hyperuricemia. Search strategy and methodology. The following key words were used for the search: “asymptomatic hyperuricemia” and “hypertension” in four databases — PubMed, Medscape, E-library Yandex.ru. Results. The review included 79 sources, including 1 monograph, 11 international and Russian guidelines, consensus documents, 67 reviews, observational, non-randomized, randomized clinical trials, their meta-analyses, requirements for uric acid blood tests. The review presents a definition, prevalence and diagnostic criteria for asymptomatic hyperuricemia, depending on the assessment method and factors affecting the concentration of uric acid, as well as the pathogenetic mechanisms of hyperuricemia. The linear relationship between uric acid level with the risk of hypertension, dyslipidemia, cardiovascular diseases and complications. The review discusses drug-induced hyperuricemia, the effect of various antihypertensive and lipid-lowering drugs on the blood concentration of uric acid, the indications for urate-reducing therapy in asymptomatic hyperuricemia. Conclusions. An algorithm for the management of patients with asymptomatic hyperuricemia and hypertension is proposed.

Background. Today, the Goldblatt model of hypertension “2 kidneys, 1 clamp” has been investigated in a large number of experimental studies. The activation of the renin-angiotensin system (RAS) underlies the development of this type of hypertension. The main buffer of the RAS is the atrial natriuretic peptide (ANP), its level is significantly increased in response to blood pressure (BP) elevation and high concentration of angiotensin II and Na+. ANP has a pronounced hypotensive effect. Clinical and experimental studies show that unilateral renovascular hypertension (URH) does not always develop even in significant stenosis of the renal artery. The purpose of this work is to investigate the activity of the RAS and the ANP, shifts in the water-electrolyte balance and renal sympathetic nervous activity via meta-analysis, to evaluate hypertensive and hypotensive mechanisms in the model of renovascular hypertension “2 kidneys, 1 clamp”. Design and methods. The meta-analysis was carried out by statistical program Review Manager 5.3 (Cochrane Library). In a meta-analysis, we used 76 publications of experimental studies of the model of renovascular hypertension in rats. Results and conclusions. The meta-analysis showed that the maintenance of URH is ensured by the high activity of the RAS and the sympathetic nervous system, as well as hypokalemia and cardiovascular remodeling. However. there is no convincing evidence of the effect of sodium-volume-dependent mechanisms on BP elevation in this model of hypertension.

Resistant arterial hypertension (HTN) is a significant risk factor for cardiovascular disease and mortality. Such clinical conditions as obesity, obstructive sleep apnea and hyperaldosteronism are interrelated links of the clinical phenotype of these patients. At the same time, these conditions are interrelated by the pathophysiological basis, i.e. activity of the sympathetic nervous system. Objective. To systematize data on the role of persistent sympathetic nervous system hyperactivation in the development and progression of resistant HTN. Design and methods. We searched for clinical studies and systematic reviews in databases (PubMed, Cochrane Library) examining the role of sympathetic overdrive, as well as treatment methods for resistant HTN aimed at blocking sympathetic activation. Results. Increased activity of the sympathetic nervous system is one of the most important links in the formation of resistance to antihypertensive therapy. Moreover, it is the chronic sympathetic overdrive that unites the most common risk factors of resistant HTN, namely obstructive sleep apnea, obesity and insulin resistance, renin-angiotensin system activation, and aldosterone hyperproduction. Conclusions. The increased interest in the study of the sympathetic nervous system in recent decades has contributed to the accumulation of new data on the pathophysiological and clinical aspects of resistant HTN, as well as expanded its treatment methods by introducing into clinical practice the technique of sympathetic denervation of the renal arteries. Further study of sympathetic activation contributes to the development of new therapeutic techniques and will change the management of patients with resistant HTN.

The review article presents the stages of the use of menopausal hormone therapy (MHT) from the standpoint of primary and secondary prevention of the risk of developing coronary heart disease (CHD) and deaths. Based on the data obtained, a number of guidelines and statement documents have been updated to reflect the need to comply with the “time hypothesis” in the appointment of MHT in order to improve the prognosis. The arguments of the possible use of MHT are shown both in the primary prevention of cardiovascular diseases in women with cardiovascular risk factors, and in patients with a history of coronary artery disease, myocardial infarctions, with the development of chronic heart failure and atrial fibrillation. In 2021, a proposal was put forward to determine the choice of MHT depending on the cardiovascular risk groups (CVR). However, such an approach to the choice of MHT excludes the personification and individualization of the possibility of using this method of treatment in the presence of certain factors of low, intermediate CVR, such as arterial hypertension, hypercholesterolemia, type 2 diabetes mellitus and others, especially with their good control. Therefore, the adoption of clinical decisions on the use of MHT in conditions of high CVR and the presence of individual clinically significant risk factors should be carried out by a multidisciplinary team, which will exclude both unmotivated prohibitions and appointments in the presence of contraindications.

