The prevalence of arterial hypertension (HTN), which is one of the most important risk factors (RF) for cardiovascular diseases (CVD), is still increasing, which represents a global problem for world health, because for many decades CVD have occupied a leading position in the structure of mortality worldwide. This article reviews the main epidemiological studies available by the end of 2023, which analyzed various indicators of HTN both in Russia and around the world. We aimed at the presenting time trends in the prevalence of HTN. We also analyze the main RF for HTN and sex differences, because the prevalence of AH is known to be higher in men than in women in Russia, and special attention is paid to indicators such as adherence to therapy, its effectiveness and HTN control.

Objective. The study assessed the incidence of high blood pressure (BP) cases in 10–17-year-old children and adolescents of Magadan through the 10-year period. Design and methods. The author compared the results of the 2009 and 2019 health monitoring surveys which involved 2533 10–17-year-old school children of the city of Magadan. All participants were of Caucasian race, natives of Magadan, without a history of chronic diseases. The data of the assessment of anthropometric and cardiovascular parameters in 2009 and 2019 were compared. Results. The author observed a significant increase in systolic BP (SBP) and diastolic BP (DBP) in both gender groups with the growth of anthropometric indices from 2009 to 2019: boys at ages 12–13 and 17 (SBP) and at 11–17 years old (DBP); girls at ages 11–13 and 15 (SBP), as well as at 11–13 and 16 years old (DBP). Analysis of the rates of high-normal BP (≥ 90^th and < 95^th percentile), the author found that girls demonstrated high-normal BP in 2009 and 2019 in 6,6 % and 8,6 % of cases, respectively, while boys showed high-normal BP in 10,2 % and 7,3 % of cases in 2009 and 2019, respectively. The incidence of high BP (≥ 95^th percentile) was 5,1 % and 7,3 % in girls; 8,0 % and 9,9 % of cases in boys in the studied years. Conclusions. The study shows a significant increase in basic anthropometric indicators as well as SBP and DBP variables for both age specific groups. The incidence of high BP (≥ 95^th percentile) was 5,1 % and 7,3 % in girls, and 8,0 % and 9,9 % in boys, respectively. Overall hypertension trends were registered in children and adolescents with BP rates increasing within ten-year period.

Objective. The aim of the study is to examine treatment patterns, hospitalizations, work disability and describe demographic and clinical characteristics of newly diagnosed patients with pulmonary arterial hypertension (PAH) before and after diagnosis verification in real clinical practice in Russia. Design and methods. Longitudinal prospective observational study with a retrospective part was conducted. Adult patients were included after PAH verification based on right heart catheterization. The data was received via patients interviewing and medical documentation analysis at enrollment and every 3 months. The retrospective design was used to collect information before enrollment. Results. Thirty-three patients with newly diagnosed PAH were enrolled in the study. Most patients had II (45,5 %) or III (36,4 %) WHO functional class. During follow-up period 2 patients died because of PAH complications, 1 patient died due to COVID-19 complications, and 1 patient was lost for follow-up. Before PAH verification 12,1 % of all patients did not work due to PAH symptoms while after verification of the diagnosis this proportion doubled. Diuretics and mineralocorticoid-receptor antagonists were the most frequently used drugs before PAH diagnosis confirmation, 9 % of patients took sildenafil. Most patients (64 %) received monotherapy as initial PAH-specific treatment, in 34 % of all patients treatment was escalated within 12 months after PAH verification. The number of hospitalizations significantly decreased after PAH verification and specific therapy prescription (р < 0,05). Conclusions. This study demonstrated a decrease in the number of hospitalizations after PAH verification, which may confirm the effectiveness of various regimens of PAH-specific therapy in real clinical practice in Russia. In addition, the study identified a number of problems associated with PAH (predominance of initial monotherapy, low vaccination coverage, problems with drug provision, etc.) The solution of these problems may improve the outcomes.

