High blood pressure (BP) remains the leading risk factor for coronary heart disease, stroke, other cardiovascular diseases, chronic kidney disease, and dementia.  

Objective. To estimate the frequency of prescribing antihypertensive drugs (AHD) with the allocation of the proportion of fixed combinations (FC) among people aged 25–64 years examined in 16 regions of the Russian Federation as part of the ESSE-RF and ESSE-RF2 studies.

Design and methods. The analysis included the results of a survey of representative samples of the population of the Russian Federation in the ESSE-RF studies (2012–2014, men: N = 8376 and women N = 13546 people) and ESSE-RF2 (2017, men: N = 3000 and women N = 3714 people). Each participant signed an informed consent. Arterial hypertension (AH) was defined as systolic BP ≥ 140 mm Hg and/or diastolic BP ≥ 90 mm Hg and/or if the examined reported taking AHD. Under the lack of control of AH, we understood the proportion of patients (%) with BP levels ≥ 140/90 mm Hg of the total number of patients with AH. Information about the AHD taken was recorded from the words of the patient (trade name of the drug) followed by coding according to the International Nonproprietary Names of Drugs.

Results. In the Russian population, there was a decrease in the proportion of uncontrolled BP from 78,5 % (95 % confidence interval (CI) 77,7–79,3) in ESSE-RF to 73,0% (95 % CI 71,3–74,6) in ESSE-RF2. FC intake was detected in 15,6 % (95 % CI 13,8–18,0) of patients treated in the ESSE-RF study, while the proportion of such patients in the ESSE-RF2 decreased to 10,9% (95% CI 9,2–12,8), p < 0,001. The most common FC was the combination of an angiotensin-converting enzyme inhibitors (ACEI) and a diuretic (ESSE-RF: 49,1 % and ESSE-RF2: 45,9 %). In second place in ESSE-RF is a diuretic + angiotensin receptor blockers (25,8 %), in ESSE-RF2 — calcium channel blockers (CCB) + ACEI (22,4%). A more modern combination, namely: the combination of ACEI and CCB, was noted only in 8,7% in ESSE-RF, while in ESSE-RF2 the proportion of this FC increased by 2,5 times.

Conclusions. In the population of the Russian Federation, only 10 %-15 % of patients with AH  receive FC AHD. An increase in FC intake may contribute to an increase in adherence to therapy, which is extremely important for the Russian population with poor BP control.

Objective to evaluate the dynamics and identify the relationship between empirically obtained dietary stereotypes and the presence of arterial hypertension (AH) according to a prospective study among the population of a large region of Siberia.

Design and methods. A clinical and epidemiological prospective group study of the population aged 35 to 70 years was carried out. The baseline study included 1124 women (70,3%) and 476 men (29,7%). The mean age was 54,9 ± 9,75 years and 52,6 ± 10,0 years, respectively, p < 0,001. The followup period was 3 years from the first visit of the respondent. An adapted questionnaire (Questionnaire Food Frequency (FFQ)) was used to assess the frequency of food consumption. To identify latent factors (stereotypes of eating behavior), we used factor analysis (method of principal components). The association of eating habits with the presence of AH was assessed using logistic regression analysis. The critical level of significance when testing statistical hypotheses in the study was taken to be ≤ 0,05.

Results. In men, the prevalence of AH was the highest among those who adhered to the fruit and vegetable dietary stereotype (75,0%), the minimum was in men who followed the mixed stereotype (60,1 %, p = 0,034). Among women, as well as among men, the maximum prevalence of AH was observed in people with a fruit and vegetable diet (71,1 %), and the minimum was observed in those with a protein-carbohydrate diet (63,2 %, p = 0,049). Among those who followed the fruit and vegetable stereotype, new cases of AH were identified in 30,9 %, protein-carbohydrate — 33,3 %, mixed — 35,7 % (p = 0,846). The structure of nutrition of the population has undergone changes during the observation period. So, 5 main stereotypes of eating behavior were determined: vegetable, protein-carbohydrate, fruit, dairy and mixed. The prevalence of AH did not differ statistically significantly among individuals with different nutritional stereotypes at the prospective stage (p = 0,337): the maximum prevalence of AH was observed among individuals who followed the vegetable stereotype (77,6%), and the minimum — fruit (67,6%). When conducting a logistic regression analysis, after leveling the influence of gender and age, no statistically significant associations were found between nutritional stereotypes and the development of AH.

