The prevalence of arterial hypertension (AH), 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 throughout the world. This article reviews the main epidemiological studies available by the end of 2023, which analyzed various indicators of AH both in Russia and around the world, with the aim of developing an understanding of time trends in the prevalence of AH. This article also analyzes the main RF for AH and sex differences, because it is known that in men the prevalence of AH is traditionally higher than in women in Russia, and special attention is paid to indicators such as adherence to therapy, effectiveness and control of AH.

This review presents current data on the epidemiology, pathogenesis, diagnosis and treatment of intracranial atherosclerosis — one of the most relevant areas of vascular neurology of the last decade. Intracranial atherosclerosis is a common cause of ischemic stroke worldwide, accounting for up to half of all ischemic strokes in South-East Asia, Latin America and Africa. Research is actively underway to assess the prevalence of intracranial atherosclerosis among the Caucasian race. New diagnostic methods for the study of intracranial atherosclerosis appear every year, in particular, the introduction of high-resolution magnetic resonance imaging of the vascular wall, the search for specific blood biomarkers broaden horizons of research in this field even at the earliest asymptomatic stages of the disease. Treatment and prevention in this cohort of patients remain ambiguous, given the high risk of recurrence of ischemic stroke. Most studies (SAMMPRIS, VISSIT, VAST) relate to the comparison of aggressive drug treatment with endovascular surgical treatment techniques. According to the latest research results, antiplatelet therapy has a significant advantage in preventing stroke.

The inclusion of spironolactone in antihypertensive therapy does not provide blood pressure (BP) control in the significant proportion of patients with resistant hypertension (HTN) and is accompanied by an increased risk of developing of hyperkalemia and complications associated with blockade of male and female sex hormone receptors. In this regard, a search is underway for new drugs that are not only capable of effectively controlling BP in this population, but also have a more favorable safety profile than their predecessors. The most promising are new drugs that selectively suppress the activity of aldosterone synthase-aldosterone-mineralcorticoid receptor hormonal system, the excessive activity of which underlies the formation of resistant HTN. The review presents data on the characteristics of pharmacokinetics and the results of the clinical studies obtained in patients with resistant HTN when assessing the effectiveness and safety of the use of the new nonsteroidal mineralcorticoid receptor antagonist finerenone and the selective aldosterone synthase inhibitor baxdrostat.

The article presents the characteristics of angiotensin receptors of the central nervous system neurons, the mechanisms of penetration and formation of angiotensin in the brain, the effect of angiotensin II on neurons of various nuclei of the brain involved in the regulation of blood circulation. The ability of angiotensin receptor blockers to penetrate the blood-brain barrier and have a central effect was noted. The prospects for the use of angiotensins (1–7) and (1–9) in the treatment of hypertension are considered.

Objective. The development of a methodology for the early detection and subsequent treatment of hypertension (HTN) in people of working age using a database of automated pre-shift and pre-trip medical examinations (APTME) indicates the purpose of the article. Design and methods. The study included the results of mandatory daily APTME of 814 male drivers. The average age of the subjects was 46,3 ± 16,6 years. The total number of medical examinations was 107 448. In all subjects the parameters of the medical examination were collected, recorded and remotely transmitted to an automated workplace to a medical worker. Based on the analyzed database of blood pressure (BP) indicators obtained during daily APTME, a risk group for HTN was formed and it comprised 285 people (35 % of the total number of employees). Results. According to the results of the analysis of the database of APTME, the following average BP values were registered in the risk group: systolic — 151 ± 6,27 mmHg, diastolic — 93 ± 3,68 mmHg. HTN of the 1st degree was detected in 82 people (60,3 %), grade 2 — in 48 people (35,3 %), 3 degrees — in 6 people (4,4 %). Only 48 employees (16,8 %) from the risk group with an established diagnosis of HTN (136 people) identified during follow-up had previously been on dispensary registration due to HTN. At the same time, regular indicators of APTME showed that these 48 employees did not achieve target BP figures, despite medical supervision. The analysis of the database of APTME and an organized set of measures made it possible to achieve the target BP in 84,7 % of drivers at risk. Conclusions. The use of APTME contributes to the early detection of elevated BP, timely referral to a doctor, diagnosis of HTN, registration at a dispensary and achievement of target BP in people at risk.