Objective. To predict the dynamics of cognitive impairment (CI) in patients with ischemic stroke based on clinical and neuroimaging data using digital morphometry of “strategic zones” of the brain and a comprehensive neuropsychological study. Design and methods. Sixty patients in the early recovery period of ischemic stroke were examined including the following methods: morphometry (in mm) of hippocampus in the mediobasal parts of temporal lobes on the coronal section and the thalamus, an interview with a clinical psychologist, the MMSE mental status assessment scale, tests for assessing the frontal dysfunction FAB and MoC A. To consider information from the psychologist’s conclusion, text mining methods were used, the TF-IDF measure was calculated, which makes it possible to identify the main topic of messages and carry out their clustering (Ward’s method identified 3 clusters). For the analysis of CI in patients, logistic regression was used, where binarized values of the MMSE and MоCA scales were considered as target variables. Results. Based on the results of modeling with target variables, respectively, where the test results on the MMSE and MoCA scales are more or less than 24 points, we found that the results of the MoCA scale or the MMSE scale assessed in the first 6 months after stroke did not predict the risk of CI after stroke. The gender did not play any role for CI development after stroke in our study. Age < 65 years decreased the possibility of CI development after stroke by an average of 0,6–1,4 % (HR = 1,006 — for MoCA and HR = 1,014 — for MMSE assessment). The results of hippocampal morphometry according to neuroimaging data showed that the height of the left hippocampus greater than 6,8 mm increases the likelihood of the absence of CI after stroke by 1,11–1,24 times (HR = 1,11 (MoCA) and HR = 1,24 (MMSE)). Being assigned to the first or second clusters by a psychologist based on neuropsychological testing reduced the risk of developing CI by 2,62–6,19 times (HR = 6,19 (MoCA) and HR = 2,62 (MMSE)) and 3,36–9,02 times (HR = 9,02 (MoCA) and HR = 3,36 (MSSE)), respectively. Conclusions. Some indicators of brain morphometry seem to be informative and helpful regarding the diagnosis and further management of patients with post-stroke CI in the early recovery period of ischemic stroke.

Background. Ischemic stroke is the leading cause of mortality and loss of working ability. Sleep disorders and sleep-wake rhythm disorders are considered to be a potential modifiable risk factor of acute stroke. Objective. To determine the peculiarities of circadian rhythms in acute stroke by assessing the daily variation of urinary excretion of cortisol and 6-sulfatoxymelatonin. Materials and methods. We examined 27 patients with acute ischemic stroke and 9 patients admitted to the hospital with suspected but not confirmed stroke. All examinations in both groups were performed in similar settings. All patients underwent neurological assessment in acute phase and before discharge including evaluation by National Institute of Health Stroke Scale, modified Rankin scale (mRs), Barthel index and Rivermead index. Within 48–72 hours after admission, urine samples were collected at 7 a. m., 3 p. m. and 11 p. m. for cortisol and 6-sulfatoxymelatonin assessment (enzyme-linked immunosorbent assay analysis). Results. Daily urinary cortisol excretion did not differ in stroke and control subjects. However, stroke patients demonstrated the highest values in the evening while control subjects had higher levels in the morning. The rhythm of urinary 6-sulfatoxymelatonin excretion is preserved in both groups with the highest level in the morning. However, stroke patients show lower levels at all time points (by 45 %, 33 % and 72 % in the morning, afternoon and evening, respectively). There were no changes in either cortisol or 6-sulfatoxymelatonin excretion depending on stroke severity. Afternoon excretion of 6-sulfatoxymelatonin correlates with Barthel index at discharge (ρ = 0,63; p = 0,004), mRs score at discharge (ρ = –0,65; p = 0,003) and Rivermead index at admission (ρ = 0,52; p = 0,024) and at discharge (ρ = 0,49; p = 0,032). Conclusion. Patients with acute mild-moderate stroke show abnormal daily rhythm of urinary cortisol excretion with the maximum in the evening. The daily rhythm of 6-sulfatoxymelatonin excretion is preserved with the maximum excretion at night, but stroke patients have lower levels compared to control subjects.

Background. Sufficiently high levels of homoarginine (hArg) in the blood are associated with the lower risk of all-cause mortality. The relationship between the level of hArg and the availability of iron for energy metabolism and oxygen transport has not yet been evaluated. Objective. The aim of the study was to assess the association of known biochemical parameters, including the levels of amino acids, iron, blood hemoglobin, with hArg levels in patients with arterial hypertension (HTN) and other cardiovascular diseases (CVD). Design and methods. The study included 86 cases (33 men and 53 women) aged 60 (46–67) years old without folic acid and vitamin B12 deficiencies out of a total of 105 examined patients with HTN. Along with routine clinical trials, the plasma concentrations of amino acids: citrulline, arginine, serine, methionine (Met), lysine, hArg, and total homocysteine (tHcy) were studied. The feature associations were investigated in the procedure of multiple linear regression analysis. Results. In 30 % of cases, iron deficiency was observed, and the level of hArg was significantly reduced in more than half of the patients. No association of hArg levels with metabolites involved in transmethylation (Met and tHcy) was found. On the contrary, its significant association with iron assessments was found. Correlations of iron levels with the levels of other amino acids were not found. The best delineation of high and low iron levels according to the ROC-analysis corresponds to a hArg value of 1,55 µM (56 % sensitivity and 92 % specificity), which is very close to the 1,61 µM hArg value calculated from the iron reference cutoff (13 µM) in regression model. Conclusions. Iron deficiency to provide energy metabolism often accompanies CVD and is accompanied by a drop in hArg levels below 1,6 μM. Thus, the hArg level becomes important not only for assessing cardiovascular risk, but also as a parameter of the iron level effect on energy metabolism.