Conclusions. 1. Over three years of observation, the prevalence of AH among residents of a large industrial region of Siberia increased from 66,4% to 72,0%. 2. With the help of factor analysis, three nutrition stereotypes were identified: fruit and vegetable, protein and carbohydrate, and mixed. During the three-year period of observation, the diet of the inhabitants of Siberia has changed: 5 main stereotypes of eating behavior have been identified — vegetable, protein-carbohydrate, fruit, dairy and mixed. 3. At the basic stage, AH was more common among people who followed the fruit and vegetable diet, especially among young men. During the prospective phase of the study — in individuals who preferred the vegetable stereotype.

Objective. To study the prevalence of non-high-density lipoprotein hypercholesterol (non-HDL–C) and the average levels of non-HDL–C in metabolic syndrome (MS), type 2 diabetes mellitus (DM2), arterial hypertension (AH) and other cardiometabolic risk factors in the Siberian population aged 45–69 years.

Design and methods. The evaluation of atherogenic dyslipidemia among persons with AН, MS, T2D was based on the materials of Siberian branch of HAPIEE project in the random sample n = 9360 surveyed in 2003–2005 HAPIEE. The study program included questionnaire survey, blood pressure (BP) measurement, anthropometry, biochemical screening. The value ≥ 3,4 mmol/l was considered as hypercholesterol-non-HDL. AH was diagnosed at systolic BP levels ≥ 140 mm hg. art. or diastolic BP ≥ 90 mm hg. art. and/or taking antihypertensive drugs within the last 2 weeks. Persons with previously diagnosed AH, but with normotonia at screening in cases of taking drugs that reduce BP, were also counted as patients with AH. DM2 was diagnozed — according to WHO criteria, 1999, ADA, 2013 — at fasted plasma glucose level ≥ 7,0 mmol/l and persons with previously diagnosed DM2. MS and its components were diagnosed according to IDF criteria (2005).

Results. The mean value of non-HDL cholesterol in the general population of Novosibirsk aged 45–69 were 4,7 ± 1,3 mmol/l and were higher in women than in men — 4,9 ± 1,3 mmol/l and 4,5 ± 1,2 mmol/l, (p < 0,0001). The prevalence of hypercholesterol-non-HDL in women varies from 84,7 to 94,3% — and is significantly higher than in men — 80,6 to 84,1%. The level of non-HDL cholesterol ≥ 3,4 mmol/l was observed in 86,8% of the examined, 11% — in the range of 2,6–3,39 and only 2,2% — less than 2,6 mmol/l. The average values of non-HDL–C in men and women in three cohorts (with DM2, MS and AH) were found to be the highest in DM2, lower in MS than in DM, and lower in AH than in MS and DM2. In the cohort with DM2, non-HDL–C, according to the criterion of non-HDL–C ≥ 3,4 mmol/l, was determined in 89,4% of men and 95,7% of women; in persons with MS, it was found in 92,4% of men and 95,1% of women, with AH — in 85,2% of men and 92,5% of women of the Siberian population aged 45–69 years. The frequencies of AH, MS and DM2 in the 5th quintile of the distribution of non-HDL–C are higher compared to the first quintile (p < 0,0001), with a predominance of these indicators in the female population.

Conclusions. According to study, the content of non-HDL–C, and its prevalence of elevated levels in the population is high, especially in people with DM2, MS, AH. In terms of developing a platform for prevention of cardiovascular diseases, MS and DM2, the non-HDL–C ratio deserves attention as a target for further research.

The high prevalence of arterial hypertension (AH) among the adult population of many countries of the civilized world, incl. Russia (about 40% among people of working age) indicates the need for early detection and prevention of this disease. Assessment of blood pressure (BP) levels in adolescence presents certain methodological difficulties. To date, 3 guidelines based on the results of large population studies of children and adolescents have been developed in the world pediatric practice. However, the application of these guidelines is still not consistent, especially regarding the assessment of BP levels in adolescence.

Objective. To study the prevalence and trends of elevated BP levels, including AH, among adolescents aged 14–18 years in Novosibirsk using the main international definitions.

