The review presents literature data on the role of arterial hypertension in the development of heart failure with preserved ejection fraction (HFpEF) and considers the underlying pathogenetic mechanisms with the focus on left ventricular hypertrophy. It also discusses diagnostic issues, including the use of speckle tracking echocardiography for evaluating global and regional myocardial function based on analysis of left atrial deformation. Special attention is given to the pre-stage of HF and its diagnosis, as well as the role of left atrial function and left atrial deformation index. The early detection of HF pre-stage has both clinical and prognostic significance, and requires intensive preventive measures to slow the progression from HF pre-stage to HFpEF.

Background. Time in target range (TTR) of blood pressure (BP) is a recently proposed and promising indicator of hypertension (HTN) control. According to several observational studies, TTR appears to have a stronger association with cardiovascular adverse events than snapshot achievement of target BP values. The left ventricular mass index (LVMI), reflecting structural cardiac remodeling, may serve as an additional surrogate endpoint for assessing the prognostic value of TTR.

Objective. To determine the presence and strength of the association between longer clinical systolic BP (SBP) TTR and the change in LVMI over 12 months in patients with initially uncontrolled hypertension.

Design and methods. This was a prospective, observational, single-center study involving patients of both sexes over the age of 18 with uncontrolled HTN (defined as receiving ≥ 1 antihypertensive medication) based on clinical BP measurements. The follow-up period was 12 months and included mandatory baseline, intermediate (3-month), and final visits for clinical BP assessment (3 visits total) and echocardiographic examinations (baseline and final visits). TTR was calculated using linear interpolation. Linear regression analysis was performed to identify predictors of ∆LVMI between the first and last visits.

Results. Seventy-six patients with both baseline and final echocardiographic data were included (19 women; mean age 46 years). At baseline, mean clinical SBP was 156 ± 16 mmHg, and mean LVMI was 120 ± 23 g/m². By the end of follow-up, both SBP and LVMI significantly decreased (∆24 ± 15 mmHg, p < 0,001 and ∆5,5 g/m² [95 % confidence interval (CI): 1,5 to 9,5], p  =  0,011). A total of 57 patients (75 %) achieved BP control. The mean TTR was 20,2 % (95 % CI: 13,3–27,0). Multiple linear regression analysis (adjusted R²  =  0,72) revealed that TTR (β  =  −0,167, p  =  0,021), higher baseline SBP (β  =  −0,428, p  =  0,028), and absence of active smoking (β  =  −11,67, p  =  0,029) were independent predictors of LVMI regression.

Conclusions. In high-risk patients with initially uncontrolled hypertension and no serious complications, significant reductions in clinical SBP and LVMI were observed over 12 months. A longer TTR was independently associated with LVMI regression, irrespective of other clinical parameters, particularly ∆SBP. These findings suggest that not just BP reduction, but sustained maintenance of BP within the target range is a key factor in reversing target organ damage.

Background. Driven by multiple factors, heart failure is a leading cause of mortality among patients with chronic kidney disease (CKD). The impact of hyperphosphatemia, a hallmark of CKD, on myocardial remodelling has not been investigated.

Objective. To assess the association between serum Pi levels and left ventricular mass index (LVMI) in a population of patients with CKD stages 1–4.

Design and methods. Thе cross-sectional cohort study included 1,213 patients with CKD (48 % male, mean age 48 ± 16 years, mean estimated glomerular filtration rate (eGFR) 58 (36; 82) ml/min/1,73 m2 ). We evaluated clinical and demographic parameters, echocardiographic measures, serum Pi levels and parameters of its renal excretion, renal electrolyte excretion, proteinuria, and eGFR. The association between serum Pi and LVMI was analysed using adjusted linear and logistic regression models combined with a pseudo-randomisation approach — 1:1 propensity score matching (PSM) and inverse probability of treatment weighting (IPTW).

Results. Patients with left ventricular hypertrophy (LVH, n = 571) had higher Pi levels compared to those without LVH (1,31 [1,12–1,43] vs 1,19 [1,09–1,31] mmol/L; p < 0,0001). Multivariable regression analysis showed that Pi was independently associated with LVMI (B = 13,67 ± 3,31; p < 0,0001; adjusted R² = 0,37), independently of other clinical indices. In IPTW and 1 : 1 PSM regression models, the estimated increase of LVMI at serum Pi levels > 1,37 mmol/L ranged from 5,7 to 11,3 g/m².

