The article presents the recent data on the pathogenic links and potential targets for the treatment of salt-sensitive hypertension (HTN). Distinguishing salt-sensitive and salt-resistant phenotypes is one approach to personalized medicine. In the review, special attention is paid to the intestinal microbiota as an etiological factor in salt-sensitive HTN, which, along with the imbalance of neurohumoral systems and the subsequent dysregulatory hemodynamic response to salt load, plays a leading role in the development of salt sensitivity. The advantages and limitations of methods for quantitative assessment of sodium intake are discussed, ways of their optimization are indicated, which is necessary for a more accurate determination of the optimal threshold for salt intake.

Objective. To assess the prevalence of hypertension (HTN) in the population of the Nizhny Novgorod region and its relationship with hyperuricemia (HU) and other cardiovascular risk factors. Design and methods. We examined 2501 people aged 35–74 in the population of the Nizhny Novgorod region, selected by the stratified multi-stage random sample. All respondents underwent a laboratory study of the following parameters: total cholesterol, low-density lipoproteins (LDL), high-density lipoproteins, triglycerides (TG), fasting glucose, creatinine, uric acid, highly sensitive C-reactive protein (Hs-CRP) and fibrinogen. We also calculated body mass index (BMI), visceral obesity index with Amato formula and glomerular filtration rate with CKD-EPI formula. Binary logistic regression method was used to construct a predictive model for the risk of HTN. Statistical analysis was performed with IBM SPSS Statistics 26 software (USA). Results. HU was identified in 29,3 % of respondents with HTN. The mean uric acid level in this group was 345,1 [285,6; 410,55] µmol/l and significantly differed from the same indicator in residents without HTN — 297,5 [249,9; 351,1] µmol/L (p < 0,001). In the multiple logistic regression model, the most significant factors associated with HTN were age over 53 years (odds ratio (OR) 2,954, 95 % confidence interval (CI) 2,456-3,554 p < 0,001), abdominal obesity (OR 2,112, 95 % CI 1,663-2,730, p < 0,001) and HU (OR 1,709, 95 % CI 1,341–2,177, p < 0,001). A lesser contribution was made by such factors as the respondents’ BMI over 25 kg/m² (OR 1,634, 95 % CI 1,262–2,117, p < 0,001), elevated TG level (OR 1,567, 95 % CI 1,289–1,906, p < 0,001), male gender (OR 1,553, 95 % CI 1,281–1,883, p < 0,001), elevated Hs-CRP (OR 1,498, 95 % CI 1,242–1,806, p < 0,001), elevated LDL (OR 1,277, 95 % CI 1,038–1,570, p = 0,020). Conclusions. The results of the study indicate the widespread prevalence of HU in residents of the Nizhny Novgorod region with HTN: almost every third (29,3 %) had this disorder. In a multiple logistic regression model, HU was found to be highly correlated with HTN (OR 1,709, 95 % CI 1,341–2,177, p < 0,001), along with traditional cardiovascular risk factors such as male gender, age, overweight and obesity, lipid metabolism disorders. The high frequency of HU, its independent correlation with HTN, and the prospects for urate-lowering therapy in the prevention of cardiovascular diseases determine the need for further research.

The objective of the study was to assess the metabolic burden within the concept of vascular ageing in hypertension (HTN) based on the results the able-bodied population study of a large industrial center. Design and methods. A continuous non-randomized cross-sectional study was performed, it included the employees of two medium-sized industrial and commercial enterprises (n = 547). All subjects underwent a formalized medical questionnaire aimed at identifying cardiovascular risk factors, symptoms and signs of cardiovascular pathology, measuring blood pressure (BP), serum levels of total cholesterol, high-density lipoproteins cholesterol, low-density lipoproteins cholesterol, triglycerides, glucose, creatinine and uric acid. Values for 10-year risk of fatal cardiovascular events, total cardiovascular risk, vascular age, and metabolic burden were calculated. Results. In the formed sample, the metabolic burden varied from 0.00 (0.00; 28.57) % in patients with low BP (without antihypertensive medication) to 42,86 (42,86; 57,14) % in patients with the 3^rd degree HTN. Positive relationships were found between the magnitude of the metabolic burden, the level of systolic BP (R = 0,432; p < 0,01), diastolic BP (R = 0,360; p < 0,01), 10-year risk of fatal cardiovascular events (R = 0,777; p < 0,01) and total cardiovascular risk (R = 0,781; p < 0,01). Patients with HTN who achieved target BP differed from those with similar BP levels by higher metabolic burden values (p < 0,05). Conclusions. HTN is associated with an increase in metabolic burden, regardless of BP level achieved during treatment. Metabolic burden assessment may be useful in identifying potentially unfavorable HTN phenotypes.