Design and methods. In one of the districts of Novosibirsk, cross-sectional population surveys of random representative samples of schoolchildren aged 14–18 years of both sexes were carried out with an interval of 5 years. Seven screenings were carried out from 1989 to 2019, 4579 adolescents were examined. The study program for adolescents was the same for all screenings and included standard questionnaire, measurement of BP by auscultatory method, anthropometry (height, body weight, chest circumference, waist and hips), the study of nutrition by the 24-h dietary recall method, collection of family history by postal parental interviews, biochemical blood tests. BP was measured twice with an interval of 2–3 minutes (before and after filling out the questionnaire), in a sitting position, on the right arm, with an aneroid sphygmomanometer. Systolic BP was recorded with the appearance of the first Korotkoff tone (I phase), diastolic BP — with the disappearance of the tones (V phase). The average of two measurements was included in the analysis. The prevalence of elevated BP levels was assessed using international criteria. To date, several guidelines have been proposed for the diagnosis of elevated BP and AH in adolescence, using both the percentile method (4th report of NHBPEP 2004) and the methods of fixed (AAP 2017) and mixed criteria (ESH 2016 / Russian recommendations 2020). Statistical analysis was performed using the SPSS package for Windows 13,5.

Results. The frequency of prehypertension according to the criteria of the 4^th report was 40,3% among boys and 26,4% among girls (P < 0,05), the frequency of elevated BP according to the AAP 2017 criteria was 20,4 % and 12,5% in boys and girls, respectively (P < 0,05), the prevalence of high normal BP was 24,6% and 13,5% (P < 0,05) according to the ESH 2016 criteria. The frequency of AH syndrome according to the AAP 2017 criteria was significantly higher when using 4^th report definitions and ESH 2016. According to the criteria of 3 different guidelines, there were a fluctual trends of AH in adolescents in Novosibirsk over a 30-year period, without a pronounced trend to decrease or increase. The prevalence of AH according to the AAP 2017 criteria was 2–3 times higher than when using percentiles (4th report) or mixed (percentiles + fixed cut-off points) European criteria (ESH 2016) during all the period.

Conclusions. Long-term population studies of adolescents aged 14–18 in Novosibirsk made it possible to study the frequency and trends of elevated levels of BP and AH syndrome in adolescence and to conduct a comparative study of a number of international and domestic criteria.

Objective. The contribution of left ventricular hypertrophy (LVH) to the risk of cardiovascular disease (CVD) and mortality is well established but the prognostic role of structural LVH patterns in the population is ambiguous. The aim of the work — to study the prognostic value of geometric variants of LVH in a 12-year cohort study.

Design and methods. The study design—cross-sectional and cohort studies—based on the material from a series of echocardiographic examinations (Echo) in general population samples in Novosibirsk city. The cohort analysis included 2006 men and women 25–64 years old with special concerns about LVH (according to the criterion of increased myocardial mass index (IMM)) and for geometric variants of LVH. The mean follow-up period was of 12,2 years (SD = 3,2) and 220 endpoints (90 CVD deaths) were registered. The risk of incident fatal and nonfatal CVD and death was assessed by Cox regression analysis.

Results. In the studied sample, the prevalence of LVH was of 22,8% (lower in men than in women, p < 0,001). Population-specific criteria for increased IMM were 124 g/m² (men) and 100 g/m² (women). LVH independently increased the 12-year risk of myocardial infarction (MI) by 1,8 times, fatal MI — by 2 times, fatal CVD — by 1,8 times and all-cause mortality — by 1,6 times. Concentric and disproportional septal forms of LVH (DS LVH) had the most unfavorable prognosis; 40–80% of the excess-risk of CVD and death in these variants was explained by myocardial mass, but the impact of DS LVH was maintained independently of left ventricle myocardial mass. The pattern of segmental LVH (based on additional 2D measurement of the thickest segment) increased the risk of CVD and mortality by 1,9–2,5 times in men.