Objective. The complex assessment of clinical, functional and hemodynamic status change according to echocardiography and right heart catheterization (RHC) within 12 months after pulmonary arterial hypertension (PAH) verification in real clinical practice. Design and methods. Incident adult patients with PAH were included in a longitudinal prospective observational study with a retrospective component after PAH verification based on RHC. The data were received by patients interviewing and medical documentation analysis at enrollment and every 3 months during one-year observational period. The retrospective design was used to collect information before enrollment. Results. Thirty three patients were enrolled. 64 % of patients received monotherapy as initial PAH-specific therapy, 24 % — a double combination, while the rest received calcium channel blockers. Follow-up echocardiography was performed in 75,8 % patients. There was a significant increase in median tricuspid annular plane systolic excursion (TAPSE, p = 0,001), median left ventricular end-diastolic diameter (p = 0,004) and a decrease in the anteroposterior diameter of the left atrium (p = 0,016) during the follow-up period. There were no significant changes in the size of the right heart chambers, pulmonary artery systolic pressure, or pulmonary artery size. Follow-up RHC was performed in 16 (48,5 %) patients. There was a significant improvement in cardiac output (p = 0,006) and cardiac index (p = 0,012), venous blood oxygen saturation (p = 0,045) and significant decrease of stroke volume (p = 0,021) during the follow-up period. The initial 6-minute walk test was performed in 75,8 % patients, the median distance was 340 m. During follow-up data were available in 14 patients, the median distance was 398 m. Median time from PAH onset to PAH verification was 13,5 months with a direct correlation between the time from the PAH onset to PAH verification and WHO functional class at the time of diagnosis (ρ = 0,394, p < 0,05). Within 12 months after PAH verification most patients subjectively noted the absence of positive dynamics in symptoms (88 %). Conclusions. We suppose that optimizing the treatment regimen for patients with PAH, improving access to PAH-specific therapy can improve the clinical and hemodynamics status and prognosis of patients with PAH.

The renin-angiotensin-aldosterone system (RAAS) is involved in the regulation of kidney function and blood pressure (BP). In renal dysfunction, hyperactivation of the RAAS leads to an increase in BP and impaired permeability of the nephron glomerular filter. Blockade of the RAAS is one of the methods of nephroprotection. Objective. To compare the effect of an angiotensin-converting enzyme inhibitor (IACE), angiotensin I receptor blocker (ARB), and a selective slow calcium channel blocker (BCC) on the functional state of the microvasculature of the skin of rats with nephrectomy (NE), fed with a high-salt diet (HS). Design and methods. Five groups of Wistar rats were studied. The SO group: sham-operated animals that received a standard diet; the HS+NE group: rats with ¾ NE and HS (4 % NaCl); HS+NE+Ler-, HS+NE+Lis-, HS+NE+Los-groups: rats with ¾ NE and HS, that were treated with the BCC lerkanidipin (Ler, 3 mg/kg), IACE lisinopril (Lis, 30 mg/kg) or the ARB losartan (Los, 10 mg/kg), respectively. After 4 months, a study was performed using laser Doppler flowmetry (LDF). Results. In rats of the HS+NE group, uremia is accompanied by an increase in BP (by 16,9 % compared to the SO group). The treatment with IACE and ARB in rats with NE and HS prevents the rise in BP, while BCC does not reduce BP. The LDF-study showed that the increased intensity of initial skin perfusion in rats of the HS+NE group (7,2 ± 0,3 compared to 6,5 ± 0,2 p. u. in the SO group) is not corrected by BCC (6,9 ± 0,3 p. u.), but is reduced by the use of IACE (6,4 ± 0,2 p. u.) and ARB (6,1 ± 0,2 p. u.). Wavelet analysis showed that the increase in tonic effects on blood vessels in the endothelial, neurogenic and myogenic regulatory circuits, characteristic of renal dysfunction, decreases with the use of all studied drugs. RAAS blockade in rats with ¾ NE and HS does not prevent a decrease in the reactivity of skin microvessels to acetylcholine (ACh), and the use of BCC restores the response of skin blood flow to ACh to the control level. Conclusions. In Wistar rats, NE in combination with HS leads to an increase in BP, an increase in tonic effects on skin microvessels in the endothelial, neurogenic and myogenic ranges, as well as a decrease in the reactivity of skin blood flow to ACh. Inhibition of the RAAS by the treatment of IACE and ARB prevents the increase in BP, but does not improve the reactivity of skin microvessels. The use of BCC in rats with NE and HS does not reduce BP, but improves the reactivity of skin microvasculature to ACh.