Frailty is a state of increased vulnerability to endo- and exogenous stress factors when the physiological reserve is decreased due to ageing. Frailty poses challenges for the management of arterial hypertension (HTN) and other chronic cardiovascular and non-cardiovascular diseases in older adultst. Although many Russian and international clinical guidelines on HTN frailty recommended to consider it in decision making process on antihypertensive therapy tactics, the optimal criteria and instruments are still uncertain. HTN is common in patients with frailty, but the direct impact of HTN on frailty development has not been fully established. Blood pressure (BP) control is important for reducing the risk of cardiovascular events and maintaining quality of life in patients with HTN and frailty. BP decreases in later life and in patients who are completely dependent in daily activity. Mortality in patients with frailty and low BP is higher than in patients with high BP, which raises the question of the optimal BP level in this vulnerable category of patients. Cognitive decline is one of the domains of frailty that is closely associated with loss of autonomy, self-care ability, and reduced quality of life. It remains controversial whether antihypertensive therapy has beneficial effects on cognition in very old patients.

Objective. To estimate the prevalence of orthostatic hypotension (OH) and analyze its associations with geriatric syndromes (GS) in subjects aged ≥ 65 years.
Design and methods. In total, 4308 subjects (30 % males) aged 65 to 107 years (mean age 78 ± 8 years) living in 11 regions of the Russian Federation were examined, who were divided into 3 age subgroups (65–74 years, 75–84 years and ≥ 85 years). All participants underwent a comprehensive geriatric assessment, which consisted of two stages: 1) questionnaire on a specially developed questionnaire; 2) objective examination. Orthostatic test was performed in 3982 (92,4 %) patients. OH was diagnosed with a decrease in systolic blood pressure (BP) by ≥ 20 mm Hg or diastolic BP — by ≥ 10 mm Hg (or a decrease in both parameters) within 3 minutes after switching to orthostasis.
Results. The frequency of OH in all subjects was 7,9 %, including 6,7 % in subjects aged 65–74 years, 8,4 % — 75–84 years, 8,8 % — ≥ 85 years (p for trend = 0,093). Univariate regression analysis showed that with an age increase per every 1 year, the odds of OH increased by 1,4 % (odds ratio [OR] 1,014; 95 % confidence interval [CI] 1,001–1,028; p = 0,042). Univariate regression analysis also demonstrated that 5 of the 15 studied GSs were associated with the presence of OH: urinary (OR 1,41; 95 % CI 1,12–1,77; p = 0,004) and fecal (OR 1,61; 95 % CI 1,01–2,58; p = 0,046) incontinence, malnutrition (OR 1,77; 95 % CI 1,15–2,72; p = 0,009), visual deficit (OR 2,23; 95 % CI 1,47–3,40; p < 0,001) and falls in the previous year (OR 1,37; 95 % CI 1,08–1,75; p = 0,010). Multivariate regression analysis adjusted for age and sex found that only 2 GSs were independently associated with the presence of OH: urinary incontinence (OR 1,36; 95 % CI 1,08–1,72; p = 0,009) and visual deficit (OR 2,01; 95 % CI 1,37–3,19; p = 0,001).
Conclusions. The EVKALIPT study first obtained domestic data on the prevalence of OH in subjects aged ≥ 65 years and studied the associations between OH and GSs.