Objective. To determine the predictors of the development of masked nocturnal hypertension (HTN) in treated patients of low and moderate cardiovascular risk (CVR). Design and methods. The study included 94 patients with treated HTN of low and moderate CVR without verified cardiovascular diseases. The median age was 42,24 ± 8,08 years. Patients were examined in accordance with the Clinical guidelines on HTN of the Russian Society of Cardiology, approved by the Ministry of Health of the Russian Federation (2020). Patients were divided into two groups depending on the presence or absence of masked nocturnal hypertension. The first group consisted of 54 (57,4 %) patients with masked nocturnal hypertension, the second group — 40 (42,6 %) patients with HTN and target indicators of office blood pressure (BP) and BP according to 24-hour BP monitoring. Results. A direct strong correlation between systolic BP at night and uric acid levels (r = 0,62, p < 0,001), a direct moderate relationship with the cardio-ankle-vascular index (CAVI1) (r = 0,31, p = 0,002), and an inverse moderate relationship with the concentration of high-density lipoprotein cholesterol (HDL cholesterol) (r = -0,47, p < 0,001) were found. When conducting logistic regression analysis and constructing a ROC-curve, the following predictors of the development of masked nocturnal HTN were established: an increase in uric acid > 389 μmol/l, a decrease in HDL < 1,49 mmol/l, an increase in the CAVI1 index > 6,9. Conclusions. In effectively treated patients with HTN with moderate and low CVR, the development of masked nocturnal HTN is associated with an increase in uric acid levels > 389 μmol/l, regardless of sex, an increase in the CAVI1 index > 6,9 and a decrease in HDL cholesterol levels < 1,49 mmol/l.

Objective. To identify features of arterial stiffness, to establish relationships with indicators of the daily blood pressure profile and peripheral artery disease in patients with hypertension (HTN) in combination with subclinical and manifested atherosclerotic lesions of the arteries of the lower extremities. Design and methods. 120 patients were divided into 3 groups: group 1-46 patients with HTN and clinically manifested AALE, group 2-39 patients with HTN and asymptomatic AALE, group 3-35 HTN patients without AALE. All patients underwent general clinical laboratory and instrumental research methods, including 24-hour blood pressure ambulatory monitoring (24h-ABPM) with the assessment of 24-hour blood pressure profile and arterial stiffness parameters, ultrasonic triplex scanning (USTS) of the arteries of the lower extremities. Statistical data processing was carried out using Microsoft Office Excel 16 (2015, Microsoft, USA), Statistica 10.0 (StatSoft, USA), IBM SPSS Statistica 26.0 (IBM, USA). Results. Higher values of pulse wave velocity (PWVao), augmentation index (AIx) and ambulatory arterial stiffness index (AASI) were found in the 1^st group in comparison to the 2^nd and 3^rd groups (p < 0,05). Lower reflected wave transit time (RWTT) (119,5 [112;127] ms) was found in the 1^st group (128 [122;132], p = 0,001 and 126 [121;129] ms, p = 0,03 in the 2^nd and and 3^rd groups, respectively) groups. The maximum rate of blood pressure increase (dP/dt_max) in patients of the 1^st (550 [466;666] mm Hg/s) and 2^nd (634 [511;695] mm Hg/s) groups was significantly lower than in patients of the 3^rd group (655 [526;806] mm Hg/s, p < 0,05). A direct correlation was found between AASI values and SBP (r = 0,291, p = 0,049) and its variability (r = 0,301, p = 0,042), AASI and PBP (r = 0,518, p < 0,001), its variability (r = 0,596, r < 0,001) in group 1, as well as AASI and PBP (r = 0,514, p < 0,001) and PBP variability (r = 0,632, p < 0,001) in group 2. A correlation between AIx and the degree of stenosis (%) of the arteries of the lower extremities was found in patients with AH and AALE of varying severity (r = 0,310, p = 0,004). Conclusions. In patients with subclinical course of AALE, lower values of dP/dt_max in comparison with HTN patients without AALE indicate an increase in arterial stiffness at the initial stages of peripheral atherosclerosis. Clinically manifested atherosclerotic lesions of the arteries of the lower extremities in HTN patients are associated with a more pronounced increase in arterial stiffness, which contributes to a higher cardiovascular risk.