Conclusions. In a population sample aged 25–64 years (Novosibirsk), LVH independently increased the 12-year risk of MI, fatal CVD and death from all causes by 1,6–2 times. Among the geometric types of LVH, concentric and DS LVH had the most unfavorable prognostic value; the impact of DS LVH to the risk of fatal CVD remained significant independently of myocardial mass. The pattern of segmental LVH based on additional 2D Echo measurements, increased the risk of CVD and death by 2–2,5 times. CVD risk and mortality levels depending on the LVH patterns suggest a number of preventive measures against cardiovascular complications and mortality.

Objective. To analyze determinants and their contribution to efficiency of arterial hypertension (AH) control in the hypertensive population.

Design and methods. In the cross-sectional study a total of 334 men and 436 women derived from a representative sample of the general population aged 25–64 years, meeting criteria for AH, were examined. All subjects signed voluntary informed consent to participate in the study. A standard questionnaire based on adapted international methods was used. The associative analysis included sets of socioeconomic, behavioral, psychosocial, medical and biological variables. We used univariable (χ², Fisher exact test, Student’s t-test, Mann–Whitney test) and multivariable statistics (logistic regression). Effective AH control was considered in case of blood pressure (BP) < 140/90 mm Hg. Probabilities of error < 5% were considered statistically significant.

Results. Irrespective of gender, use of hypotensive drugs was the most influential factor in ensuring effective control of AH in the population. A major barrier to reaching target BP levels in women was the number of current metabolic risk factors (RF). Age (more significant in men), general obesity (both sexes), history of kidney disease (men), elevated glucose and triglycerides (women) were also associated with ineffective AH control. Angiotensine receptor blockers, angiotensin converting enzyme inhibitors (ACEI), sympatholytics/ spasmolythics in men and ACEI, beta-blockers and diuretics (at moderate or higher affluence only) in women were associated with a higher probability of reaching BP targets. Knowledge of cholesterol level (both sexes), cardiovascular disease, use of statins, reduced quality of life (difficulty with daily activities), sedentary working activity and affluence in men were also associated with effective control of BP.

Conclusions. The data obtained demonstrate that with an increase in the coverage of the hypertensive population with antihypertensive treatment, an increase in the proportion of people reaching the target BP levels may be significant, but still the most important issue is the treatment efficiency. The need to correct behavioral factors that lead to the development of metabolic disorders, especially obesity, but also other RF, remains the most challenging issue in this regard. The findings convince us that it is advisable to take measures to increase awareness of the main cardiovascular disease RF, to involve patients more in controlling their RF, to prescribe statins more frequently, to create conditions for taking antihypertensive drugs in the so-called “mobile” types of working activity, to keep developing infrastructure for mass participation of population in sport activities, and to improve economic conditions.

Background. Arterial hypertension (AH) is often associated with type 2 diabetes mellitus (DM2), is one of the leading modifiable risk factors for cardiovascular disease, atrial fibrillation (AF), chronic kidney disease (CKD). Progression of renal dysfunction is a powerful predictor of the onset of AF in patients with high blood pressure. Irrational prescription of drugs is a risk factor for adverse drug reactions, which is especially important for elderly patients and leads to an increased risk of adverse clinical outcomes.

Objective. To analyze the concordance of pharmacotherapy with the STOPP/START criteria in comorbid elderly patients with AH and combined DM2, CKD and AF treated in a multidisciplinary hospitals.

Design and methods. Included data from medical records of 1600 patients aged ≥ 65 years with AH and/or AF admitted to multidisciplinary hospitals in Moscow from July 1, 2018 to June 30, 2019. Patients were divided into two groups — (1) AH in combination with AF (n = 822, women — 73%, median age 87 [79; 90]) and (2) control group (n = 778, women — 79,9%, median age 78 [71; 85]) Evaluation of the appointment of drugs was made according to the “STOPP/START” criteria.