Background. No increase or decrease in heart rate (HR) after transition to the upright position during orthostatic test is an important criterion for identifying older adults at risk of falls, but its relationship with other geriatric syndromes is unknown. Objective. To investigate the relationship between no increase or decrease of HR after transition to the upright position during orthostatic test and the prevalence of other geriatric syndromes.
Design and methods. A cross-sectional cohort epidemiological study of EUCALYPTUS. Sample: random sample of community-dwelling older adults aged 65 years and older (n = 396). Methods: orthostatic test, analysis of medication therapy, comorbid chronic diseases, laboratory tests, comprehensive geriatric assessment.
Results. No increase/ decrease in HR in the first minute after transition to the upright position during orthostatic test was associated with increased prevalence of frailty, as well as other geriatric syndromes, of which low level of physical function was the most significant. After adjusting for sex and age, atrial fibrillation, cognitive impairment, malnutrition, autonomy decline, and anemia, study participants with low physical function were 3,6 times more likely to find no increase or decrease in HR in the first minute after transition to the upright position during orthostatic test [odds ratio (95 % confidence interval) 3,620 (1,499 to 8,742)].
Conclusions. The use of the marker “no increase/ decrease of HR in the first minute after transition to the upright position during” orthostatic test in older adults can serve as one of the important components of cardiovascular system reserve assessment and diagnosis of patients with decreased functional status and frailty.

Objective. The aim of the study was to study the prevalence of cognitive impairment (CI) and chronic heart failure (CHF) in people aged ≥ 65 years, as well as to analyze the relationship between them.
Design and methods. In the subanalysis of the multicenter EUCALYPTUS study, 3537 patients aged 65 to 107 years (average age 78,7 ± 8,4 years) were selected who had information about the presence/absence of CHF and who underwent a Mini- Cog test. All patients were stratified into 2 groups: with the presence (n = 2111) and absence (n = 1426) of CHF.
Results. The prevalence of CHF in this sample was 59,7 %, CI — 60,8 %. With increasing age, the prevalence of both CHF and CI increased significantly. Patients with CHF were on average 4 years older than patients without CHF, but did not differ by gender. In general, the frequency of probable CI (≤ 3 points in the Mini-Cog test) in patients with CHF was significantly higher than without CHF (64,5 % против 55,4 %; p < 0,001). One-factor regression analysis demonstrated that an increase in the sum of points in the Mini-Cog test for every 1 point reduces the chances of having CHF by 14 %, and the presence of probable CI is associated with an increase in the chances of having CHF by 46 %. Univariate regression analysis showed that compared with the absence of CI (reference category; odds ratio = 1,0), patients with CI had a 72 % higher chance of having CHF, whereas the presence of a moderate risk of CI was not associated with an increased chance of having CHF. However, when adjusting for age and gender in the model, all of the above associations lost their significance due to the fact that age is significantly associated with both CHF and CI.
Conclusions. Thus, the results of a multicenter study of EUCALYPTUS demonstrate a high prevalence of both probable CI and CHF among the elderly and senile in the Russian population and their relationship.

Objective. In persons aged ≥ 65 years, to estimate the prevalence of chronic heart failure (CHF), assess geriatric status and analyze associations of CHF with geriatric syndromes (GS).
Design and methods. The study included 4308 people (30 % men) aged 65 to 107 years (mean age 78 ± 8 years) living in 11 regions of the Russian Federation, who were divided into 3 age subgroups (65–74 years, 75–84 years and ≥ 85 years). All participants underwent a comprehensive geriatric assessment, which consisted of two stages: 1) questioning according to a specially designed questionnaire; 2) objective examination. The presence of 15 GS was assessed. The presence of CHF was judged on the basis of the submitted medical documentation.
Results. The frequency of CHF in all subjects was 57,8 %, including 44,2 % in persons aged 65–74 years, 60,2 % in 75–84 years, 72,6 % in ≥ 85 years (p for a trend < 0,001). In patients with CHF, the frequency of 13 out of 15 GS was higher (except for orthostatic hypotension and malnutrition). One-way regression analysis showed that the presence of CHF is associated with an increase in the chances of having these GS by 1,3–1,9 times. Multivariate regression analysis adjusted for age and sex found that age was independently associated with the presence of CHF (odds ratio (OR) 1,06 for every 1 year; 95 % confidence interval (CI) 1,05–1,07; p < 0,001), basic dependence in everyday life (OR 1,22; 95 % CI 1,04–1,42; p = 0,015), probable depression (OR 1,35; 95 % CI 1,16–1,56; p < 0,001), fecal incontinence (OR 1,80; 95 % CI 1,21–2,69; p = 0,004) and chronic pain syndrome (OR 1,97; 95 % CI 1,58–2,45; p < 0,001).
Conclusions. In the EUCALYPTUS study, for the first time, national data on the prevalence of CHF in people aged ≥ 65 years were obtained and associations between CHF and 15 GS were studied.