Objective. To study the possibility of using the new arterial stiffness index START in healthy individuals of different ages. Design and methods. The study included data from healthy individuals without any medical history (n = 190), 121 men and 69 women aged 25–64 years. Arterial stiffness was assessed for all subjects on the VaSera VS-1000 device (Fukuda Denshi, Japan). As an additional parameter, the new domestic stiffness index START was analyzed retrospectively. Results. The average age of the participants was 37,0 ± 8,1 years, 63,7 % men. The median of the CAVI index was 6,6 on the right, 6,7 on the left. The median of the START index was 5,02 on the right, 5,3 on the left. A strong correlation between CAVI and START indicators was found (r = 0,829, p < 0,001). The relationship of age with the CAVI and START indices was established (CAVI r = 0,469, p < 0,001, START r = 0,49, p < 0,001). The dependence of vascular wall stiffness indicators on smoking experience (CAVI r = 0,458, p < 0,001, START r = 0,466, p < 0,001), glomerular filtration rate (GFR) (CAVI r = –0,265, p < 0,001, START r = –0,282, p < 0,001) was found. The gender features of the dependence of vascular wall stiffness on the level of high-density lipoproteins (HDL) (in women, CAVI r = 0,241, p = 0,048; START r = 0,358, p = 0,003) and body mass index (BMI) (in women, CAVI r = 0,411, p = 0,027, START r = 0,374, p = 0,046). Conclusions. When examining healthy individuals, a high correlation of the new START index with the CAVI index was shown both in the whole sample and in men and women separately. The START index had a statistically significant correlation with age, smoking experience and GFR among all surveyed, as well as with HDL and BMI in women.

Objective. To investigate the adipokine blood profile in young people with hypertension (HTN) and abdominal obesity (AO). Design and methods. In total. 530 people were included in the study, including 267 people with HTN, of which 169 had AO. In the control group (without HTN) there were 263 people comparable to the study group by gender and age. Among them there were 106 people with AO. The blood levels of adiponectin, adipsin, lipocalin-2, resistin and plasminogen activator inhibitor-1 (PAI-1) were determined in all examined patients by multiplex analysis. Statistical data processing was carried out with the use of SPSS 13.0 program. Results. The levels of adiponectin and lipocalin-2 were lower in the group of HTN patients by 1,46 (p < 0,01) and 1,14 times (p < 0,05), respectively. The level of adipsin in HTN patients was significantly higher (p < 0,01) by 19,14 % compared to the control. The levels of resistin and PAI- did not differ in the control group and the group with HTN. Adiponectin level was 1,35 times lower (p < 0,05) in the group with AO compared to those without AO, the other indicators did not differ in the AO group and controls. In the HTN group, higher levels of PAI-1 were found in the subgroup with AO. When comparing the subgroup without HTN and without AO with the subgroup with HTN and AO, a significant decrease in concentration of adiponectin and lipocalin-2 was found. For the subgroups with AO, a decrease in adiponectin levels and an increase in adipsin levels  (p < 0,01) were found in HTN patients. No statistically significant difference was found for the remaining indicators. The relative chance of early onset HTN was associated with the decrease in adiponectin and lipocalin-2 levels, and with the increase in adipsin levels, regardless of gender, age and the presence of AO. Conclusions. Thus, an increased level of adipsin and a reduced level of adiponectin and lipocalin-2 can serve as potential biomarkers indicating a high probability of developing early HTN in people under 45 years of age.

Objective. To determine the prognostic role of the polymorphism of candidate genes for hypertension (HTN) in the effectiveness of antihypertensive therapy in the population of Mountain Shoria, taking into account the ethnic factor. Design and methods. The material for the study was the population of indigenous (Shors) and nonindigenous inhabitants of Mountain Shoria. In the first stage of the study (2013–2017), 901 indigenous people and 508 non-indigenous people were included in the continuous method. A group of patients with HTN was identified — 367 (40,7 %) shors and 230 (45,3 %) representatives of non-indigenous ethnic group. The second stage of the study involved 525 patients with HTN (317 shors, 208 non-indigenous representatives). According to the recommendations of National Guidelines of the Russian Society of Cardiology/the Russian Medical Society on Arterial Hypertension (2010), antihypertensive therapy was prescribed by a cardiologist. A re-examination of patients with HTN included in the prospective stage of the study was carried out after a month, 3 months and 6 months by a paramedic of the local feldsher-obstetric center and after 12 months by a cardiologist. Gene polymorphism ACE (I/D, rs 4340), AGT (c. 803T > C, rs699), AGTR 1 (А1166С, rs5186), ADRB 1 (с. 145A > G, Ser49Gly, rs1801252), ADRA2B (I/D, rs28365031), MTHFR (c. 677C > T, Ala222Val, rs1801133) and NOS 3 (VNTR, 4b/4a) were tested using polymerase chain reaction. Results. In the Shors cohort, the minor allele D of the ACE gene and the favorable allele A of the AGTR 1 gene were associated with a significant decrease in blood pressure (BP) with the 2-component therapy for HTN using blockers of the renin-angiotensin-aldosterone system (RAAS) with a diuretic (odds ratio (OR) = 5,01 and OR = 6,28). The carriage of the mutant allele D of the ACE gene in subjects with the 3-component therapy (RAAS blocker, calcium channel blocker (CCB), diuretic) also determined the achievement of the target BP level (OR = 3,11). In the cohort of non-indigenous nationality, allele A of the AGTR 1 gene was associated with positive dynamics of BP with the use of another combination therapy with a RAAS blocker and CCB (OR = 5,38). Conclusions. Taking into account the ethnicity, genetic characteristics of the patient when choosing drugs is a key point in the effectiveness of therapy in HTN patients. The possibility of using pharmacogenetics in the practice of a cardiologist opens up promising areas and has a great future.

