Aortic aneurysm (AA) is one of the most formidable cardiovascular diseases, characterized by subtle clinical manifestations and a high risk of complications. Predisposing factors in the development of AA are age, arterial hypertension (HTN), atherosclerosis, and inflammatory aortic diseases. Those are associated with changes in vascular stiffness. HTN causes increased tension in the aortic wall when the pulse wave of blood pressure (BP) rises in patients with AA. Indicators of central BP and vascular stiffness are of particular interest. They present as independent risk factors for cardiovascular events but are poorly studied among patients with AA. The purpose of the review is to summarize the ideas about the relationship of AA with the indicators of vascular stiffness and central hemodynamics in patients with non-operated AA, as well as after endovascular AA repair. Here we discuss the predictive accuracy and applicability of individual markers concerning AA progression and surgical treatment outcomes, as well as unresolved issues and prospects for further research.

The angiotensin-converting enzyme (ACE) was discovered in 1956 and has been actively studied to date. It has a unique structure of two homologous domains, each containing a catalytic zinc ion. Domains have different substrate specificity. In terms of function, ACE is a zinc metallopeptidase widely present on the surface of endothelial and epithelial cells. The gene encoding ACE is located on the long arm of chromosome 17 (17q23) and is 21 kb long, including 26 exons and 25 introns. The structure of ACE may be the result of an ancient gene duplication that occurred approximately 700 million years ago. The main function of ACE is the conversion of AngI to the vasoconstrictor AngII, which is the main active product. In addition, ACE metabolizes bradykinin, which is a potent vasodilator. ACE is involved in the metabolism of other angiotensins, in particular Ang(1–7), forming, together with ACE 2 and other components of the renin-angiotensin-aldosterone system (RAAS), a complex balanced system for maintaining blood pressure, water and electrolyte balance, and many other components  of systemic, tissue and cellular homeostasis that have not yet been fully studied. More data are accumulating confirming the role of ACE for the renal development, early hematopoiesis, normal male fertility, erythropoiesis, myelopoiesis. ACE plays important roles in the immune response, intracellular signaling.

Despite the fact that the principles of diagnosing hypertrophic cardiomyopathy (HCM) are clearly defined in current guidelines, in real clinical practice one has to deal with a large number of comorbid patients where the diagnosis of HCM is not so obvious. Objective. To analyze the clinical and demographic characteristics of patients referred to the Almazov National Medical Research Center with the diagnosis of HCM. Design and methods. The registry included 1168 patients who were provisionally or definitively diagnosed with HCM in the period from 2010–2021. Out of them, 280 patients were excluded from the study. The patients included in the registry were divided into two groups: 1) patients meeting the criteria for HCM — 578 people (57,0 %); 2) patients of the so-called “gray zone” with the left ventricular wall thickness of 15-19 mm and concomitant arterial hypertension (HTN) — 310 (30,0 %) people. Results. In the first group of patients with HCM criteria, 326 (56,4 %) patients were aged 31–59 years and 35,5 % in the group older than 60 years. In the 2nd group there were 52,9 % (n = 164) patients older than 60 years, p < 0,001. 69,2 % of patients in the first group and 96,1 % of the 2nd group had a previous history of HTN. In relatives of patients of the first group, sudden cardiac death was more common — 3,5 versus 0,6 % in group 2, p < 0,05. Family history of HCM was observed in 6,2 % in group 1 versus 0,3 % in group 2, p < 0,001. In the first group, the obstructive form of HCM was more common — 54,5 versus 37,7 % in the second group, p < 0,001. Using logistic regression, the correctness of the classification of patients with HCM was assessed. The percentage of correct diagnoses was 94,1 % (Wald test = 78,317, p < 0,0001). Conclusions. Traditional risk factors, such as HTN and diabetes mellitus, not only make it difficult to diagnose HCM, but also aggravate its clinical presentation: myocardial hypertrophy, ventricular arrhythmias, and atrial fibrillation. The most important indicators in the classification of patients with suspected HCM were the thickness of the left ventricular wall according to echocardiographic data and the presence of HTN disproportionate to the degree of structural changes in the myocardium.