Conclusion. In CKD patients, serum inorganic phosphate concentration can be an independent factor for left ventricular remodelling and represents a potential target for therapeutic interventions to improve cardiovascular outcomes.

Background. A comprehensive, integrated assessment of serum biomarkers and modern noninvasive imaging methods reflecting myocardial and vascular remodeling processes can facilitate the early diagnosis of heart failure in patients with arterial hypertension (HTN) and coronary artery disease (CAD) living in the Far North.

Objective. To study the characteristics of laboratory and instrumental parameters reflecting cardiac and vascular remodeling processes in patients with HTN and CAD living in the Far North and temperate climate zones.

Design and methods. In a comparative cohort study, patients with HTN and CHD (n = 99) were divided into two groups based on their place of permanent residence. Group 1 (n = 41) resided in a temperate climate zone, while Group 2 (n = 58) resided in the Far North. Inclusion criterion for the study was left ventricular (LV) ejection fraction > 50 %. All participants underwent assessment of immune inflammation and remodeling biomarkers and transthoracic echocardiography to measure left heart deformation parameters: global LV longitudinal strain and left atrial (LA) reservoir phase strain using spot tracking. Noninvasive hemodynamic and tissue fluid assessment was performed using regional bioimpedance cardiography.

Results. Patients in Group 2 had higher levels of matrix metalloproteinases 2 and 9 (MMP-2, MMP-9), and growth differentiation factor 15 (GDF-15), and a trend toward increased malondialdehyde concentrations. Both groups showed initial signs of impaired diastolic function of the LA, manifested by increased lateral and septal mitral annular velocities and elevated total peripheral resistance. Patients in Group 2 had more pronounced impairment of global LV longitudinal strain. A relationship was found between LV filling pressure (E/eʼ) and arterial compliance in both groups. In Group 2, with an increased number of segments (≥ 3) with impaired LV deformation, decreased LV systolic function and arterial compliance, as well as increased MMP-9 and homocysteine levels, were observed.

Conclusions. Myocardial and vascular remodeling is more pronounced in patients with HTN and CAD in the Far North compared to those living in temperate climates. This is determined by impaired LV longitudinal deformation, higher levels of serum biomarkers of myocardial remodeling and immune inflammation, and an association between arterial compliance and LA strain.

Objective. We aimed to assess the impact of the adaptation index in relation to dosed physical activity and average daily blood pressure (BP) variability on the risk of heart failure with preserved ejection fraction (HFpEF) in Arctic shift-workers (both men (M) and women (W)), based on the study of 24-hour ambulatory BP monitoring (ABPM), treadmill ergometry, calculation of the adaptation potential (AP) index and echocardiography indicators in groups with low and intermediate probability according to the H2FPEF algorithm.

Design and methods. In the Arctic settlement of Yamburg (68° 21' 40" N), 99 M and 81 W with stage 1–2 arterial hypertension (HTN) and normotensive individuals were examined in the medical unit of Gazprom Dobycha Yamburg. They were comparable by age (p = 0,450), shift work experience (p = 0,824), office systolic BP (SBP) (p = 0,251) and diastolic BP (DBP) (p = 0,579). We performed ABPM (BPLab v.3.2, Russia), echocardiography (Phillips CX 50, Netherlands), and a treadmill test (Schiller Cardiovit CS-200, Switzerland) with AP index calculation. Patients were divided into subgroups with low and intermediate probability of HFpEF based on the H2FPEF algorithm (Heavy; Hypertensive; Atrial Fibrillation; Pulmonary Hypertension; Elder; Filling Pressure) with scoring.

Results. Group 1 included 95 patients (52 M and 43 W) with H₂FPEF score of 0–1, group 2 consisted of 85 patients (47 M and 38 W) with a score of 2–5. In group 2, M and W were more likely to experience tension or poor adaptation to dosed physical activity, and a hypertensive response to exercise was more common. Significantly increased average daily variability in SBP (SBP24) and DBP (DBP24) was observed due to both average daytime and nighttime values. W in group 2 had significantly reduced left ventricular ejection fraction and increased right atrial volume. M of group 2 showed significantly reduced movement velocities of the mitral valve fibrous ring. According to the logistic regression analysis, M in group 2 with a poor adaptation to physical activity and AP index value ≥ 3,1 had a 7,5-fold increased risk of developing HFpEF, and each 1 mmHg increase in DBP24 variability increased the risk by 76  %. In W with an AP index value ≥ 3,1, the probability of developing HFpEF increased by 3,9 times. An increase of 1 mmHg in the SBP24 variability increased the risk of HFpEF by 44,4 %. An increase in nighttime DBP variability also increased the risk by 37,2 %. The model correctly identified distinctive features that increased the likelihood of HFpEF development in M with sensitivity of 76,6 % and specificity of 75,0 %. In W, the model had a sensitivity of 84,2 % and specificity of 81,4 %.