Background. Cardiovascular disease is one of the major causes of death throughout the world. Early detection of target organ damage is important for more successful cardiovascular prevention and improvement of patient outcomes. Vascular wall is one of the target organs, and its damage is associated with the loss of elastic properties and increase in stiffness. The increased vascular stiffness is an independent predictor of cardiovascular risk. Objective. To evaluate parameters of the 24-hour arterial stiffness monitoring in hypertensive and normotensive patients with bronchial asthma. Design and methods. The study enrolled 100 patients with asthma. The control group included 30 healthy volunteers matched by gender and age. Each patient underwent ambulatory blood pressure and arterial stiffness monitoring using BPLab MnSDP-2 device (Petr Telegin, Russia). Results. Normotensive patients with asthma show higher values of arterial stiffness index and pulse wave velocity in the aorta in comparison with the control group. Comorbid patients with bronchial asthma and hypertension show the highest arterial stiffness. Conclusion. Patients with asthma with and without hypertension demonstrated significantly increased arterial stiffness in comparison with control group.

Objective. To determine the blood concentrations of biomarkers of fibrosis and inflammation in patients with metabolic syndrome (MS), atrial fibrillation (AF) and obstructive sleep apnea (OSA) and to establish their role in the formation of left atrial myocardial fibrosis. Design and methods. A cross-sectional case-control study included 286 patients aged 35 to 65 years: 78 patients with MS(+)/AF(+)/OSA(+), 79 patients with MS(+) / AF(+)/OSA(-), 73 patients with MS(+)/AF(-)/OSA(+) and 56 patients with MS(+)/AF(-)/OSA(-). Patients with AF and MS (n = 71) were assessed for the severity of left atrial myocardial fibrosis with electroanatomical mapping. Results. It was found that the concentration of profibrogenic biomarkers circulating in the blood of patients with MS(+)/AF(+)/OSA(+) is higher than in patients with MS(+)/AF(-)/OSA(+): galectin-3 (13,4 (8,5-17,6) and 8,4 (5,1-11,6) pg/ml, p < 0,0001), growth differentiation factor-15 (GDF-15) (1648,3 (775,32568,1) and 856,0 (622,5-1956,4) pg/ml, p < 0,0001), N-terminal peptide of type III procollagen (PIIINP) (95,6 (78,6-120,4) and 50,6 (38,9-68,3) ng/ml, p < 0,0001), N-terminal peptide of type I procollagen (PINP) (3459,4 (2167,1-4112,1) and 2355,3 (1925,0-3382,1) pg/ml, p < 0,0001). In the examined cohort of patients with OSA, positive correlations were found between galectin-3 and cardiotrophin-1 (r = 0,410, p = 0,00002), galectin-3 and GDF-15 (r = 0,430, p = 0,0003), galectin-3 and PIIINP (r = 0,451, p = 0,0001). Correlation analysis showed a strong positive relationship between the apnea/hypopnea index (AHI) and blood concentrations of GDF-15 (r = 0,661, p < 0,00001), galectin-3 (r = 0,519, p < 0,00001), interleukin 6 (r = 0,310, p = 0,0001) and C-reactive protein (CRP) (r = 0,361, p = 0,002). Negative correlations of the average level of SpO2 with CRP (r = -0,354, p = 0,001), galectin-3 (r = -0,451, p < 0,00001), GDF-15 (r = -0,637, p < 0,00001) were found. In patients with AF and OSA, fibrosis was more severe than in patients with AF without OSA (28,6 (23,6-36,6) and 13,5 (9,9-23,6) %, p = 0,0002). AHI positively correlated with the severity of fibrosis (r = 0,708, p < 0,00001). The patients with AF and OSA showed the strongest positive relationship between the severity of fibrosis and PINP (r = 0,572, p < 0,0001; в = 0,511, p < 0,0001) and galectin-3 (r = 0,449, p = 0,0009; в = 0,807, p < 0,0001). Conclusions. An increase in the concentration of fibrosis biomarkers in the blood is associated with an increase in the severity of left atrial myocardial fibrosis and probably has a pathogenetic role in increasing the risk of AF in patients with MS and OSA.

Background. Hypertension (HTN) is a major risk factor for the development of cardiovascular disease in young and middle age, however, data on its effect on cardiovascular risk in older adults are contradictory. Objective. To evaluate the impact of high blood pressure on mortality and the course of major geriatric syndromes in the population aged 65 years and older. Design and methods. The prospective cohort Crystal study (2 examinations, 9 years of follow-up), the cross-sectional cohort Eucalyptus study. Sample: a random sample of community-dwelling older adults aged 65 and older (n = 1007). Main parameters: blood pressure, analysis of drug treatment, medical history, laboratory tests, comprehensive geriatric assessment. Results. HTN has been identified as a risk factor for myocardial infarction, cognitive decline, slow gait speed and low muscle strength. However, in people with frailty and slow gait speed, the presence of HTN was associated with a lower risk of all-cause mortality. The lowest risk of all — cause mortality in participants with a slow gait speed was found with systolic blood pressure 140-159 mm Hg [risk ratio (95 % confidence interval) 0,049 (0,009-0,283)], with frailty — with systolic blood pressure 160-180 mm Hg [risk ratio (95 % confidence interval) = 0,109 (0,016-0,758)]. Conclusions. HTN retains its negative predictive value in older adults and is associated with an increased risk of cardiovascular complications, decreased cognitive and physical functions, but a lower risk of mortality in people with frailty and a low level of physical function. An individual approach and an obligatory assessment of the level of physical function in older patients are required when prescribing antihypertensive therapy.

