Hypertension is a risk factor for some neurological disorders (like stroke, transient ischemic attack, cognitive dysfunction, including the most severe forms, such as dementia). In other diseases of neurology system systemic hypertension might either contribute to the progression of the disease, or decrease the treatment efficiency. Thus, the management of hypertension in a patient with co-morbid neurological disorder is a complex task requiring the comprehensive approach and the joint efforts of both cardiologist and neurologist. This will result in the best control of hypertension and the most efficient risk reduction. The current guidelines on diagnostics, management and prevention of hypertension (by the Joint National Committee of the USA, European Society of Cardiology / European Society of Hypertension, American Society of Hypertension / International Society of Hypertension, and national guidelines by Russian Society of Cardiology) consider some issues of the management of a hypertensive patient with concomitant neurology disorder (mainly, stroke, and transient ischemic attack). The paper shows the evidence-based data on the hypertension management in co-existent neurodegenerative diseases, cognitive dysfunction, neuromuscular diseases, epilepsy, migraine etc. 

Multiple sclerosis (MS) is known to be a chronic immune-mediated disease of the central nervous system characterized by lesions predominantly in white matter of the brain and spinal cord and by a chronic progression. It affects mainly young people and leads to their irreversible disability. This fact determines high social and economic significance of MS. A multifactorial nature of MS is suggested by the results of investigation, and vitamin D deficiency is presumed to be a possible risk factor. “Non-classical” effects of vitamin D, including its effect on the immune response, are widely studied in the recent years. This review is devoted to the analysis of clinical and experimental data about the association between vitamin D deficiency and MS. It also discusses the pathogenetic effect of vitamin D and analyzed the need and ways for correction of vitamin D deficiency in MS. In this publication we discuss the possible direction of further research in order to establish the optimal dosage and duration of vitamin D treatment in MS. 

Objective. To study the variability of blood pressure (BP) based on ambulatory BP monitoring and its correlation with the state of the walls of the carotid arteries in hypertensive post-stroke patients. Design and methods. Anthropometry, fasting blood glucose tests and lipid profile, BP monitoring, doppler ultrasound of the carotid arteries were performed in 90 subjects. Results. There is a positive correlation between indicators of ambulatory BP monitoring and the state of the walls of the carotid arteries, in particular, between daytime variability of systolic BP (SBP) and the diameter of the common carotid arteries (R = 0,5; p < 0,05). A negative correlation between nocturnal SBP variability and blood flow velocity in the common carotid arteries (R = –0,5; p < 0,05) and a positive relation between daytime time index of SBP and resistivity index in external carotid arteries (R = 0,61; p < 0,05) were determined. Mean ambulatory SBP level is directly correlated with the resistivity index of the internal carotid arteries and blood flow velocity in the common carotid arteries (R = 0,52; p < 0,05). There is a correlation between the degree of nocturnal SBP reduction and intima-media thickness (R = –0,62; p < 0,001). Correlation was determined between the degree of nocturnal diastolic BP reduction and blood flow velocity in the common carotid arteries (R = 0,65; p < 0,05). Conclusions. There is a violation of circadian BP profile in all hypertensive patients after stroke, despite achieved target levels of BP. There is a correlation between the severity of atherosclerotic lesions of common carotid arteries and lipid metabolism, age, as well as with ambulatory BP indices. Thus, 24-hour BP parameters should be considered when evaluating the effectiveness of antihypertensive therapy in hypertensive post-stroke patients. 

Objective. The aim of the study was to assess the prevalence of coronary artery disease (CAD) and metabolic syndrome (MS) with high level of anxiety trait (AT) in open male population aged 25–64 of averaged urbanized Siberian city. Design and methods. Single epidemiological study was performed based on representative selection formed from voting lists of men aged 25–64 of one of the administrative districts of Tyumen. For analysis, we used epidemiological criteria for CAD estimation, and IDF criteria for MS (2005) and Spilberger self-rating scale. Results. The chances for development of «certain» CAD and CAD based on the expanded epidemiological criteria increase in open population of an averaged urbanized Siberian city in men aged 25–64 years with high level of AT. MS is closely related to the lower level of AT in young people (25–44 years old), and to the higher level of AT in older people (aged 55–64 years). Conclusions. In open male population aged 25–64 years, high level of AT is associated with clusters of MS: combination of abdominal obesity (AO) with hypertriglyceridemia and hypertension (HTN), AO with hypo-high-density lipoprotein cholesterol and HTN, AO with HTN and hyperglycemia. 