Objective. To study target organ damage in patients with chronic heart failure (CHF) infected with the human immunodeficiency virus (HIV), depending on the control of blood pressure (BP) in a single-stage clinical study. Design and methods. We examined 240 patients with HIV infection in a multidisciplinary hospital. The diagnosis of CHF was confirmed by the plasma level of the N-terminal fragment of the brain natriuretic peptide (NT-proBNP), echocardiographic criteria, and clinical signs. Subsequently, patients with CHF and elevated BP ≥ 140/90 mm Hg (40 people) and with BP from 91/61 to 139/89 mm Hg (76 people) were selected. In all patients we assessed serum levels of tissue inhibitor of metalloproteinases-1 (TIMP-1) and cystatin C to assess renal filtration function. We also performed non-invasive arteriography with the determination of daytime BP for 3 hours using TensioMed ArterioGraph 24 (Great Britain). The data were processed using the Statistica 13.0 program. Results. In patients with CHF and HIV infection BP ≥ 140/90 mm Hg was associated with subclinical arterial disease, manifested by an increase in augmentation indices and pulse wave velocity, as well as an increase in serum level of TIMP-1. It was also accompanied by a decrease in the renal filtration function, which was confirmed by a higher serum level of cystatin C and a lower glomerular filtration rate calculated on the basis of cystatin C using the CKD-EPIcys. Myocardial remodeling in patients with CHF, HIV and elevated BP ≥ 140/90 mm Hg is presented by a more frequent left ventricular diastolic dysfunction, left ventricular hypertrophy (LVH), and left atrial dilatation. In patients with CHF and HIV infection, BP ≥ 140/90 mm Hg is associated with a higher incidence of heart failure, thrombocytopenia and a history of serum iron deficiency, as well as the intake of protease inhibitors and nucleoside reverse transcriptase inhibitors. Conclusions. In patients with HIV infection and CHF, an increase in BP ≥ 140/90 mm Hg is associated with the subclinical damage of arterial wall, kidneys and myocardium (mainly diastolic dysfunction, LVH and left atrial dilatation). The use of protease inhibitors and nucleoside reverse transcriptase inhibitors is more common in individuals with elevated BP ≥ 140/90 mm Hg.

Significant atherosclerotic stenosis of the carotid arteries can provoke ischemic stroke and is one of the factors considered when assessing eligibility for carotid endarterectomy (CEE). Objective. To identify risk factors for the development of adverse vascular events (AVE) after undergoing CEA in the medium-term (5 and 7 years) and long-term (10 years) follow-up. Design and methods. In total, 257 patients underwent reconstructive surgery on the carotid arteries in the period from 2007 to 2010, and at 1–1,5-year follow-up after the operation, we assessed the regularity of taking prescribed medications, vital activity according to the Barthel index, FIM scale, scales of anxiety, depression and mental status assessment (MMSE); and lipid profile. Long-term endpoints (death or acute cerebrovascular accident) were registered for 5-10 years after surgery. During follow-up, 129 patients dropped out at different stages of the study, 47 died during the study period (30 died from cardiovascular disease), 37 had a stroke. Cox’s proportional hazards model was used as a tool for survival analysis. Results. Older age (over 60 years) at the time of surgery increases the risk of death and the onset of AVE in the period up to 5, 7 and 10 years after surgery by 1,106 (1,245) times, 1,137 (1,247) and 1,182 (1,182) times, respectively; smoking increases the risk of death within 5, 7 and 10 years by 2,963, 2,419 and 2,44 times; the presence of diagnosed depression in accordance with the HADS scale (part II) increases the risk of death after CEE in the period up to 5 years by 1,176 times. An increase in the atherogenicity coefficient by each unit relative to the average value (3,0) leads to an increase in the risk of death or the onset of AVE in the period of 5 years after the operation by 1,915 (2,159) times, in the period of 7 years — by 1,966 (2,183), and in 10 years — by 1,991 (2,264) times. Each additional point of the Barthel index relative to the mean value (95 points) reduced the risk of death or the onset of AVE in a 5-year period by 7 (9,5) % compared to the baseline, in 7 and 10-year periods by 4,5 (9) and 10 (10,5) %, respectively. A decrease in adherence to drug therapy increases the risk of death in the period up to 7 years — by 1,406 times, in 10 years — by 1,426 times. The lack of regular intake of acetylsalicylic acid increases the risk of AVE in the 5-year period after the operation by 3,278 times, in 7 years — by 2,892 times, in 10 years — by 2,837 times; each additional point of the MMSE scale from the mean value (28 points) reduces the risk of death in the period up to 10 years after CEE compared with the baseline risk by 1,51 times, the female gender increases the risk of AVE in the period up to 5, 7 and 10 years by 4,762, 3,952 and 3,484 times, respectively. Conclusions. Risk factors for the development of AVE after long-term follow-up after CEE have been identified, which can be used for the personalized preventive measures.

Objective. The aim of the study was to determine the associations of a high level of personal anxiety (PA) with stress at work among women in an open urban population. Design and methods. A cross-sectional epidemiological study was conducted on a representative sample of 1000 women aged 25-64, formed from the electoral lists of citizens of the city of Tyumen, the response rate was 70,3 %. PA and stress at work was assessed by the standard WHO MONICA-MOPSY questionnaire. Results. Among women of the open population of a medium urbanized city of Western Siberia, PA is rather prevalent with the prevalence of its high level over a low level in the age range and the achievement of an absolute maximum in a high level of PA in the fifth decade of life. Stress at work during the previous twelve months was manifested as following: more than a third of respondents began to perform additional work, by the sixth decade of life, the workload had stabilized. Responsibility at the workplace was reported as high by more than half of the population, about 40 % of women denied the possibility of a good rest after a working day. In women with a high level of PA, stress at work was associated with the increase in responsibility at the workplace and the lack of opportunities for rest after a working day. Conclusions. Thus, the results of the study obtained on an open urban population identified the most vulnerable age categories of women with a high level of PA, as well as the relationships between PA and work-related stress. Our results can serve as a scientific basis for the development of preventive programs to reduce the risks of cardiovascular diseases in female populations of medium urbanized cities of Western Siberia.