Limited studies have been performed on the association of distorted folates metabolism genetic markers with progression of clinically manifesting chronic heart failure with preserved ejection fraction (CHF-pEF) in patients with arterial hypertension (HTN) and type 2 diabetes mellitus (DM2).
Objective. To identify folate cycle genes polymorphisms in patients with HTN, DM2 and CHF-pEF.
Design and methods. We have identified the occurrence frequency of several MTHFR genes polymorphisms: 677 C > T (rs1801133), MTHFR: 1298 A > C (rs1801131), MTR: 2756 A > G (rs1805087), MTRR: 66 A > G (rs1801394) in patients with CHF-pEF and DM2 (n = 52), chronic heart failure with reduced ejection fraction (CHF-rEF) and DM2 (n = 49) and control patients without CHF or DM2 (n = 66). Mean aged was 69,9 ± 10,1 years old.
Results. In comparison to the controls, the CHF-pEF group showed higher frequencies of rs1801133: CHF-pEF group — 61,54 % vs. 28,57 % (odds ratio (OR) — 4,0, confidence interval (CI) — 1,788–8,948, p < 0,002); rs1805087–75,0 % vs. 25,0 % (OR — 9,0, CI — 3,573–22,673, p < 0,001), rs1801394–90,38 % vs. 69,39 % (OR — 4,2, CI — 1,375–12,510, p < 0,017). Compared to the CHF-rFV group, the following frequencies were found: CHF-rFV — rs1805087–75,0 % against 36,96 % (OR — 5,2, CI — 2,110–12,414, p < 0,001), rs1801394–90,38 % vs. 68,75 % (OR — 4,3, CI — 1,414–12,909, p < 0,011). The polymorphism frequencies in CHF-rFV were generally comparable with such of the controls. Conclusions. Higher frequencies of rs1801133, rs1805087 and rs1801394 polymorphisms were detected in patients with HTN, DM2 and those with CHF-pEF, as compared to either helthy patients and those with reduced ejection fraction. There is also high rate of rs1801394 polymorphism in patients with HTN, DM2, regardless of the ejection fraction.