Results. The number of patients who were not prescribed the recommended drugs was statistically significant (p < 0,001) and higher in the AH + AF group (785 people, 95,5%) compared to the control group (623 people, 80,1%). The number of patients who were prescribed potentially non-recommended drugs was similarly statistically significant (p < 0,001) higher in the AH + AF group (439, 53,4%) compared to the control group (328, 42,2%). The most common START criteria were: 1. Statins with a documented history of coronary, cerebral or peripheral vascular disease (in the AH + AF group — 672, 81,8% of the number of patients in the group; in the control group — 464, 59,6%; p < 0,001) 2. Clopidogrel in patients with ischemic stroke or a history of peripheral vascular disease (c respectively, 324, 39,4% and 237, 30,5%; p < 0,001) 3. Warfarin/direct oral anticoagulants in AF (in the group AG + FP — 294, 35,8%). The most common STOPP criteria were: 1. Drugs that can increase constipation in chronic constipation, if there is a more suitable alternative (in the AH + AF group — 160, 19,5% of the number of patients in the group; in the control group — 47,6%; p < 0,001). 2. Drugs with anticholinergic activity in chronic constipation (respectively, 111, 13,5% and 74, 9,5%; p = 0,013). 3. Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in patients with hyperkalemia (respectively, 26, 3,2 % and 94, 12,1%; p < 0,001). Similar results were obtained in the analysis of subgroups of AH + AF with concomitant DM2, CKD and without them.

Conclusions. The results obtained dictate the need to optimize pharmacotherapy in elderly and very old patients with AH and comorbidities in a hospital setting. In practice, START criteria are more common than STOPP, that is, in reality, the necessary drugs are often not prescribed where they are indicated and drugs with an unfavorable safety profile are prescribed relatively rarely in elderly and senile patients.

Relevance. Persistent high levels of morbidity and mortality of the working-age population from cardiovascular diseases (CVD) in Russia require the search for new targets for screening programs and subsequent development of evidence-based prevention models in organized populations showing their clinical and economic effectiveness in long-term prospective follow-up.

Objective. To carry out a comprehensive assessment of the prognostic factors of arterial hypertension (AH) according to the data of 8-year prospective study of an organized sample taking into account gender and sex characteristics.

Design and methods. We conducted a two-stage study: a one-stage integral study of an organized population (400 people) followed by a prospective 8-year follow-up of a group of relatively healthy subjects without clinical manifestations of CVD (193 people aged 21 to 64 years, mean age 49,0 [42,0; 58,0], of whom men 48,2%). Stage I indicators under study: sociodemographic characteristics; clinical and physical findings; behavioral factors; family history of early CVD; occupational interview and degree of work stress; psychological characteristics; biochemical indices of stress response; cardiovascular remodeling indices. Stage II indicators under study: newly diagnosed cases of AH.

Results. The pattern of prognostic factors for AH depended on gender. Among women, prognostic factors for 8-year incidence of AH were: marital status (widow) (Hazard ratio (HR) 10,1), diastolic blood pressure level (HR1,1), and physical activity outside work (HR0,3). In men, in addition to behavioral (smoking history, HR1,1) and clinical (high normal blood pressure, HR4,1) factors, there was also an independent contribution of a psychological factor (personality anxiety, HR6,5).

Conclusions. Our findings substantiate the need for a poly-professional approach (physician-internistpsychiatrist-medical psychologist) to the prevention of CVD in the studied organized population, taking into account gender-specific features.

Objective. Arterial hypertension (AH) and diabetes mellitus (DM) are frequent comorbid diseases, which are associated with a high level of disability and mortality. According to the literature hypertension occurs in 50–80% of patients with type 2 diabetes (DM2) (which constitute more than 90% of the population with type 2 diabetes), compared with 30% of patients with type 1 diabetes (DM1). Comparative studies on the frequency of AH in young patients with different types of DM in the Siberian region have not been conducted. The aim of the research work was to study the frequency of AH and associations of AH with clinical and laboratory parameters in various types of DM diagnosed before the age of 45 years.

Design and methods. 174 patients with the onset of DM from 18 to 45 years old were included. They were under observation at the Research Institute of Internal and Preventive Medicine — Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences: in 20 patients DM1 was verified (group 1), in 80 — DM2 (group 2), 20 had HNF1A-MODY (Maturity-Onset Diabetes of the Young) (group 3), 36 had GCK-MODY (group 4), 18 had LADA (“latent autoimmune diabetes in adults”) (Group 5). All patients was done a clinical examination, determination of indicators of carbohydrate metabolism and basic biochemical parameters.