Objective. This research assessed the influence of polymorphism –786T>C (rs2070744) of the NOS3 gene on the hemodynamic impairments in the Northern residents. Design and methods. One hundred and one volunteers of Magadan region, mainly Caucasians by ethnicity, underwent molecular genetic examination, and a continuous method was used to form the study sample. DNA was isolated by phenol-chloroform extraction followed by polymorphism genotyping by the polymerase chain reaction. Results. In male Northerners, the following percentage variation in the genotype frequencies by the eNOS locus (rs2070744) was found: –786ТТ — 42,57 %, –786ТС — 43,56 %, –786СС — 13,87 %. The concentration of the eNOS *C allele was 35,64 %, the ancestral eNOS *T allele occurred with the frequency of 64,36 %. The observed distribution of frequencies of alleles and genotypes corresponded to the Hardy-Weinberg equilibrium (χ²_(HWE) = 0.26, p > 0.05). The presence of even one eNOS *C allele in the genotype causes a significant increase in diastolic blood pressure level. The lowest blood pressure (80,3 ± 5,9 mmHg) was found in male homozygotes by the ancestral eNOS *T allele, while the T/C heterozygotes and the C/C homozygotes showed significantly higher blood pressure (83,2 ± 7,3 and 82,9 ± 3,7 mmHg, respectively). The individuals with the C/C genotype showed lower cardiovascular adaptabilities, in particular lower indicators of stroke volume (SV, 43,6 ± 3,7 mL) and cardiac output (CO, 2836,3 ± 182,4 mL/min) with a significant increase in total peripheral vascular resistance (TPVR, 3028,3 ± 252,7 dyn² s cm^-5) compared to the T/T homozygotes (SV, 49,6 ± 7,9 mL; CO, 3393,1 ± 546,8 mL/min; TPVR, 2572,8 ± 559,4 dyn² s cm^-5). Conclusions. This study showed that the eNOS *C allele is associated with the hemodynamic disorders. These results can be used to calculate the risk of cardiovascular pathologies at younger ages, which can develop under the North extremes.

Objective. This study aims to assess the efficacy of single-pill combination ramipril/indapamide (Konsilar-D 24) in patients with grade 1 and 2 hypertension who did not achieve blood pressure (BP) control through previous therapy or did not receive antihypertensive treatment in routine clinical practice. The assessment is based on home BP monitoring (HBPM), long-term BP variability, and quality of life according to the visual analog scale (VAS) EuroQol. Design and methods. A multicenter open observational program involved 358 CONSONANCE program patients who provided home BP monitoring (HBPM) data and self-monitoring diaries for all visits. Among them, 326 patients (91,1 %) evaluated their well-being using VAS at each visit. The program protocol was approved by the independent ethics committee of the Almazov National Medical Research Centre (protocol № 200219 от 11.02.2019). All participants provided written informed consent before inclusion. Clinical BP changes were evaluated at baseline, 0,5, 1, 3 and 6 months into treatment. Patients measured their BP daily for the initial 2 weeks and then at least 3 times a week. The average of two consecutive measurements represented each reading. The effectiveness criterion for HBPM was achieving an average BP < 135/85 mm Hg. Visit-to-visit BP variability was assessed using standard deviation (SD). Patients self-assessed their quality of life by the VAS EuroQol scale from 1 to 100 points. Statistical analysis was performed with the use of Statistica 10. Quantitative variables were presented as means and standard deviations, and their changes were evaluated using paired Student’s t-test. Qualitative features were compared using McNemar’s test with Yates’ continuity correction. A p-value < 0,05 denoted statistical significance. Results. After 2 weeks of treatment, 268 (74,9 %) patients achieved clinical BP < 140/90 mm Hg, the number increased up to 356 (99,4 %) after 6 months. For home BP, 271 (75,7 %) and 326 (91,1 %) patients reached the target after 2 weeks and after 6 months, respectively. Visit-to-visit BP variability, while on unchanged antihypertensive therapy, was 4,1 ± 2,3 / 2,5 ± 1,1 mm Hg for clinical BP and 4,5 ± 3,5 / 2,8 ± 1,9 mm Hg for home BP. The initial VAS score was 54,7 ± 19,1 points, increasing to 86,6 ± 6,1 points after  6 months of treatment (a change of 31,9 ± 18,5 points; p < 0,0001). Conclusions. Optimizing antihypertensive therapy with the single-pill combination ramipril/indapamide (Consilar D 24) effectively reduces both clinical and home BP, leading to the swift achievement of the target BP level for most patients with previously uncontrolled arterial hypertension. Treatment with this single-pill combination also reduces visit-to-visit BP variability and enhances patients’ quality of life in real clinical settings.

The article describes the main milestones in the study of hypertension (HTN). In a chronological aspect, the main discoveries in the field of hypertension since the 16^th century are presented. The contribution of Russian scientists to the field and approaches to its treatment is noted. The facts related to the development of national recommendations on HTN is presented.