Objective. The structural and functional changes in extraand intracranial arteries in patients from different ethnic groups with coronary artery disease (CAD) before coronary arteriography and operative intervention were studied. Design and methods. We examined 120 patients with CAD including 50 patients of Korean nationality aged 54–73 years (average age 62,5 ± 1,03 years) and 70 patients of Slavic ethnicity aged 53–74 years (mean age 63,2 ± 1,1 years), residents of the Sakhalin Region. All patients received standard antihypertensive, lipid-lowering and antiplatelet therapy. Duplex scanning of extracranial arteries was performed using B-mode, power and color Doppler-mode with spectral analysis of the blood flow. In case of severe stenosis of carotid arteries and in patients with a history of transient ischemic attacks transcranial duplex scanning was performed. Results. Hypertension stage III was diagnosed in 89 % patients of South Asian ethnicity and in 81 % Slavs, and type 2 diabetes mellitus — in 29 and 22 %, respectively. There were no significant differences in mean systolic blood pressure and fasting blood glucose level between the groups. Patients of South Asian ethnicity had higher triglyceride levels and lower values of high-density lipoprotein cholesterol. Conclusions. Ethnicity should be considered when multifocal atherosclerosis structural and functional changes in extra-and intracranial arteries are assessed in patients with CAD. Patients of South Asian ethnicity with CAD show reduced thickness of intima-media complex (1,02 ± 0,01 and 1,07 ± 0,02 mm in the right and left CCA, respectively) compared with the Slavs (1,13 ± 0,02 and 1,23 ± 0,01 mm), although they had more pronounced atherogenic lipid changes inherent to metabolic syndrome. Patients of South Asian ethnicity had 2-fold higher risk of stenotic lesions (> 70 %) and 1,7–2,0-fold risk of pathological deformations of the carotid arteries, which could explain higher rate cerebral circulation disorders in this population compared to those in Caucasians (14 vs. 9 %).

Objective. The purpose of the study is to explore the role of AMPA receptors in the neuroprotective effect of ischemic postconditioning (IРost) in the model of reversible global forebrain ischemia in Mongolian gerbils. Design and methods. Reversible global cerebral ischemia was induced by bilateral occlusion of common carotid arteries in Mongolian gerbils for 7 minutes. IРost was induced by three 15-s episodes of reperfusion/reocclusion. Antagonist of AMPA receptors NBQX was administered intraperitoneally at 2nd minute of ischemia at a dose of 30 mg/kg. In the early and delayed reperfusion period, the number of viable neurons in the CA1, CA2, CA, and CA4 fields of the hippocampus was estimated. Results. Reversible 7 minutes ischemia followed by 48 hours of reperfusion resulted in a significant reduction in the number of viable neurons in the fields CA1 and СА3 of the hippocampus, while in the late reperfusion period a significant reduction in the number of viable neurons was observed in fields CA1, СА3 and CA4. Application of IРost has led to an increase in the number of viable neurons in fields CA1 and CA3 in the early reperfusion period and in fields CA1, CA3 and CA4 — in delayed period. AMPA receptor antagonist NBQX attenuated neuroprotective effect of IPost to a level comparable with the effect of a separate application of NBQX for neurons in the CA1 and CA3 fields of the hippocampus. Conclusions. Along with other mechanisms, the activation of AMPA receptors might be implicated in the mechanisms of cerebral IPost. 

Background. Сardiovascular diseases and their complications occupy one of the leading positions among causes of death in patients with rheumatologic diseases (RD), though the precise underlying mechanisms explaining fast progression of cardiovascular diseases are unknown. Early onset and high progression rate of atherosclerosis are the most common features, which cannot be fully explained by traditional cardiovascular risk factors. Inflammation, which is present in all RD and is involved in the pathogenesis of atherosclerosis, may contribute to the development of cardiovascular complications. Evaluation of the association between inflammation and endothelial dysfunction (an early predictor of atherosclerosis) may facilitate the understanding this mechanism. The objective of our study was to assess endothelial function in patients with systemic lupus erythematosus (SLE), systemic sclerosis (SSc), ankylosing spondylitis (AS) and rheumatoid arthritis (RA) and to evaluate the significance of various markers of endothelial dysfunction (ED), depending on the type of RD. Design and methods. The study enrolled 213 patients with various RD, 63 patients with ≥ 2 cardiovascular risk factors without RD and 10 healthy volunteers. Markers of endothelial dysfunction — homocysteine, asymmetric dimethylarginine (ADMA), endothelin 1–21, vascular cell adhesion molecule 1, 1sVCAM-1; intercellular adhesion molecule 1, sICAM-1 — and reactive hyperemia index (EndoPat 2000, Itamar Medical) were assessed in all patients. Results. The profile of ED markers differs in various RD, however, the most universal indicator is the ADMA level, especially in autoimmune RD with circulating autoantibodies (SLE, RA, SSc). 