Objective. To analyze the results of a laboratory examination for chromogranin A in the blood performed in the laboratory at Almazov National Medical Research Centre in patients with confirmed diagnosis of pheochromocytoma/paraganglioma (PPGL) and in patients with unconfirmed neuroendocrine tumor based on the results of a comprehensive examination and to determine the possibilities of this method in the diagnosis of PPGL. Design and methods. A single-center retrospective cohort study was conducted. Electronic medical histories of patients with valid chromogranin A blood test in the period from 2015 to 2021 were studied. The patients included in the study were divided into 2 groups. Group 1 (study group) included 51 patients with a confirmed diagnosis of PPGL, and Group 2 (control group) included 120 patients, who were examined for suspected neuroendocrine tumor, but the diagnosis was not confirmed. The threshold value of chromogranin A was determined using ROC-analysis, the presence of PPGL was selected as a dependent variable. Results. The median of chromogranin A in the study group was 495,93 µg/l (0–100). According to the ROC-analysis, the optimal point of separation of the chromogranin A value for the diagnosis of PPGL with a test sensitivity of 82,4 %, specificity of 94,2 % (area under curve AUC — 0,939, standard error — 0,024, 95 % confidence interval — 0,892–0,986, p < 0,001) was 97,2 µg/l. After dividing patients with PPGL into 3 subgroups, depending on the size of the adrenal gland formation and the prevalence of the lesion according to computer tomography (less than 5 cm — subgroup 1, 5 cm or more — subgroup 2, multiple lesion — subgroup 3), the sensitivity of the threshold value of chromogranin A 97 µg/l in subgroup 1 was 70 %, in subgroup 2 — 95 % and in subgroup 3 — 82 %. Conclusions. Performing a blood test for chromogranin A can be used as an effective marker of PPGL, complementing the standard methods of laboratory diagnostics. This indicator may be an additional factor in the diagnosis of PPGL, especially in the presence of large formations, but the absence of an increase in chromogranin A should not be used to exclude the diagnosis.

Objective. To assess the distribution of cardiac troponin I (cTnI) in a sample of the Kyrgyz Republic population, to study its associations with risk factors and to identify the possible ethnic differences. Design and methods. This observational cross-sectional study includes a representative sample of the Kyrgyz Republic population aged 20–64 years (n = 1256). The analysis of cTnI levels in the population and associations of cTnI levels with socio-demographic parameters (sex, age, education, etc.), risk factors (smoking, obesity, hypertension, etc.), blood biochemical parameters (triglycerides, lipid profile, glucose) and an anamnesis of cardiovascular diseases and total cardiovascular risk according to the SCORE scale. The statistical significance level was considered equal to 0,05. Results. The median cTnI level in the Kyrgyz sample was 0,90 pg/ml [0,40; 1,80]. The 99^th percentile for the entire sample was 21,4 pg/ml in men and 12,2 pg/ml in women. The median cTnI in the Slavs sample was 1,40 pg/ml [0,60; 2,20]. The 99^th percentile for the entire sample was 21,2 pg/ml in men and 25,2 pg/ml in women. The cTnI level log increases significantly with age in both men and women. At the age of 20-30 years, the cTnI level in men is higher than in women in both ethnic groups. However, with age, the increase rate of cTnI in women is higher than in men in both ethnic groups. In a multivariate analysis, significant associations of cTnI levels with sex, age, hypertension, stroke, blood levels of total cholesterol and triglycerides were obtained. Insufficient accuracy of classification of study participants by SCORE risk was revealed. Conclusions. cTnI is a potential strong biomarker that complements traditional risk scales and is applicable in the framework of cardiovascular diseases primary prevention strategies, which was confirmed in this study on the Kyrgyz Republic population.