Results. All groups were comparable in terms of gender, age, and duration of DM. AH of 1–2 degrees in group 1 was detected in 5 patients (25,0%), in 2 — in 20 people (25,0%), in 3 — in 5 (25,0%), in 4 — in 4 (11,1%), in 5 — in 4 (22,2%), significant differences were not identified. In different types of DM the development of AH is associated with various clinical and laboratory parameters. In DM1, the development of AH has a correlation with the age of the patient, with the level of low-density lipoprotein cholesterol; in DM2 — with the duration of diabetes, the patient’s age, body mass index, glucose level, lipid spectrum and diabetic complications; with HNF1A-MODY— with diabetic complications; with GCK-MODY — with the duration of diabetes, the age of the patient, with the level of total cholesterol, with the development of nephropathy; with LADA — with indicators of carbohydrate metabolism and triglycerides.

Conclusions. It is necessary to screen for the presence of AH for any type of DM in young people. It is necessary to take into account the clinical and laboratory parameters associated with the AH depending on the type of DM.

The aim of the study was to evaluate the putative association of the rs11064153 variant of the SCNN1A sodium channel gene with arterial hypertension (AH) among patients suffering from AH and relatively healthy people in the Trans-Baikal Territory.

Design and methods. The present study included 106 patients with a confirmed diagnosis of AH. All participants were included in the study after signing informed consent. The control group consisted of 98 practically healthy people. The groups were comparable in age: the average age in the group with primary AH was 45 ± 9,7 years, in the control group— 42,5 ± 5,8 years. The number of men in group 1 was 73,6% (78/106), in group 2–55,1% (54/98) of the total number of cases (Chi-square = 7,62, df = 1, p < 0,005). Molecular genetics typing of the studied genes was carried out. SNPs of the sodium channel genes SCNN1A (rs11064153) were determined by real-time polymerase chain reaction. We have evaluated the subordination of the distribution of genotypes of samples to the Hardy-Weinberg equilibrium, χ² -test, and also estimated the odds ratio (OR).

Results. Carriage of the T/T genotype in the group of patients with AH was more frequent than in the control group (97,4% and 86,6%, respectively; χ² = 8,60, p = 0,01). Thus, carriage of the T/T genotype of the SCNN1A gene increased the likelihood of AH in patients (OR = 2,27, 95% confidence interval (CI) 1,29–4,01, p = 0,01). Among patients, the T allele was detected 1,5 times more often with a frequency of 0,78 compared with the group of healthy individuals — 0,22 (χ² = 7,28; p = 0,007). The C/C genotype was detected only in three patients from the AH group (2,8%) and in seven patients from the control group (7,1%). It was found that the C allele of the SCNN1А gene (rs11064153) 5 times less often than in the control group, and its frequency was 0,22 versus 0,34, respectively (χ² = 7,28, p = 0,007). The carriage of the C allele (C/C+T/C genotypes) is associated with a lower incidence in patients with AH (OR = 0.54; 95% CI 0,35–0,85, p = 0,007). In the samples examined by us, the carriage of the C allele reduced the likelihood of AH by 2,3 times.

Conclusions. We have found that the T allele and the T/T genotype of the rs11064153 variant of the SCNN 1A gene increase the likelihood of developing hypertension. Carrying allele C and the C/C SCNN1A genotype (rs11064153) reduces the likelihood of developing AH.

Improving blood pressure (BP) control and reducing the risk of developing unfavorable cardiovascular and renal outcomes in patients with refractory hypertension (HTN) is an urgent problem of cardiology. According to clinical studies, patients with refractory HTN receiving intensive diuretic therapy with chlorthalidone and a mineralcorticoid receptor antagonist differ from patients with refractory HTN by a higher sympathetic nervous system (SNS) activity. Overactivity of sympathetic nerves may be one of the key pathogenetic factors that is involved in the kidney in the formation of refractory HTN, exerting a direct stimulating effect on the type 3 Na+ / H+ exchanger (NHE3) and type 2 sodium glucose cotransporter (SGLT2), which are involved in BP control by mechanism of pressure natriuresis. The review presents data on the peculiarities of sympathetic regulation of sodium tubular transport and the results of studies devoted the elucidating in the patients with resistant and refractory HTN the clinical efficacy of SGLT2 inhibitors glyflozins, sympatholytic reserpine and brain aminopeptidase A inhibitor firibastat, which suppresses the activity of central structures of SNS.