Objective. To study associations of personality type D and depression level with coping strategies for coping with stress in patients with coronary heart disease (CHD). Design and methods. The study included 112 patients (68 men and 45 women), aged 25 to 81 years, who were admitted for elective percutaneous coronary intervention at the Research Institute for Complex Issues of Cardiovascular Diseases. To determine the type of personality D, the DS-14 questionnaire was used. To determine the level of anxiety and depression, the hospital scale HADS (Hospital Anxiety and Depression Scale) was used. To evaluate coping strategies, the questionnaires “Ways of Coping Behavior” (WCQ) and “Indicator of Coping Strategies” (The Coping Strategy Indication, CSI) were used. The patients were divided into groups in two variants: 1) with the presence or absence of personality type D and 2) with the presence of subclinical or clinical depression and its absence. Results. The presence of personality type D was detected in 35,4 % of patients, absence — in 64,6 % of patients. The presence of depression was detected in 25,5 % of patients, the absence of depression — in 74,5 % of patients. Patients with type no-D were more likely to use rare “Self-control” strategies (p = 0,04) and “Escape-avoidance” compared to type D (p = 0,05). Patients with depression more often used the strategies of “Problem resolution” (43 % and 11 %, p = 0,020), “Search for social support” (43 % and 5 %, p = 0,001) and “Avoidance” (21 % and 2 %, p = 0,012), rarely used “Confrontational coping” (36 % vs. 9 %, p = 0,001), without depression — moderate use of this strategy (66 % vs. 43 %, p = 0,033). The independent factors associated with type D were the level of anxiety (p = 0,022), the presence of depression (p = 0,044) and a moderate preference for the coping strategy “Taking responsibility” (p = 0,019). The binary logistic regression model was statistically significant (χ²(3) = 19,3, p < 0,001). Independent factors associated with depression were the level of negative excitability (p = 0,001) and the rare use of the “Confrontational coping” strategy (p = 0,001). The binary logistic regression model was statistically significant (χ²(2) = 21,9, p < 0,001). Conclusions. In patients with CHD with depression, the predominance of coping strategies was found: “Social support search strategy”, “Avoidance Strategy”, “Problem resolution Strategy” and, less often, “Confrontational coping”. With personality type D, the coping strategy “Self-control” was used less often and the “Escape-avoidance” strategy was used more often.

Fixed-dose combinations are generally believed to be the best tool to improve patients’ adherence, thus they are recommended as a first choice for drug prescription in majority of hypertension guidelines all over the world, including Russia. At the same time real world prescription rate is rather low, especially for triple combinations. The review summarizes the treatment benefits of triple antihypertension drug combination with a focus on amlodipine + indapamide + perindopril. The benefits from studies based in real world evidence for outcome, hospitalization rate and treatment costs are presented.

Objective. The aim is to study antihypertensive and lipid-lowering effects of polypill therapy in patients with arterial hypertension (HTN) grade 1–2 and dyslipidemia, who had a novel coronavirus infection. Design and methods. We enrolled 65 patients with HTN and dyslipidemia after COronaVIrus Disease-2019, of which 60 people (92,3 %) completed observation. During 24 weeks patients took polypill therapy, including indapamide, perindopril and rosuvastatin. Office blood pressure (BP) measurements using the Korotkov method and 24-hour ambulatory BP monitoring (ABPM) were performed; level of total cholesterol, triglycerides, high density lipoprotein cholesterol were assessed. Low-density lipoprotein cholesterol (LDL–C) and non-high-density lipoprotein cholesterol levels were calculated. Results. After 24 weeks of polypill therapy 54 patients (90 %) reached target BP levels. According to 24-hour ABPM data, there was a significant decrease in the average daily, average day and night BP values, reduction in blood pressure load and BP variability (p < 0,001). By the end of treatment, there was an increase in the number of patients with normal daily profile (dipper) (р < 0,05). After 24 weeks, an improvement of lipid profile indicators was recorded, target level of LDL–C was achieved in 28 (84,8 %) patients at high risk and 15 (55,6 %) patients at very high risk. Chances of simultaneous achievement of target values for BP and LDL–C in the high risk group were 4 times higher than in the very high risk group (odds ratio 4,2 [95 % confidence interval 1,3–13,4]; p = 0,028). Conclusions. According to 24-hour ABPM data, 24-week polypill therapy including indapamide, perindopril and rosuvastatin leads to a significant reduction in average daily BP values and contributes to the normalization of the daily profile. After 6-months therapy, target BP and LDL–C levels were achieved in 68,3 % patients with HTN and dyslipidemia who have had COVID-19.