Objective. To identify objective measures of sleep and molecular markers of sleep reactivity to stress to determine its role for insomnia prevention and management. Design and methods. The sample included 42 subjects with sleep disturbances and 23 subjects without sleep-related complaints (control group) aged 18 to 72 years. Altogether there are 19 men and 55 women. Nine participants were excluded from the study. Sleep reactivity to stress was assessed using the Ford Insomnia Response to Stress Test (FIRST) questionnaire. The Integrative Anxiety Test was used to screen for anxiety. Sleep indices were assessed by polysomnography (PSG). Blood plasma samples were collected in the morning after PSG to determine brain-derived neurotrophic factor (BDNF), and 24-hour urine was collected one week after PSG to assess metanephrine levels. Results. There were 64 % healthy subjects with low sleep reactivity to stress and low anxiety and 79 % subjects showed insomnia among persons with high sleep reactivity and anxiety. Significant differences in PSG measures were found in groups with low and high sleep reactivity: the efficiency of sleep and the percentage of the second stage of NREM sleep were higher in group with low reactivity, also sleep latency and wake time after sleep onset were lower in group with high reactivity. In addition, serum BDNF level was significantly higher in group with low reactivity, and it correlates positively with daily urinary metanephrine excretion and the absolute duration of stage N3 and negatively with sleep latency. Conclusions. Subjects with high reactivity to stress have lower sleep quality and depth that corresponds to other studies. The level of BDNF is a possible marker of sleep reactivity to stress and it can indicate the potential adaptation to stress.

Giant aneurysms of the vertebrobasilar basin manifesting as brain stem compression are a rare pathology with an incidence ranging from 3 to 13,5 %. Surgery of such aneurysms is often associated with unsatisfactory treatment results due to the high traumatic nature of direct surgery on aneurysms of this region, as well as the close proximity of vital brain structures. Surgical intervention is also hampered by the large volume of the aneurysm, possible presence of thrombus in the sac, frequent absence of the neck, location in the anatomically difficult region, and small volume of the posterior cranial fossa (PCF). The above factors make it difficult to clip the aneurysm and increase the risk of perioperative complications. Endovascular intervention is a method of choice in most cases allowing to switch an aneurysm off the blood flow, however in the presence of mass effect aneurysm occlusion does not always achieve a clinical effect due to the preservation of brain stem compression. The aim of this publication was to demonstrate the possibility of successful combined surgical treatment of a giant aneurysm located in the PCF and accompanied by brain stem compression.

Objective. To evaluate adherence to therapy in patients with hypertension (HTN) and atrial fibrillation (AF) in combination with extracardiac comorbid pathology. Design and methods. In an observational cohort study, 884 patients aged 45–65 years with AF (paroxysmal and persistent form) and HTN were observed, in combination with extracardiac comorbid diseases: diabetes mellitus (DM), n = 123; abdominal obesity (AO), n = 171; chronic obstructive pulmonary disease (COPD), n = 137, hypothyroidism, n = 156; thyrotoxicosis, n = 112. The comparison group consisted of 185 patients with AF and HTN, without concomitant extracardiac pathology. Clinical, anthropometric parameters, the Morischi–Green adherence test were evaluated in the work. To assess the social aspects of low adherence, special questionnaires were developed. All statistical calculations were performed using the Rstudio program. Results. Among patients with AF and HTN, 66 % had concomitant extracardiac comorbid pathology, 20 % of them with DM; COPD was detected in 22 % of patients, and AO was observed in 44 % of patients, 6 % patients had thyroid disease. 15,2 % patients were insufficiently adherent (ADH), 37,2 % were not adherent to therapy (NADH), and only 47,8 % respondents were adherent to therapy. The duration of HTN was not a significant motivation for adherence, because the NADH group had a significantly longer duration of arterial hypertension compared with the ADH group (12.3 vs 10.5 years; p < 0.03); patients with the permanent form of AF were more than ADH (p = 0,001), and the adherence did not differ between groups depending on extracardiac diseases. The blockers of the renin-angiotensin-aldosterone system showed the greatest use — up to 66 %, while adherent patients were more likely to take single-pill combination (SPC) of perindopril (SPC indapamide/perindopril and SPC amlodipine/indapamide/perindopril) (p = 0,003; p = 0,01). Based on the analysis, it was found that the presence of a family, higher education, income level, motivation and trust in doctors are significant factors that increase adherence to treatment. Conclusions. The problem of non-commitment has been and remains one of the most complex and difficult to solve. The main reason for low adherence among patients with AF with concomitant extracardiac diseases was polypharmacy, and it is associated with the use of a large number of drugs and a complex treatment regimen. Thus, the limitation of the use of fixed combinations is one of the main reasons for the lack of adherence and needs to be addressed soon.