Objective. To evaluate of differences in the effectiveness of sympathetic radiofrequency denervation (RDN) of renal arteries (RA) in patients with resistant arterial hypertension (RAH) with hyperuricemia (HUA) during 3 years of follow-up. Design and methods. The study included 80 patients with RAH, who were randomized to RDN RA group with medication therapy (MT) and MT group. Groups were comparable in age, gender, duration of hypertension and the number of antihypertensive medications. In 12 months, comparative study was completed, and RDN RA group of patients was examined in 24 and 36 months, results were analyzed depending on the initial level of uric acid (UA). Results. In RDN RA group, compared with MT group, beneficial antihypertensive effect was found both in terms of office blood pressure (BP) and ambulatory BP monitoring (ABPM). After RDN RA, significant decrease in BP persisted for 3 years. Analysis of antihypertensive effect of interventional treatment depending on UA level showed significant decrease in office BP and all indicators of ABPM in patients with normal levels of UA. In HUA patients, only decrease in office BP and mean daily systolic BP was revealed. The majority of patients with favorable response to RDN (“responders” group) showed normal UA (75 % vs. 83,3 %, respectively, at 24, 36 months of follow-up). The creatinine and cystatin C levels in dynamics were slightly increased, but within reference ranges. Conclusions. Obtained data indicated more pronounced clinical efficacy of RDN RA in patients without HUA.

Objective. The aim of study was to assess the state of cardiovascular system in female students in the northern region during the seasons with extreme photoperiod. Design and methods. The study was conducted in Nizhnevartovsk, Khanty-Mansi Autonomous Okrug-Yugra (a region equated to the Far North) in the seasons with extreme values of photoperiod. The female students of Nizhnevartovsk State University (n = 73) aged 18-21 years were examined. Anthropometric measurements were carried out. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were recorded automatically using UA-101 model tonometer. Pulse and mean dynamic pressure were calculated according to Hickam's formula. On the basis of HR we determined the average duration of cardiac cycle. Autonomic tone was assessed according to calculated Kerdo index (KI). We used CardioVisor-06c to determine the prenosological state of cardiac activity. Results. There was a significant increase in body weight in the short daylight period. The HR during the long daylight period was significantly higher than during light deprivation, leading to a shorter cardiac cycle duration. Seasonal dynamics of blood pressure characteristics were not evident, although during “white nights” at least 10 % female students had SBP higher than 130 mm Hg, and maximal SBP reached 135 mm Hg. KI values demonstrated significant changes in autonomic tone. During short daylight hours average characteristics of KI were negative and reflected activity of parasympathetic activity. Increase of sympathetic influences was during longer daylight hours. During “biological twilight” “Myocardium” index was significantly lower than during white nights. During short daylight hours only 10 % students showed “Myocardium” index over normal values (15 %), while half of respondents had higher values during white nights. “Rhythm” index was normal during the short daylight hours and significantly higher during the long daylight hours, only 10 % participants had normal values. Conclusions. The analysis of electrophysiological parameters of myocardium showed seasonal changes in female students and “white nights” were associated with more negative effects than “biological twilight”. During “white nights” we showed increase in integral indices of dispersion mapping, increase in resting HR and KI.

Hypertension (HTN) is currently regarded as the most prevalent risk factor, which can lead to both stroke and cognitive impairment. The versatility and similarity of HTN and chronic cerebral ischemia (CCI) pathogenetic mechanisms should be considered in prevention and treatment strategies. The severity of pathological changes in central nervous system (CNS) depends on the degree of HTN and concomitant neurological pathologies. The drug effects on both vascular and cognitive dysfunctions as well as comorbidities and polypharmacy should be considered. The use of agents with polymodal pleiotropic effects both at metabolic and circulation levels appears feasible and rewarding ethylmethylhydroxypyridine malate can be recommended in HTN co-existent with CCI and cognitive disorders. The combination therapy of ethylmethylhydroxypyridine malate with antihypertensive, anti-ischemic drugs, anticoagulants and statins has been proven to be safe, shows low risk of adverse events and can be implemented in a wide range of vascular and comorbid diseases.

On December 1, 2021, a meeting of the Council of experts on the treatment of hypertension, coronary heart disease, and chronic heart failure during the COVID-19 pandemic was held remotely to adjust and adapt current approaches to outpatient treatment of the above pathologies under the current epidemiological situation. The meeting was attended by leading Russian specialists from federal medical research centers of cardiology and therapy.