Objective. To assess lipid metabolism and prevalence of cardiovascular diseases in patients with type 2 diabetes mellitus (T2DM) — the bearers of different TaqIB genotypes of the polymorphism of the cholesteryl ester transfer protein (CETP), citizens of St Petersburg. Design and methods. We examined 382 patients, who have not received statin therapy previously, and 187 control individuals. The study included the assessment of clinical data and blood lipid profile analysis, as well as molecular genetic research. Results. The distribution of genotypes and alleles of TaqIB polymorphism of the СETP gene in T2DM patients and control group individuals was comparable (В1 В1 29,6 and 24,3 %, В1 В2 50,8 and 51,9 %, В2 В2 19,6 and 23,8 %, respectively). B1B1 genotype in T2DM patients is associated with the 1,85-fold increase of the risk of stroke (p = 0,012). B1B2 genotype of TaqIB polymorphism of the СEТР gene in healthy individuals is associated with higher triglycerides values, cholesterol of low density lipoproteins, cholesterol of very low density lipoproteins and atherogenicity factor, as compared to lipid profile in T2DM patients (the bearers of B2B2 genotype). Lipid profile was also comparable in subgroups of T2DM patients with different TaqIB genotypes. Conclusions. B1B1 genotype of CETP is associated with 1,85-fold increase of the risk of stroke in T2DM patients. The distribution of genotypes and alleles of TaqIB polymorphism of the СETP gene is comparable in T2DM patients and healthy individuals; and fasting lipid profiles are similar in the bearers of different genotypes of this gene. 

Background. Chronic obstructive pulmonary disease (COPD) and hypertension (HTN) are linked to each other by different associated factors which are playing an important role in their clinical course and progression. “Pulmonigenic” mechanisms of HTN in COPD are discussed due to the frequent onset of HTN few years after the first clinical presentations of COPD and due to the association between blood pressure (BP) elevation and exacerbation of pulmonary disease with progression of bronchial obstruction and hypoxemia worsening. Design and methods. Our study group consisted of 30 male patients (mean age 62,4 ± 4,2 years) with COPD and concomitant HTN. The control group was formed by 30 male hypertensive patients (mean age 63,7 ± 3,9 years). The higher rate of patients with concomitant COPD and HTN demonstrated adverse BP daily profile «nightpeakers» than in control group. This might be an additional risk factor for cardiovascular complications such as a myocardial infarction and a brain stroke. The search for combinations of antihypertensive drugs not influencing the bronchial patency and having longer antihypertensive effect duration is ongoing in order to reduce the risk of complications. In our study “Noliprel A Bi-Forte” was an investigational drug (Perindopril Arginine 10 mg and Indapamide 2,5 mg). Administration of a single dose “Noliprel A Bi-Forte” led to a reliable BP decrease and stabilization according to the results of daily BP monitoring. Serious adverse effects were not registered during the study. 

Background. Hyperhomocysteinemia (HH) is considered a risk factor for generalized atherosclerosis, coronary artery disease, ischemic cerebrovascular events. Objective. To improve diagnostics and primary and secondary prevention of cerebrovascular diseases based on the complex analysis of physical examination, blood tests, instrumental examination in patients with and without HH. Design and methods. Altogether we examined 242 patients. The main inclusion criteria was the presence of chronic cerebrovascular diseases with or without HH of various severity. All subjects underwent physical examination and neurovizualizing tests (magnetic resonance imaging and/or computer scan of the brain). Total homocystein level was assessed by the highperformance liquid chromatography (Agilent 1100) with the photometry detection. Results. Cognitive decline, pyramidal insufficiency (central hemiplegia, cerebellar ataxia), and radicular syndrome were the predominant neurological findings. Conclusion. The result of this study is to expand the range of diagnostic methods and the ability to perform the assessment of the severity of neurological decline taking into account the novel risk factors (such as homocysteine). 

This review summarizes the main problems of acetylsalicylic acid (ASA) use in clinical practice. The prescription of antiplatelet therapy for primary cardiovascular prevention is the most controversial. The available clinical guidelines are contradictory. Antiplatelet drugs are the most commonly prescribed medication in routine practice, and the rates are growing. The article reviews the data of clinical trials and basic meta-analysis on the effectiveness and safety of ASA in patients with hypertension (HTN), diabetes mellitus (DM), renal dysfunction, as well as age- and gender-associated differences. Additional criteria are considered in high-risk patients. A special attention is paid to the main clinical recommendations regarding the use of ASA in patients with HTN and DM. Common use of ASA increases the risk of complications and requires the search for possible preventive approaches. Thus, the main risk groups for gastrointestinal bleeding are listed. Moreover, the main preventive approaches regarding the various forms of ASA, the use of adjunctive therapy by secretion blockers and eradication therapy are discussed. 

Stroke is the most widely spread reason of disability. In Russian Federation the number of disabled people is higher than in Europe, that is partly due to the underdeveloped rehabilitation system. The present article discusses the medical, physical, psychological, social, professional and pedagogical issues of rehabilitation in stroke patients. The main causes of stroke in young subjects are reviewed, and the main aspects of rehabilitation in patients with movement, speech and cognitive post-stroke dysfunction are presented. The early rehabilitation is of great importance for the recovery, and should be aimed at the prevention of post-stroke complications (pneumonia, venous thrombosis etc.). It is worth noting that post-stroke cognitive impairment is associated with worse outcome and higher death rate, that is extremely important as dementia rate in patients after stroke can reach 26 %. The role of medical supply and, in particular, nicergoline (a drug with both vasoactive and neurometabolic properties) effects are discussed. Complex rehabilitation procedures lead to the cognitive improvement (proved by neuropsychological exams) and to the decrease in post-stroke movement disorder.