Conclusion. In Arctic shifts-workers with HTN, poor adaptation to physical activity and increased average daily BP variability are important factors that increase the risk of HFpEF according to the H₂FPEF algorithm. These findings suggest a significant role for the autonomic nervous system dysfunction in the development of the disease and warrant further investigation. Our data indicate the need for regular monitoring of high-risk groups in a medical facility and the implementation of preventive and therapeutic measures.

Background. Heart failure (HF) with preserved ejection fraction (HFpEF) is a complex condition with various pathophysiological mechanisms that are based on different combinations of age-related changes in the hypothalamic-pituitary-adrenal-gonadal axis, the component of which is a follicle-stimulating hormone (FSH). The relationship between FSH and other sex hormones (SH) for HFpEF in postmenopausal women has not been well studied, which makes our study relevant.

Objective. To evaluate the clinical and echocardiographic parameters of postmenopausal women with different levels of FSH in relation to other SH and biomarkers of immune and sympathetic-adrenal function, as well as fiber formation.

Design and methods. We examined 98 postmenopausal women (67,0 ± 5,2 years old). Using a diastolic stress test, we identified groups with and without HF. In each group the FSH median level was determined. Based on this level, the participants were divided into four subgroups: 1) without HF and FSH level below the median (n = 18), 2) without HF but with FSH above the median (n = 19), 3) with HF and FSH below the median (n = 30), and 4) with HF and FSH above the median (n = 31). Reproductive factors, SH, biomarkers of inflammation, fibrosis and catecholamines were also studied. A correlation analysis between SH and echocardiographic parameters and biomarkers was performed.

Results. Various hormonal patterns in subgroups associated with reproductive factors, heart remodeling, sympathetic-adrenal, immune and fibrotic activity were identified. The best remodeling was observed in the first subgroup with the lowest number of pregnancies, while the worst was seen in the fourth subgroup with late menarche and the lowest reproductive period. An important role of testosterone, progesterone in the genesis of HFpEF was noted. Correlations between SH and echocardiographic and biochemical parameters were also identified.

Conclusion. There is a wide range of circulating sex hormones that determine the variety of phenotypic and clinical manifestations associated with varying degrees of myocardial remodeling, sympathoadrenal, immune and fibrotic activity. The study of the hormonal profile in postmenopausal women contributes to the verification of HFpEF and the timely implementation of personalized preventive therapy.

Objective. To compare clinical and anamnestic data and echocardiographic parameters in patients with obstructive and non-obstructive forms of hypertrophic cardiomyopathy (HCM) examined at a specialized centre for pregnancy and cardiac disease.

Design and methods. A retrospective analysis of 100 pregnancy cases in patients with HCM (mean age 29,8 ± 6,0 years) from 2011 to 2025 was conducted. Patients were divided into groups based on left ventricular outflow tract (LVOT) obstruction and prior pregnancy history. Clinical and echocardiographic parameters, along with the frequency of pregnancy complications, were assessed. Statistical analysis was performed using the R programming language (Student’s t-test, Mann–Whitney U test, χ², linear regression).

Results. The clinical manifestations of the disease did not differ between the forms of HCM. An increase in left atrial diameter was observed in the third trimester compared to the second trimester, along with a trend toward a reduction in the peak LVOT obstruction gradient by the third trimester. Analysis of life-threatening arrhythmias (ventricular tachycardia) showed no significant differences between patients with different HCM forms. A higher frequency of ventricular arrhythmias was noted in patients with non-obstructive HCM during the first trimester.

Conclusions. Pregnancy in patients with HCM is associated with an increased incidence of ventricular arrhythmias and a higher estimated risk of sudden cardiac death (SCD) according to the European Society of Cardiology ESC HCM Risk-SCD risk score. The analysis revealed no significant differences in pregnancy course between patients with obstructive and non-obstructive forms of HCM.