Selective transcatheter thrombolysis (STT) in patients with pulmonary embolism (PE) with an intermediatehigh risk of 30-day mortality is an option for rapid lung reperfusion with a decrease in right ventricular (RV) afterload, which largely determines the prognosis of patients.
Objective. Comparison of the efficacy of STT using reduced doses of alteplase and routine conservative treatment of patients with PE with an intermediate-high risk of 30-day mortality using a retrospective analysis of the data from Almazov National Medical Research Centre.
Design and methods. The retrospective single-center study included 45 patients (18 men (40 %) and 27 women (60 %)) admitted to the anaesthesiology and resuscitation department of the Almazov National Medical Research Centre from January 1, 2021 to May 1, 2022 with the confirmed diagnosis of acute PE. Intermediate-high risk patients (22 people (57,9 %)) were divided into two groups according to the treatment strategy: the group receiving standard anticoagulant therapy (n = 15 (68,2 %)) and the group with STT by alteplase at a total dose of 50 mg (n = 7 (31,8 %)). In order to assess the effectiveness of treatment, the main laboratory and instrumental indicators were compared based on data from the medical information system.
Results. Baseline clinical characteristics of the compared groups did not differ. Systolic pressure in the pulmonary artery (SPPA) in the transcatheter treatment group decreased from 59 [50; 82] to 35 [30; 65] mmHg; in the conservative treatment group: from 65 [50; 70] to 52 [40; 59] mmHg. In the selective thrombolysis group, there was a significant trend for a greater decrease SPPA compared to the anticoagulant therapy group: –25 [–29; –3] versus — 10 [–23; –6] mmHg, р = 0,047. There was a significant change in the level of leukocytes and platelets in the group of transcatheter treatment versus anticoagulant therapy: –5,0 [6,1; 4,1] × 10⁹/l vs –2,8 [4,3; 1,8] × 10⁹/l (p = 0,017) and 130 [32; 181] × 10¹²/l vs 31 [2; 56] × 10¹²/l (р = 0,044). There were no significant differences in the change in the RV size between the groups. The groups did not differ in the total number of hemorrhagic complications. When bleeding was divided by severity (according to the TIMI classification), moderate bleeding was more common in the selective thrombolysis group (2 cases versus 0 with a conservative approach, p = 0,014). There were no differences in the duration of treatment in the anaesthesiology and resuscitation department and the terms of inpatient treatment.
Conclusions. A single center retrospective study demonstrated the high quality of approaches to the diagnosis and treatment of PE in terms of current guidelines. The STT with reduced doses of alteplase was associated with a more significant decrease SPPA and normalization of hemogram parameters when compared to the standard treatment approach. At the same time, selective thrombolysis was associated with a higher risk of hemorrhagic complications. A prospective study of the efficacy and safety of prolonged STT with the selection of the dose of thrombolytic in patients with PE with an intermediate-high risk of 30-day mortality is needed.

Objective. To study the dynamics of quality of life, exercise tolerance, parameters of central and peripheral blood pressure, adverse cardiovascular events depending on the achievement and maintenance of the target level (TL) of low-density lipoprotein cholesterol (LDL) against the background of 48-week high-dose therapy with atorvastatin.
Design and methods. In total, 141 patients with acute myocardial infarction with ST-segment elevation were included. Within 48 weeks patients received atorvastatin 40–80 mg/day. A comprehensive examination was performed on days 7–9, after 24 and 48 weeks. After 192 weeks the endpoints were assessed.
Results. The study was completed by 125 people (88,7 %). The patients were divided into groups: “А” (n = 41) — with achieved TL of LDL after 24 and 48 weeks; “PA” (n = 35) — partially achieved TL of LDL — on one of two visits; “NA” (n = 49) — not achieved TL. According to the Minnesota questionnaire, the symptoms of chronic heart failure increased in the groups “PA” (+53,5 %; p = 0,009) and “NA” (+75 %; p = 0,001). During applanation tonometry in the “PA” group, the number of people with elevated pulse pressure in the aorta increased. In the “NA” group, an increase in cases of normal and elevated central aortic systolic, pulse pressure was diagnosed. After 192 weeks the frequency of endpoints in the “PA” and “NA” groups was 38,1 % vs 17,1 % in the “А” group (p = 0,017); the odds ratio was 3,0 (95 % confidence interval 1,2–7,5).
Conclusions. Our study demonstrated the most favorable clinical profile and prognosis in patients who achieved and maintained LDL for 48 weeks treatment.

Traditionally an iodine-containing contrast agent is used for renal arteries angiography. However, patients with chronic kidney disease (CKD) and allergic reaction to iodine, despite infusion and desensitization therapy, have a very high risk of developing complications after procedure. We present a clinical case of successful and safe use of carboxyangiography for renal artery denervation in a patient with resistant arterial hypertension (HTN) in combination with type 2 diabetes mellitus and CKD against the background of an allergic reaction to iodine contrast agents in the form of an anaphylactoid reaction in anamnesis (angioedema). An alternative type of angiography allowed us to carry out successful endovascular treatment of HTN resulting in the achievement of target blood pressure levels without intervention-related complications at early- and long-term follow-up.