Objective. To analyze associations between demographic, behavioral, psycho-emotional, and clinical characteristics and the likelihood of receiving treatment, achieving control, and treatment effectiveness for hypertension among participants of the ESSE-RF study.

Design and methods. A multivariable logistic regression analysis was performed using data from 9,966 participants (3,846 men; 6,120 women) aged 25–64 years with a confirmed diagnosis of hypertension from the ESSE-RF study. Three binary outcomes were assessed: antihypertensive therapy (AHT), hypertension control (achieving target blood pressure among all individuals with hypertension), and treatment effectiveness (achieving target blood pressure among those receiving AHT). Fortyseven potential predictors were included in the regression model.

Results. Among ESSE-RF participants with hypertension, 62,5% received AHT and only 23 % of all patients achieved target blood pressure levels; and 35,4 % were effectively treated (targets achieved among those receiving AHT). The likelihood of receiving AHT was positively associated with female sex (OR 1,86), history of stroke (OR 4,70), cardiac arrhythmias (OR 2,19), ischemic heart disease (OR 1,99), diabetes mellitus (OR 1,89), and high physical activity (OR 4,3). Sleep apnea complaints, older age, higher BMI, and higher anxiety level were associated with a lower likelihood of receiving AHT. Hypertension control was more frequent in women (OR 2,08), in individuals with educational attainment, and with higher physical activity (OR 2,55 for high activity). The presence of certain comorbidities and a high level of anxiety (OR 0,95) reduced the odds of hypertension control. Treatment effectiveness was higher in women (OR 1,83), in older individuals, in those with higher BMI, with kidney disease (OR 1,31), and with higher education. Chronic bronchitis (OR 0,70) and high anxiety level (OR 0,95) predicted lower treatment effectiveness.

Conclusions. Both treatment coverage and effectiveness for hypertension in the Russian population remain insufficient. Female sex, higher education, moderate/high physical activity are universal predictors of better hypertension management. High anxiety is an important barrier at all stages of hypertension care. The observed associations with sleep related complaints and comorbidities warrant further investigation and may indicate specific psychosocial barriers.

Background. Aortic pressure dynamics significantly affect the development of arteriosclerosis, and chronic changes in the aortic wall, including surface stiffness, are strongly associated with cardiovascular mortality and morbidity. Variations in central aortic pressure and its derivatives have an impact on myocardial structural remodeling and function.

This study aimed to determine the associations between invasively measured central aortic pressure and its derivatives and between left ventricular (LV) diastolic function status and torsion.

Design and methods. This prospective study included 90 participants with normal LV function who were referred for elective coronary angiography.

Results. There was a significant linear correlation between echocardiographic parameters reflecting LV diastolic function, such as the left atrial volume index (LAVI), the LV E/еʼ (ratio between mitral early diastolic velocity and early diastolic tissue annular velocity), and central aortic pressure. LV twist did not correlate with central aortic pressure parameters. Only 15 patients out of 90 had LV diastolic dysfunction of grade 2 and above, with a mean LV twist of 19,65 ± 9,4 vs 16,70 ± 8,6 degrees, as determined by normal LV end-diastolic pressure (p = 0,206). This difference appears clinically significant, illustrating that the increase in LV twist is predominant in patients with higher grades of LV diastolic dysfunction, irrespective of LV mass.

Conclusion. There was a relationship and interaction between central aortic pressure and LV diastolic function status. Despite all participants had normal LV ejection fraction, LV twist appeared to be increased among the patients with LV diastolic dysfunction of grade 2 or above.

Arterial hypertension (HTN) remains the leading risk factor for cardiovascular diseases and premature mortality worldwide. To achieve the target blood pressure (BP) levels, most patients require combination therapy. Current Russian and international clinical guidelines support the preferential use of fixed combinations (FC) in the treatment of patients with HTN. Comparative studies aim to solve the question whether FC is superior or inferior to free (separate) combinations (SC) in terms of effectiveness and safety. This article discusses issues related to the comparison of FC versus SC of antihypertensive drugs for the effective BP control, adherence to therapy, and the impact on the risks of cardiovascular complications and mortality. FC were shown to be an effective strategy for BP control and reducing cardiovascular risk, especially in patients with low adherence to treatment. However, SC therapy remains preferable when personalized treatment is needed. Therefore, the rational choice of antihypertensive therapy requires consideration of the specific clinical situation and individual risk factors.